Taylor S Riall
- Professor, Surgery
- Chief, Surgical Oncology Division
- Associate Director, Cancer Services - Cancer Center
- Member of the Graduate Faculty
- (520) 626-2635
- Arizona Health Sciences Center, Rm. 4325D
- Tucson, AZ 85724
- tsriall@arizona.edu
Biography
Taylor S. Riall, MD, PhD, FACS, is internationally known for her work on comparative effectiveness (research comparing different treatments to understand the right treatment, for the right patient, in the right setting) and patient-centered cancer and general surgery outcomes. Dr. Riall is Acting Chair of the Department of Surgery and Chief of the Division of General Surgery/Surgical Oncology, the largest division within the Department of Surgery at the University of Arizona College of Medicine – Tucson.
Dr. Riall is the coauthor of more than 120 peer-reviewed publications and 20 book chapters. She serves on the editorial boards of the Annals of Surgery, Journal of GI Surgery and Surgery.
Dr. Riall joined the University of Arizona from the University of Texas Medical Branch at Galveston, where she was the John Sealy Distinguished Chair in Clinical Research and the director of the Center for Comparative Effectiveness and Outcomes. Her clinical expertise is in general and pancreaticobiliary surgery, including pancreatic and periampullary cancer, acute and chronic pancreatitis, gallstone disease, gastrointestinal cancer, appendicitis, hernias, and other minor general surgical procedures. She is also Vice Chair for Quality and Performance within the Department of Surgery. She has extensive expertise in comparative effectiveness and health services research. Her research has focused on the quality of cancer care and the care of surgical patients. Dr. Riall has been instrumental in developing and implementing critical pathways to streamline care, improve outcomes, and decrease cost of patients undergoing pancreatic, gallbladder, and colorectal surgery. She is using her expertise to position the Division of General Surgery/Surgical Oncology to transition to a model of evidence-based, personalized health care delivery.
Degrees
- Ph.D. Clinical Science
- The University of Texas Medical Branch, Galveston, Texas, United States
- M.D. Medical Doctor
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- B.A. Chemistry, Highest honors
- Rutgers University, Douglass College, New Brunswick, New Jersey, United States
Work Experience
- University of Arizona, College of Medicine (2017 - 2018)
- University of Arizona, College of Medicine, Department of Surgery (2015 - Ongoing)
- University of Arizona, College of Medicine, Department of Surgery (2015 - Ongoing)
- University of Arizona, College of Medicine, Department of Surgery (2015 - 2017)
- The University of Texas Medical Branch, Department of Surgery (2013 - 2015)
- The University of Texas Medical Branch, Department of Surgery (2013 - 2015)
- The University of Texas Medical Branch, Department of Surgery (2009 - 2015)
- The University of Texas Medical Branch, Department of Surgery (2009 - 2010)
- The University of Texas Medical Branch, Department of Surgery (2008 - 2015)
- The University of Texas Medical Branch, Department of Surgery (2008 - 2013)
- The University of Texas Medical Branch, Department of Surgery (2005 - 2008)
- The Johns Hopkins Medical Institutions, Department of Surgery (2004 - 2005)
- The Johns Hopkins Medical Institutions, Department of Surgery (2002 - 2004)
- The Johns Hopkins Medical Institutions, Department of Surgery, Laboratory of Scott E. Kern, M.D. Molecular Genetics/Pancreatic Cancer Research (1999 - 2002)
- The Johns Hopkins Medical Institutions, Department of Surgery (1998 - 1999)
- The Johns Hopkins Medical Institutions, Department of Surgery (1997 - 1998)
- The Johns Hopkins Medical Institutions, Department of Surgery (1996 - 1997)
Awards
- Niarchos Foundation Research Grant
- Summer 1999
- SSAT/Ross Resident's Research Competition
- Society for Surgery of the Alimentary Tract, Fall 1998
- Upjohn Award for Clinical Research
- Fall 1998
- William Stewart Halsted Award, General Surgery
- Fall 1996
- American College of Surgeons Medical Student Program
- Fall 1995
- Phi Beta Kappa
- Rutgers UniversityNew Brunswick, NJ, Fall 1992
- B.A., Highest Honors
- Rutgers UniversityNew Brunswick, NJ, Spring 1992
- Barry M. Goldwater Scholarship
- Fall 1991
- Roger B. Sweet Award, Organic Chemistry
- Fall 1991
- John B. Zajac Award, General Chemistry
- Fall 1990
- Douglass Scholar, Academic Scholarship
- Rutgers University, Douglass CollegeNew Brunswick, NJ, Fall 1989
- New Jersey Distinguished Scholar
- Fall 1989
- Award for Teaching and Mentoring Excellence
- The University of Arizona Cancer Center, Fall 2023
- Castle Connolly Top Doctor
- Spring 2023
- Spring 2022
- Spring 2017
- Spring 2008
- The Charles F. Zukoski Award: Outstanding Role Model In Surgery
- The University of Arizona, Department of Surgery General Surgery Residency Program, Summer 2021
- Faculty Mentoring Award
- University of Arizona College of Medicine, Spring 2019
- Furrow Award for Excellence with Innovation in Medical School Teaching
- University of Arizona, Fall 2018
- Top Doctor
- Houstonia Magazine, Spring 2015
- US News and World Report, Fall 2012
- Executive Leadership in Academic Medicine (ELAM), Fellow
- Spring 2014
- The Douglass Society Award
- Rutgers University, Douglass CollegeNew Brunswick, NJ, Fall 2012
- Integrating Geriatrics into Comparative Effectiveness Research (CER) Junior Scholar Travel Grant Award
- American Geriatrics Society, Fall 2010
- SLD Industries, Guide to America's Top Surgeons
- Summer 2010
- Arthur M. Shipley Award
- Southern Surgical Association, Fall 2009
- Cambridge Who's Who
- Fall 2009
- John Sealy Distinguished Chair in Clinical Research
- Fall 2008
- AAMC Early Career Women's Professional Development Conference
- Fall 2007
- Best Paper in Journal of Gastrointestinal Surgery
- Fall 2007
- Marquis Who's Who in America
- Fall 2007
- Phi Kappa Phi Graduate School Honor Society
- Fall 2007
- Fellow, American College of Surgeons, (elected)
- American College of Surgeons, Fall 2006
- NIH Loan Repayment Program
- Fall 2006
- Resident Teaching Award
- The University of Texas Medical BranchGalveston, TX, Fall 2006
- Sealy Center for Vaccine Development Graduate Student Award
- The University of Texas Medical BranchGalveston, TX, Fall 2006
- Clinical Research Scholars Program
- The University of Texas Medical BranchGalveston, TX, Fall 2005
- Alpha Omega Alpha
- Fall 2004
- The A. McGehee Harvey Research Award
- Johns Hopkins School of Medicine - Young Investigators' Day, Fall 2002
- American Hepato-Pancreato-Biliary Association/Ethicon Research Award
- Fall 2000
Licensure & Certification
- Certified Professional Coach (CPC), Institute for Professional Excellence in Coaching, Shrewsbury, NJ (2015)
- Executive Leadership in Academic Medicine (ELAM) (2015)
- Graduate Certificate in Health Care Management, Rice University/Jones Graduate School of Business, Houston TX (2011)
- Energy Leadership Index Master Pratitioner (2015)
- American Board of Surgery Recertifying Exam, American Board of Surgery (2013)
- American Board of Surgery Certifying Exam, American Board of Surgery (2005)
- American Board of Surgery Qualifying Exam, American Board of Surgery (2004)
- Wisconsin Medical License #52863-20, Wisconsin Department of Safety and Professional Services (2009)
- Texas Medical License #M1318, Texas Medical Board (2009)
- Maryland Medical Board License #D0055343, Maryland Board of Physicians (1999)
- Arizona Medical Board License #50982, Arizona Medical Board (2015)
- Basic Life Support (BLS), American Heart Association (2005)
- Advanced Cardiovascular Life Support (ACLS), American Heart Association (2011)
- Advanced Trauma Life Support (ATLS), American Heart Association (1996)
Interests
No activities entered.
Courses
No activities entered.
Scholarly Contributions
Chapters
- Arrington, A. K., & Riall, T. S. (2022). Endocrine Pancreas. In Sabiston Textbook of Surgery : The Biological Basis of Modern Surgical Practice(pp 941-963). Philadelphia, PA: Elsevier, Inc.
- Weigel, R. J., Brasel, K. J., de Virgilio, C. M., Riall, T. S., & Turner, P. L. (2022). Resources. In Optimal Resources for Surgical Education and Training. American College of Surgeons.
- Arrington, A. K., & Riall, T. S. (2019). Operative Palliation of Pancreatic Cancer. In Master Techniques in Surgery: Hepatobiliary and Pancreatic Surgery(pp 57-68). Philadelphia, PA: Wolters Kluwer.
- Dimou, F. M., & Riall, T. S. (2018). Proper Use of Cholecystostomy Tubes. In Advances in Surgery(pp 52: 57-71). Philadelphia, PA.
- Mehta, H., & Riall, T. S. (2017). Study Design and Analysis in Clinical Research. In Success in Academic Surgery, 2nd Editon.
- Perone, J., Riall, T. S., & Olino, K. (2016). Palliative Care for Pancreatic and Periampullary Cancer. In Surgical Clinics of North America. Pancreatic and Periampullary Cancers(pp 1415-1430).
- Riall, T. S. (2016). Pancreas Anatomy and Physiology. In Greenfield's Surgery: Scientific Surgery & Practice, 6e(pp Chapter 52). Riverwoods, IL: Wolters Kluwer.
- White, R., & Riall, T. S. (2017). Endocrine Pancreas. In Sabiston’s Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 20th Ed.(pp 941-4). Philadelphia, PA: Elsevier, Inc.
- Sheffield, K., & Riall, T. S. (2014). Methods for enhancing casual inference in observational studies. In Success in Academic Surgery: Health Services Research(pp 167-182). Springer.
- Riall, T. S., & Demola, S. (2013). Prevention and diagnosis of infection. In ACS Surgery: Principles and Practice Online.
- Riall, T. S., & Duncan, C. (2013). Unusual Pancreatic Tumors. In Current Surgical Therapy. 11th edition(pp 492-501). Philadelphia, PA.
- Riall, T. S., & Evers, B. (2013). Endocrine Tumors of the Pancreas. In Maingot’s Abdominal Operations 11th ed(pp 1211-1226). McGraw Hill.
- Riall, T. S. (2012). Analyzing your data. In Success in Academic Surgery Part I(pp 59-80).
- Riall, T. S., & Townsend, C. (2012). Endocrine Pancreas. In Sabiston’s Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 19th edition(pp 944-962). Philadelphia, PA: Townsend CM. Elsevier, Inc.
- Riall, T. S. (2011). Pancreatic Anatomy and Physiology. In Surgery: Scientific Principles and Practice 5th edition(pp 799-818). Philadelphia, PA.
- Riall, T. S. (2010). Choledochoduodenostomy and Hepaticojejunostomy. In Atlas of General Surgery Techniques(pp 436-452). Philadelphia, PA: Saunders Elsevier.
- Riall, T. S. (2010). Laparoscopic and Open Cholecystectomy. In Atlas of General Surgery Techniques(pp 422-435). Philadelphia, PA.
- Riall, T. S. (2010). Sphincteroplasty. In Atlas of General Surgery Techniques(pp 453-461). Philadelphia, PA: Saunders Elsevier.
- Riall, T. S. (2009). Periampullary adenocarcinoma: Diagnosis and survival after pancreaticoduodenectomy. In Gastrointestinal Carcinoma: Methods of Cancer Diagnosis, Therapy and Prognosis, Volume 3(pp 211-226). Springer.
- Riall, T. S. (2009). What is the effect of age on pancreatic resection?. In Advances in surgery(pp 233-49).More infoBoth morbidity and mortality rates following pancreatic resection increase with advanced age. The reported mortality rates following pancreatic surgery arc underestimated in single-institution studies. There is a significant publication bias where only centers with good results report their outcomes. The population-based data are critical to provide a more realistic view of mortality rates following pancreatic resection. It is essential in counseling elderly patients that they understand that mortality rates are increased, morbidity rates are increased, and the effect of complications often leads to a prolonged convalescence. They will have a longer length of stay and up to a 30% to 40% chance that they will not be able to go home but will need to recover in an extended care facility following hospital discharge. Although the morbidity and mortality rates are increased for elderly patients, they are well within the acceptable range for major abdominal surgery when performed at experienced centers. Patients also need to be aware that surgical resection is the only curative option for pancreatic cancer. In reasonable risk elderly patients the benefit of surgical resection does not decrease with age and these patients can experience long-term survival and good quality of life. Once patients over 80 get beyond the 2-year survival mark without cancer recurrence their survival parallels that of their age-matched counterparts. One should also keep in mind that the reported survival rates are mostly for pancreatic cancer, but patients with other periampullary cancers have improved long-term survival when compared with those with pancreatic cancer. Elderly patients also need to be aware of the fact that hospital volume and surgeon experience significantly impact outcomes. The mortality rates following surgery in the oldest patients, those over 80, are nearly twice as high at low-volume facilities compared with high-volume facilities. The overall mortality rate and the difference decrease with decreasing age. This likely represents improved processes of care at experienced centers and better ability to manage the complications of pancreatic surgery, which occur more commonly in elderly patients. It is important to educate both physicians and elderly patients about this difference. Currently, elderly patients are less likely to be resected at high-volume centers than younger patients. The reasons for this are unclear but include lack of awareness of the importance of hospital volume and surgeon experience and reluctance of patients in this age group to travel long distances from home for their care. When reviewing the data, one must be aware that these studies (both population-based and single-institution) are retrospective and subject to significant selection bias. The elderly patients undergoing resection were dearly carefully chosen. There is still nihilism, however, toward aggressive care in these patients, with fewer than 10% of patients over 80 with locoregional disease and no comorbidities being resected, whereas 40% of patients 66 to 70 in the same category are resected. These data provide an excellent foundation to guide informed decision-making in the elderly population with pancreatic and periampullary cancer. Patients need to know that surgical resection offers the only hope for cure and that the benefit of surgical resection does not diminish with age. The diagnosis (pancreatic versus other periampullary cancers versus benign disease or premalignant lesions) needs to be taken into account to balance fully the risks and benefits. Older patients need to be aware of the increased morbidity, mortality, and prolonged convalescence they may experience. They also need to be advised to have their surgery done by experienced surgeons at experienced centers where these complications can be best managed. Further studies are needed to guide patient selection. The effect of patient comorbidities, cognitive status, preoperative functional status, and frailty need to be more formally assessed to select patients, maximize surgical resection in appropriate candidates, and improve short-term outcomes. Once better characterized, specialized geriatric pathways may optimize surgical resection rates, streamline care, and improve outcomes in this challenging population. Age alone, however, should not be a contraindication to pancreatic resection in elderly patients with pancreatic cancer.
- Riall, T. S., & Woodside, K. (2008). Intraductal Papillary Mucinous Neoplasms of the Pancreas. In Current Surgical Therapy 9th edition. Philadelphia, PA: Cameron JL. Elsevier.
- Riall, T. S., & Yeo, C. (2005). Neoplasms of the endocrine pancreas. In Surgery: Scientific Principles and Practice 4th edition. Philadelphia, PA.
- Riall, T. S., & Yeo, C. (2005). Standard versus pylorus preserving pancreaticoduodenectomy. In Pancreatic Cancer(pp 313-320). Sudbury, MA.
- Riall, T. S., & Lillemoe, K. (2002). Tumors of the gallbladder, bile ducts, and ampulla. In Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 7th ed(pp 1153-1166). Philadelphia: W.B. Saunders Co.
- Riall, T. S., & Yeo, C. (2002). Pancreas, biliary tract, liver and portal hypertension, spleen. In Shackelford’s Surgery of the Alimentary Tract, 4th ed. Philadelphia: W.B. Saunders Co.
- Riall, T. S., & Yeo, C. (2002). Pancreatic and periampullary carcinoma (nonendocrine). In Shackelford’s Surgery of the Alimentary Tract, 4th ed(pp 63-80). Philadelphia: W.B. Saunders Co.
- Riall, T. S., & Lillemoe, K. (2001). The surgical palliation of periampullary adenocarcinoma. In Atlas of Clinical Oncology, Pancreatic Cancer. Toronto.
Journals/Publications
- Riall, T. S., & Worrell, S. G. (2023). Communication in your department and beyond. Surgery.More infoTechnical skills and clinical acumen are necessary for success in a surgical career. However, these skills alone are not sufficient. A surgeon's emotional intelligence and ability to communicate, manage conflict, and cultivate relationships may be even more critical to success. Health care environments are increasingly complex. An individual surgeon's or surgical department's success depends highly on the teams around them, including anesthesia, nursing, hospital administration, clinic teams, and many more. The surgeon's ability to communicate across the organization and lead by influence is critical.
- Ashouri, Y., Ho, K., Ho, H., Hsu, C. H., Ghaderi, I., Riall, T. S., Konstantinidis, I. T., & Maegawa, F. B. (2022). Minimally invasive vs open pancreatoduodenectomy on oncological adequacy: a propensity score-matched analysis. Surgical endoscopy, 36(10), 7302-7311.More infoThe adoption of minimally invasive pancreatoduodenectomy (MIPD) has increased over the last decade. Most of the data on perioperative and oncological outcomes derives from single-center high-volume hospitals. The impact of MIPD on oncological outcomes in a multicenter setting is poorly understood.
- Ashouri, Y., Hsu, C. H., Riall, T. S., Konstantinidis, I. T., & Maegawa, F. B. (2022). Aspartate Aminotransferase-to-Platelet Ratio Index Predicts Liver Failure After Resection of Colorectal Liver Metastases. Digestive diseases and sciences, 67(10), 4950-4958.More infoChemotherapy agents for metastatic colorectal cancer can cause liver injury, increasing the risk of post-hepatectomy liver failure after hepatectomy for metastases. The role of noninvasive fibrosis markers in this setting is not well established.
- Benzie, A. L., Logarajah, S., Darwish, M. B., Nagatomo, K., Cho, E. E., Riall, T. S., & Jeyarajah, D. R. (2022). A self-selecting prophecy: prevalence of burnout in surgical fellows. Surgical endoscopy, 1-8.More infoBurnout has become a prominent topic, yet there are limited data on the manifestation of this phenomenon among surgical fellows. The goal of this study is to elucidate the prevalence of burnout and determine if there are protective or predisposing factors in surgical fellowship training.
- Dauch, J., Hamidi, M., Arrington, A. K., O'Grady, C. L., Hsu, C. H., Joseph, B., Riall, T. S., & Khreiss, M. (2022). The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(3), 608-614.More infoThe aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM).
- Greenberg, A. L., Sullins, V. F., Donahue, T. R., Sundaram, V. M., Saldinger, P. F., Divino, C. M., Anton, N. E., Stefanidis, D., Reilly, L. M., Egan, R. J., Beals, C. K., Riall, T. S., Duh, Q. Y., Mukhtar, R. A., Hirose, K., & Lebares, C. C. (2022). Emotional Regulation in Surgery: Fostering Well-Being, Performance, and Leadership. The Journal of surgical research, 277, A25-A35.More infoEmotional regulation is increasingly gaining acceptance as a means to improve well-being, performance, and leadership across high-stakes professions, representing innovation in thinking within the field of surgical education. As one part of a broader cognitive skill set that can be trained and honed, emotional regulation has a strong evidence base in high-stress, high-performance fields. Nevertheless, even as Program Directors and surgical educators have become increasingly aware of this data, with emerging evidence in the surgical education literature supporting efficacy, hurdles to sustainable implementation exist. In this white paper, we present evidence supporting the value of emotional regulation training in surgery and share case studies in order to illustrate practical steps for the development, adaptation, and implementation of emotional regulation curricula in three key developmental contexts: basic cognitive skills training, technical skills acquisition and performance, and preparation for independence. We focus on the practical aspects of each case to elucidate the challenges and opportunities of introducing and adopting a curricular innovation into surgical education. We propose an integrated curriculum consisting of all three applied contexts for emotional regulation skills and advocate for the dissemination of such a longitudinal curriculum on a national level.
- Greenberg, A. L., Tenzing, N., Ghadimi, T. R., Tilahun, M. N., Berler, M. H., Lebares, C. C., & , G. S. (2022). Well-Being Intervention in General Surgery: Multicenter Study of Program Director and Resident Perspectives. Journal of the American College of Surgeons, 235(2), 217-224.More infoPhysician well-being is critical for optimal care, but rates of psychological distress among surgical trainees are rising. Although numerous efforts have been made, the perceived efficacy of well-being interventions is not well understood.
- Hamidi, M., O'Grady, C. L., Brown, S. D., Arrington, A. K., Morris-Wiseman, L., Riall, T. S., & Khreiss, M. (2022). Does Preoperative Estimated Glomerular Filtration Rate (eGFR) Predict Short-Term Surgical Outcomes in Patients Undergoing Pancreatic Resections?. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(4), 861-868.More infoPreoperative eGFR has been found to be a reliable predictor of post-operative outcomes in patients with normal creatinine levels who undergo surgery. The aim of our study was to evaluate the impact of preoperative eGFR levels on short-term post-operative outcomes in patients undergoing pancreatectomy.
- Morrill, K. E., Robles-Morales, R., Lopez-Pentecost, M., Martínez Portilla, R. J., Saleh, A. A., Skiba, M. B., Riall, T. S., Austin, J. D., Hirschey, R., Jacobs, E. T., Spotleson, L., & Hanna, T. P. (2022). Factors associated with cancer treatment delay: a protocol for a systematic review and meta-analysis. BMJ open, 12(6), e061121.More infoTreatment delays are significantly associated with increased mortality risk among adult cancer patients; however, factors associated with these delays have not been robustly evaluated. This review and meta-analysis will evaluate factors associated with treatment delays among patients with five common cancers.
- Wiseman, J. E., Morris-Wiseman, L. F., Hsu, C. H., & Riall, T. S. (2022). Attending Surgeon Influences Operative Time More Than Resident Level in Laparoscopic Cholecystectomy. The Journal of surgical research, 270, 564-570.More infoPrior studies on laparoscopic cholecystectomy (LC) have concluded that resident involvement lengthens operative time without impacting outcomes. However, the lack of effect of resident level on operative duration has not been explained. We hypothesized that attending-specific influence on average operative time for LC is more pronounced than resident post-graduate year level.
- Arrington, A. K., & Riall, T. S. (2021). Response to Zhong-Qing et al Regarding "GI Cancers Lymph Node Status Significance After Neoadujuvant Chemotherapy: An Unsolved Problem". Annals of surgery, 274(6), e859-e860.
- Arrington, A. K., Hsu, C. H., Schaefer, K. L., O'Grady, C. L., Khreiss, M., & Riall, T. S. (2021). Survival after Margin-Positive Resection in the Era of Modern Chemotherapy for Pancreatic Cancer: Do Patients Still Benefit?. Journal of the American College of Surgeons, 233(1), 100-109.More infoR0 resection for pancreatic cancer is considered standard of care, but is not always achieved. This study looks at R1/R2 resection outcomes compared with chemotherapy alone. Our hypothesis is that patients with margin-positive disease have better outcomes than those receiving chemotherapy alone.
- Guerrero, M. A., Anderson, B., Carr, G., Snyder, K. L., Boyle, P., Ugwu, S. A., Davis, M., Bohnenkamp, S. K., Nfonsam, V., & Riall, T. S. (2021). Adherence to a standardized infection reduction bundle decreases surgical site infections after colon surgery: a retrospective cohort study on 526 patients. Patient safety in surgery, 15(1), 15.More infoColon surgical site infections (SSI) are detrimental to patient safety and wellbeing. To achieve clinical excellence, our hospital set to improve patient safety for those undergoing colon surgery. Our goal was to implement a perioperative SSI prevention bundle for all colon surgeries to reduce colon surgery SSI rates.
- Hamidi, M., Dauch, J., Watson, R., O'Grady, C., Hsu, P., Arrington, A., Riall, T. S., & Khreiss, M. (2021). Outcomes with Preoperative Biliary Stenting After Pancreaticoduodenectomy In the Modern Era. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 25(1), 162-168.More infoPrevious studies have documented increased complications following pancreaticoduodenectomy in patients who undergo preoperative biliary stenting (PBS). However, in the modern era, the vast majority of patients with jaundice are stented. We hypothesized that there is no difference in short-term postoperative outcomes between PBS and no PBS in patient with obstructive jaundice undergoing pancreaticoduodenectomy.
- Khorfan, R., Hu, Y. Y., Agarwal, G., Eng, J., Riall, T., Choi, J., Are, C., Shanafelt, T., Bilimoria, K. Y., & Cheung, E. O. (2021). The Role of Personal Accomplishment in General Surgery Resident Well-being. Annals of surgery, 274(1), 12-17.More infoTo investigate the association of personal accomplishment (PA) with the other subscales, assess its association with well-being outcomes, and evaluate drivers of PA by resident level.
- Maegawa, F. B., Ashouri, Y., Bartz-Kurycki, M., Ahmad, M., De La Rosa, E., Philipovskiy, A., Riall, T. S., & Konstantinidis, I. T. (2021). Impact of facility type on survival after pancreatoduodenectomy for small pancreatic adenocarcinoma (≤ 2 cm). American journal of surgery, 222(1), 145-152.More infoPrevious studies have demonstrated that even small pancreatic cancers are associated with poor survival. The role of facility type on survival in this setting is unknown.
- Maegawa, F. B., Ashouri, Y., Hamidi, M., Hsu, C. H., & Riall, T. S. (2021). Gallbladder Cancer Surgery in the United States: Lymphadenectomy Trends and Impact on Survival. The Journal of surgical research, 258, 54-63.More infoGallbladder cancer has a poor prognosis, and surgery is the only curative treatment. However, lymphadenectomy has been underperformed. We evaluate the trend of lymphadenectomy in the United States and its impact on survival.
- Riall, T. S. (2021). Percutaneous Cholecystolithotomy: An Alternative to Cholecystectomy after Cholecystostomy Tube Placement in the Truly High-Risk Surgical Patient. Journal of the American College of Surgeons, 232(2), 201-202.
- Zhang, L. M., Cheung, E. O., Eng, J. S., Ma, M., Etkin, C. D., Agarwal, G., Shanafelt, T. D., Riall, T. S., Nasca, T., Bilimoria, K. Y., Hu, Y. Y., & Johnson, J. K. (2021). Development of a conceptual model for understanding the learning environment and surgical resident well-being. American journal of surgery, 221(2), 323-330.More infoSurgeon burnout is linked to poor outcomes for physicians and patients. Several conceptual models exist that describe drivers of physician wellness generally. No such model exists for surgical residents specifically.
- Arrington, A. K., O'Grady, C., Schaefer, K., Khreiss, M., & Riall, T. S. (2020). Significance of Lymph Node Resection After Neoadjuvant Therapy in Pancreatic, Gastric, and Rectal Cancers. Annals of surgery, 272(3), 438-446.More infoGastrointestinal cancers are increasingly being treated with NAT before surgical resection. Currently, quality metrics are linked to the number of LNs resected to determine subsequent treatment and prognosis. We hypothesize that NAT decreases LN metastasis, downstages patients, and decreases overall lymph node yields (LNY) compared to initial surgical resection. With increasing use of NAT, this brings into question the validity of quality metrics.
- Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., Bonjer, J., McDonald, M., Alseidi, A., Ujiki, M., Riall, T. S., Hammill, C., Moulton, C. A., Pucher, P. H., Parks, R. W., Ansari, M. T., Connor, S., Dirks, R. C., Anderson, B., , Altieri, M. S., et al. (2020). Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Annals of surgery, 272(1), 3-23.More infoBDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI.
- Driesen, A. M., Romero Arenas, M. A., Arora, T. K., Tang, A., Nfonsam, V. N., O'Grady, C. L., Riall, T. S., & Morris-Wiseman, L. F. (2020). Do General Surgery Residency Program Websites Feature Diversity?. Journal of surgical education, 77(6), e110-e115.More infoThis study assesses ways in which General Surgery residency program websites demonstrate diversity.
- Martinez, C., Omesiete, P., Pandit, V., Thompson, E., Nocera, M., Riall, T., Guerrero, M., & Nfonsam, V. (2020). A Protocol-Driven Reduction in Surgical Site Infections After Colon Surgery. The Journal of surgical research, 246, 100-105.More infoSurgical site infection (SSI) is an established quality indicator and predictor for adverse patient outcomes. Multiple strategies have been established to reduce SSI; however, optimum protocol remains unclear. The aim of the study was to assess the impact of established protocol on SSI after colon surgery.
- Michael Brunt, L., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., Bonjer, J., McDonald, M., Alseidi, A., Ujiki, M., Riall, T. S., Hammill, C., Moulton, C. A., Pucher, P. H., Parks, R. W., Ansari, M. T., Connor, S., Dirks, R. C., Anderson, B., , Altieri, M. S., et al. (2020). Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy. Surgical endoscopy, 34(7), 2827-2855.More infoBile duct injury (BDI) is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI.
- Price, E. T., Coverley, C. R., Arrington, A. K., Nfonsam, V. N., Morris-Wiseman, L., & Riall, T. S. (2020). Are We Making an Impact? A Qualitative Program Assessment of the Resident Leadership, Well-being, and Resiliency Program for General Surgery Residents. Journal of surgical education, 77(3), 508-519.More infoAfter implementing a formal resident well-being and resiliency program in our surgery residency, we performed in-depth qualitative interviews to understand residents' perceptions of: (1) the impact and benefits, (2) the essential elements for success, and (3) the desired changes to the well-being program.
- Sakran, J. V., Nance, M., Riall, T., Asmar, S., Chehab, M., & Joseph, B. (2020). Pediatric Firearm Injuries and Fatalities: Do Racial Disparities Exist?. Annals of surgery, 272(4), 556-561.More infoTo evaluate racial disparities among White and Black pediatric firearm injury patients on a national level.
- Arrington, A. K., & Riall, T. S. (2019). Pancreatic Cancer Lymph Node Status: An Unsolved Problem that Impacts Recommendation Despite Guidelines: In reply to Hyer and colleagues. Journal of the American College of Surgeons, 229(2), 223-224.
- Arrington, A. K., Price, E. T., Golisch, K., & Riall, T. S. (2019). Pancreatic Cancer Lymph Node Resection Revisited: A Novel Calculation of Number of Lymph Nodes Required. Journal of the American College of Surgeons, 228(4), 662-669.More infoPancreatic cancer is the third leading cause of cancer related deaths in the US. Although lymph node (LN) metastasis is a prognostic indicator, the extent of LN resection is still debated. Our goal was to use the distribution of the ratio of positive to negative LNs to derive a more adequate number of necessary examined LNs based on the target LN threshold (TLNT).
- Knudsen, E. S., Kumarasamy, V., Ruiz, A., Sivinski, J., Chung, S., Grant, A., Vail, P., Chauhan, S. S., Jie, T., Riall, T. S., & Witkiewicz, A. K. (2019). Cell cycle plasticity driven by MTOR signaling: integral resistance to CDK4/6 inhibition in patient-derived models of pancreatic cancer. Oncogene, 38(18), 3355-3370.More infoPancreatic ductal adenocarcinoma (PDAC), like many KRAS-driven tumors, preferentially loses CDKN2A that encodes an endogenous CDK4/6 inhibitor to bypass the RB-mediated cell cycle suppression. Analysis of a panel of patient-derived cell lines and matched xenografts indicated that many pancreatic cancers have intrinsic resistance to CDK4/6 inhibition that is not due to any established mechanism or published biomarker. Rather, there is a KRAS-dependent rapid adaptive response that leads to the upregulation of cyclin proteins, which participate in functional complexes to mediate resistance. In vivo, the degree of response is associated with the suppression of a gene expression signature that is strongly prognostic in pancreatic cancer. Resistance is associated with an adaptive gene expression signature that is common to multiple kinase inhibitors, but is attenuated with MTOR inhibitors. Combination treatment with MTOR and CDK4/6 inhibitors had potent activity across a large number of patient-derived models of PDAC underscoring the potential clinical efficacy.
- Maegawa, F. B., Shehorn, L., Aziz, H., Kettelle, J., Jie, T., & Riall, T. S. (2019). Association Between Noninvasive Fibrosis Markers and Postoperative Mortality After Hepatectomy for Hepatocellular Carcinoma. JAMA network open, 2(1), e187142.More infoThe selection criteria for hepatectomy for hepatocellular carcinoma (HCC) is not well established. The role of noninvasive fibrosis markers in this setting is unknown in the US population.
- Mehta, H. B., Yong, S., Sura, S. D., Hughes, B. D., Kuo, Y. F., Williams, S. B., Tyler, D. S., Riall, T. S., & Goodwin, J. S. (2019). Development of comorbidity score for patients undergoing major surgery. Health services research, 54(6), 1223-1232.More infoTo develop and validate a claims-based comorbidity score for patients undergoing major surgery, and compare its performance with established comorbidity scores.
- Dimou, F. M., & Riall, T. S. (2018). Proper Use of Cholecystostomy Tubes. Advances in surgery, 52(1), 57-71.
- Joseph, B. A., Jehan, F., & Riall, T. s. (2018). Evaluating the Diagnostic Accuracy and Management Protocols: In Reply to Strasberg. Journal of the American College of Surgeons, 227(6), 624-626. doi:10.1016/j.jamcollsurg.2018.09.006
- Joseph, B., Jehan, F., Dacey, M., Kulvatunyou, N., Khan, M., Zeeshan, M., Gries, L., O'Keeffe, T., & Riall, T. S. (2018). Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American College of Surgeons.More infoThe 2013 Tokyo Guidelines (TG13) are used to diagnose, grade severity, and guide management of acute cholecystitis (AC). The aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on the TG13.
- Riall, T. S. (2018). Enjoy the journey. Surgery, 164(6), 1382-1387.
- Riall, T. S. (2018). Evaluating the Feasibility of Stress-Resilience Training in Surgical Residency: A Step Toward Improving Surgeon Well-being. JAMA surgery, 153(10), e182735.
- Riall, T. S. (2018). Invited Commentary on: Gender Differences in Utilization of Duty-hour Regulations, Aspects of Burnout, and Psychological Well-being Among General Surgery Residents in the U.S. Annals of surgery, 268(2), 212-214.
- Riall, T. S. (2018). Resident Well-Being Programs: In reply to De Oliveira. Journal of the American College of Surgeons, 227(1), 143-145.
- Riall, T. S., Teiman, J., Chang, M., Cole, D., Leighn, T., McClafferty, H., & Nfonsam, V. N. (2018). Maintaining the Fire but Avoiding Burnout: Implementation and Evaluation of a Resident Well-Being Program. Journal of the American College of Surgeons, 226(4), 369-379.More infoThere have been few programs designed to improve surgical resident well-being, and such efforts often lack formal evaluation.
- Beane, J. D., House, M. G., Pitt, S. C., Zarzaur, B., Kilbane, E. M., Hall, B. L., Riall, T. S., & Pitt, H. A. (2017). Pancreatoduodenectomy with venous or arterial resection: a NSQIP propensity score analysis. HPB : the official journal of the International Hepato Pancreato Biliary Association, 19(3), 254-263.More infoVascular resection during pancreatoduodenectomy (PD) is being performed more frequently. Our aim was to analyze the outcomes of PD with and without vascular resection in a large, multicenter cohort.
- Dimou, F. M., Adhikari, D., Mehta, H. B., & Riall, T. S. (2017). Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis. Journal of the American College of Surgeons, 224(4), 502-511.e1.More infoThe Tokyo Guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis.
- Dolejs, S., Zarzaur, B. L., Zyromski, N. J., Pitt, H. A., Riall, T. S., Hall, B. L., & Behrman, S. W. (2017). Does Hyperbilirubinemia Contribute to Adverse Patient Outcomes Following Pancreatoduodenectomy?. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 21(4), 647-656.More infoJaundice due to biliary obstruction leads to multiple physiologic derangements and a decline in performance status that may result in unfavorable intra- and postoperative outcomes following a Whipple procedure. While preoperative biliary decompression may improve synthetic function, this strategy has been reported to increase the incidence of infectious complications following surgery. We hypothesized that hyperbilirubinemia at the time of pancreatoduodenectomy (PD) would be a risk factor for increased morbidity and mortality postoperatively.
- Kantor, O., Talamonti, M. S., Pitt, H. A., Vollmer, C. M., Riall, T. S., Hall, B. L., Wang, C. H., & Baker, M. S. (2017). Using the NSQIP Pancreatic Demonstration Project to Derive a Modified Fistula Risk Score for Preoperative Risk Stratification in Patients Undergoing Pancreaticoduodenectomy. Journal of the American College of Surgeons, 224(5), 816-825.More infoThe Fistula Risk Score (FRS) is a clinical tool developed from single-institutional data using primarily intraoperative factors to characterize the risk of clinically relevant pancreatic fistula (CR-POPF) after pancreaticoduodenectomy. We developed a modified FRS based on objective, nationally accrued data that is more readily determined before resection.
- Mehta, H. B., Vargas, G. M., Adhikari, D., Dimou, F., & Riall, T. S. (2017). Comparative effectiveness of chemotherapy versus resection of the primary tumor as the initial treatment in older patients with stage IV colorectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 19(6), O210-O218.More infoThe objective was to determine trends in the use of chemotherapy as the initial treatment and evaluate the comparative effectiveness of initial chemotherapy versus resection of the primary tumour on survival (intention-to-treat analysis) in stage IV colorectal cancer (CRC).
- Plotkin, A., Ceppa, E. P., Zarzaur, B. L., Kilbane, E. M., Riall, T. S., & Pitt, H. A. (2017). Reduced morbidity with minimally invasive distal pancreatectomy for pancreatic adenocarcinoma. HPB : the official journal of the International Hepato Pancreato Biliary Association, 19(3), 279-285.More infoMinimally invasive distal pancreatectomy (MISDP) has been shown to be safe relative to open distal pancreatectomy (ODP). However, MISDP has been slow to adopt for pancreatic adenocarcinoma (PDAC). This study sought to compare outcomes following MISDP vs. ODP for PDAC.
- Tamirisa, N. P., Goodwin, J. S., Kandalam, A., Linder, S. K., Weller, S., Turrubiate, S., Silva, C., & Riall, T. S. (2017). Patient and physician views of shared decision making in cancer. Health expectations : an international journal of public participation in health care and health policy, 20(6), 1248-1253.More infoEngaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences.
- Valencia, O. M., Samuel, S. E., Viscusi, R. K., Riall, T. S., Neumayer, L. A., & Aziz, H. (2017). The Role of Genetic Testing in Patients With Breast Cancer: A Review. Journal of the American Medical Association, Surgery, 152(6), 589-594.More infoIn the United States from 2009 to 2013, the incidence of breast cancer was the highest of any cancer and the death rate was second to that of lung cancer. Approximately 5% to 10% of breast cancers are inheritable.
- Van Buren, G., Bloomston, M., Schmidt, C. R., Behrman, S. W., Zyromski, N. J., Ball, C. G., Morgan, K. A., Hughes, S. J., Karanicolas, P. J., Allendorf, J. D., Vollmer, C. M., Ly, Q., Brown, K. M., Velanovich, V., Winter, J. M., McElhany, A. L., Muscarella, P., Schmidt, C. M., House, M. G., , Dixon, E., et al. (2017). A Prospective Randomized Multicenter Trial of Distal Pancreatectomy With and Without Routine Intraperitoneal Drainage. Annals of surgery, 266(3), 421-431.More infoThe objective of this study was to test the hypothesis that distal pancreatectomy (DP) without intraperitoneal drainage does not affect the frequency of grade 2 or higher grade complications.
- Bagla, P., Sarria, J. C., & Riall, T. S. (2016). Management of acute cholecystitis. Current Opinion in Infectious Diseases, 29(5), 508-13.More infoVarious aspects of the management of acute calculous cholecystitis, including type and timing of surgery, role of antibiotics, and nonoperative management, remain controversial. This review focuses on recently published studies addressing the timing of cholecystectomy, use of cholecystostomy tubes, and role of antibiotics in this condition.
- Dimou, F. M., & Riall, T. S. (2016). On Surgeon Burnout: In reply to Bianchi and colleagues. Journal of the American College of Surgeons, 223(2), 425-6.
- Dimou, F. M., Adhikari, D., Mehta, H. B., NP, T., & Riall, T. S. (2016). Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis. Journal of the American College of Surgeons, 222(4), 377-384.More infoFewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones.
- Dimou, F. M., Adhikari, D., Mehta, H. B., Olino, K., Riall, T. S., & Brown, K. M. (2016). Incidence of hepaticojejunostomy stricture after hepaticojejunostomy. Surgery, 160(3), 691-8.More infoOperations requiring biliary-enteric anastomosis are uncommon, and the true incidence of postoperative stricture is unknown. Our goal was to determine the timing, incidence, and management of stricture after biliary-enteric anastomosis.
- Dimou, F. M., Eckelbarger, D., & Riall, T. S. (2016). Surgeon Burnout: A Systematic Review. Journal of the American College of Surgeons, 222(6), 1230-9.
- Dimou, F. M., Mehta, H. B., Adhikari, D., Harland, R. C., Riall, T. S., & Kuo, Y. (2016). The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis. Surgery, [Epub ahead of print].More infoNonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use.
- Dimou, F., Sineshaw, H., Parmar, A. D., Tamirisa, N. P., Jemal, A., & Riall, T. S. (2016). Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer. Journal of Gastrointestinal Surgery, 20(1), 93-103.More infoPancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regard to age and treatment center in the receipt of multimodality therapy.
- Hassan, A., Mazhar, K., Joseph, B. A., Evan, O., Riall, T. S., & Jie, T. (2016). Comparative Analysis of Outcomes of Distal Pancreatectomy with or without Splenectomy Using the National Inpatient Sample. Journal of the Pancreas, 17(4), 379-384.
- Jupiter, D. C., Fang, X., Adhikari, D., Mehta, H. B., & Riall, T. S. (2016). Safety of Continued Clopidogrel Use in the Preoperative Course of Gastrointestinal Surgery: A Retrospective Cohort Study. Annals of surgery.More infoOur study aimed to estimate postoperative bleeding risk in older adults taking clopidogrel before gastrointestinal (GI) surgery, to aid surgeons in decisions regarding clopigogrel cessation.
- Jupiter, D., Fang, X., Adhikari, D., Mehta, H., & Riall, T. S. (2016). Safety of continued clopidogrel use in the preoperative course of gastrointestinal surgery: A retrospective cohort study. Annals of Surgery, [Epub ahead of print].
- Mehta, H. B., Dimou, F., Adhikari, D., Tamirisa, N. P., Sieloff, E., Williams, T. P., Kuo, Y., & Riall, T. S. (2016). Comparison of Comorbidity Scores in Predicting Surgical Outcomes. Medical Care, 54(2), 180-7.More infoThe optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications, and failure to rescue (FTR) using claims data has not been established.
- Mehta, H. B., Parmar, A. D., Adhikari, D., Tamirisa, N. P., Dimou, F., Jupiter, D., & Riall, T. S. (2016). Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients. The Journal of Surgical Research, 204(2), 326-34.More infoSurgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients.
- Mehta, H., Sura, S., Sharma, M., Johnson, M., & Riall, T. S. (2016). Comparative performance of diagnosis and prescription based comorbidity scores to predict health-related quality of life. Medical Care, 54(5), 519-27.
- Perone, J. A., & Riall, T. S. (2016). Commentary: Appendectomy and increased risk of ischemic heart disease. The Journal of Surgical Research, 200(1), 36-8.
- Perone, J. A., Riall, T. S., & Olino, K. (2016). Palliative Care for Pancreatic and Periampullary Cancer. Surgical Clinic of North America, 96(6), 1415-1430.More infoMost patients with pancreatic cancer will present with metastatic or locally advanced disease. Unfortunately, most patients with localized disease will experience recurrence even after multimodality therapy. As such, pancreatic cancer patients arrive at a common endpoint where decisions pertaining to palliative care come to the forefront. This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.
- Riall, T. S., & Parikh, P. (2016). Quality of Care and Cost at Safety-Net Hospitals—Is Redistribution of Cases Possible?. Journal of the American Medical Association (JAMA) Surgery, 151(10), 914-915. doi:10.1001/jamasurg.2016.1798
- Sharma, G., Nishi, S. P., Lin, Y., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2016). Pattern of Imaging After Lung Cancer Resection: 1992-2005. Annals of the American Thoracic Society, 13(9), 1559-1567.More infoImaging intensity following lung cancer resection performed with curative intent is unknown.
- Tamirisa, N. P., Parmar, A. D., Vargas, G. M., Mehta, H. B., Kilbane, E. M., Hall, B. L., Pitt, H. A., & Riall, T. S. (2016). Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy. Annals of surgery, 263(2), 385-91.More infoFor pancreatectomy patients, mortality increases with increasing age. Our study evaluated the relative contribution of overall postoperative complications and failure to rescue rates on the observed increased mortality in older patients undergoing pancreatic resection at specialized centers.
- Vargas, G. M., Sieloff, E. P., Parmar, A. D., Tamirisa, N. P., Mehta, H. B., & Riall, T. S. (2016). Laparoscopy decreases complications for obese patients undergoing elective rectal surgery. Surgical Endoscopy, 30(5), 1826-32.More infoWhile there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients.
- Beane, J. D., House, M. G., Pitt, S. C., Kilbane, E. M., Hall, B. L., Parmar, A. D., Riall, T. S., & Pitt, H. A. (2015). Distal pancreatectomy with celiac axis resection: what are the added risks?. HPB (Oxford), 17(9), 777-84.More infoReported series of a distal pancreatectomy with celiac axis resection (DP-CAR) are either small or not adequately controlled. The aim of this analysis was to report a multicentre series of modified Appleby procedures with a comparison group to determine the relative operative risk.
- Behrman, S. W., Zarzaur, B. L., Parmar, A., Riall, T. S., Hall, B. L., & Pitt, H. A. (2015). Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications. Journal of Gastrointestinal Surgery, 19(1), 72-9; discussion 79.More infoRoutine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative.
- Cooper, A. B., Parmar, A. D., Riall, T. S., Hall, B. L., Katz, M. H., Aloia, T. A., & Pitt, H. A. (2015). Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates?. Journal of Gastrointestinal Surgery, 19(1), 80-6; discussion 86-7.More infoThe impact of neoadjuvant therapy on postpancreatectomy complications is inadequately described.
- Dimou, F. M., & Riall, T. S. (2015). Pancreatic Resection Results in a Statewide Surgical Collaborative. Annals of Surgical Oncology, 22(8), 2462-3.
- Parmar, A. D., Sheffield, K. M., Adhikari, D., Davee, R. A., Vargas, G. M., Tamirisa, N. P., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2015). PREOP Gallstones: A Prognostic Nomogram for the Management of Symptomatic Cholelithiasis in Older Patients. Annals of surgery, 261(6), 1184-90.More infoThe decision regarding elective cholecystectomy in older patients with symptomatic cholelithiasis is complicated. We developed and validated a prognostic nomogram to guide shared decision making for these patients.
- Riall, T. S., Adhikari, D., Parmar, A. D., Linder, S. K., Dimou, F. M., Crowell, W., Tamirisa, N. P., Townsend, C. M., & Goodwin, J. S. (2015). The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications. Journal of the American College of Surgeons, 220(4), 682-90.More infoWe recently developed and validated a prognostic model that accurately predicts the 2-year risk of emergent gallstone-related hospitalization in older patients presenting with symptomatic gallstones.
- Tamirisa, N. P., Sheffield, K. M., Parmar, A. D., Zimmermann, C. J., Adhikari, D., Vargas, G. M., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2015). Surgeon and Facility Variation in the Use of Minimally Invasive Breast Biopsy in Texas. Annals of surgery, 262(1), 171-8.More infoMinimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of more than 90% and vary across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with the use of MIBB.
- Williams, T. P., Dimou, F. M., Adhikari, D., Kimbrough, T. D., & Riall, T. S. (2015). Hospital readmission after emergency room visit for cholelithiasis. The Journal of surgical research, 197(2), 318-23.More infoFor patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up.
- Lee, C. W., Pitt, H. A., Riall, T. S., Ronnekleiv-Kelly, S. S., Israel, J. S., Leverson, G. E., Parmar, A. D., Kilbane, E. M., Hall, B. L., & Weber, S. M. (2014). Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. Journal of Gastrointestinal Surgery, 18(11), 1902-10.More infoImprovements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.
- Parmar, A. D., Coutin, M. D., Vargas, G. M., Tamirisa, N. P., Sheffield, K. M., & Riall, T. S. (2014). Cost-effectiveness of elective laparoscopic cholecystectomy versus observation in older patients presenting with mild biliary disease. Journal of Gastrointestinal Surgery, 18(9), 1616-22.More infoOur objective was to determine the probability threshold for recurrent symptoms at which elective cholecystectomy compared to observation in older patients with symptomatic cholelithiasis is the more effective and cost-effective option. We built a decision model of elective cholecystectomy versus observation in patients >65 presenting with initial episodes of symptomatic cholelithiasis that did not require initial hospitalization or cholecystectomy. Probabilities for subsequent hospitalization, emergency cholecystectomy, and perioperative complications were based on previously published probabilities from a 5 % national sample of Medicare patients. Costs were estimated from Medicare reimbursements and from the Healthcare Cost and Utilization Project. Utilities (quality-adjusted life years, QALYs) were obtained from established literature estimates. Elective cholecystectomy compared to observation in all patients was associated with lower effectiveness (-0.10 QALYs) and had an increased cost of $3,422.83 per patient at 2-year follow-up. Elective cholecystectomy became the more effective option when the likelihood for continued symptoms exceeded 45.3 %. Elective cholecystectomy was both more effective and less costly when the probability for continued symptoms exceeded 82.7 %. An individualized shared decision-making strategy based on these data can increase elective cholecystectomy rates in patients at high risk for recurrent symptoms and minimize unnecessary cholecystectomy for patients unlikely to benefit.
- Parmar, A. D., Vargas, G. M., Tamirisa, N. P., Sheffield, K. M., & Riall, T. S. (2014). Trajectory of care and use of multimodality therapy in older patients with pancreatic adenocarcinoma. Surgery, 156(2), 280-9.More infoMultimodality therapy with chemotherapy and operative resection is recommended for patients with locoregional pancreatic cancer but is not received by many patients.
- Van Buren, G., Bloomston, M., Hughes, S. J., Winter, J., Behrman, S. W., Zyromski, N. J., Vollmer, C., Velanovich, V., Riall, T., Muscarella, P., Trevino, J., Nakeeb, A., Schmidt, C. M., Behrns, K., Ellison, E. C., Barakat, O., Perry, K. A., Drebin, J., House, M., , Abdel-Misih, S., et al. (2014). A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Annals of surgery, 259(4), 605-12.More infoTo test by randomized prospective multicenter trial the hypothesis that pancreaticoduodenectomy (PD) without the use of intraperitoneal drainage does not increase the frequency or severity of complications.
- Vargas, G. M., Parmar, A. D., Sheffield, K. M., Tamirisa, N. P., Brown, K. M., & Riall, T. S. (2014). Impact of liver-directed therapy in colorectal cancer liver metastases. The Journal of Surgical Research, 191(1), 42-50.More infoThere is a paucity of data on the current management and outcomes of liver-directed therapy (LDT) in older patients presenting with stage IV colorectal cancer (CRC). The aim of the study was to evaluate treatment patterns and outcomes in use of LDT in the setting of improved chemotherapy.
- Vargas, G. M., Sheffield, K. M., Parmar, A. D., Han, Y., Gajjar, A., Brown, K. M., & Riall, T. S. (2014). Trends in treatment and survival in older patients presenting with stage IV colorectal cancer. Journal of Gastrointestinal Surgery, 18(2), 369-77.More infoTrends in the use of modern chemotherapeutic regimens, primary tumor resection, and the timing of chemotherapy and resection in older patients with stage IV colorectal cancer have not been evaluated.
- Benarroch-Gampel, J., & Riall, T. S. (2013). What laboratory tests are required for ambulatory surgery?. Advances in surgery, 47, 81-98.More infoCurrent recommendations from the 2002 ASA Task Force on Preanesthesia Evaluation are not specific to ambulatory surgery and are not based on strongly designed and adequately powered studies. Furthermore, although the ASA does not advocate routine testing or testing without indication, the guidelines for "selective" or "indicated" testing are unclear. As a result, preoperative testing in the United States is overused relative to the current ASA Task Force recommendations. Uncertainty regarding indications leads to wide variation in the use of preoperative testing across providers. There is evidence to suggest that current guidelines may recommend testing more than is necessary. Several studies reviewed in this article have shown that the elimination of routine testing and more selective use based on patient history and physical examination findings would decrease cost and increase patient satisfaction without detriment to patient care. Future studies should evaluate the effectiveness of testing in specific clinical situations, allowing for identification of clear conditions under which preoperative testing should be performed. This approach would allow the promulgation of clear guidelines, the development of which should involve surgeons (as members of a multidisciplinary team), anesthesiologists, and hospital administrators, together with governing bodies such as the ASA and American College of Surgeons that offer support for the dissemination and broad adoption of guidelines. In the future, studies should focus not only on identifying specific clinical situations whereby preoperative testing will be beneficial but also on determining current barriers to improving adherence to guidelines. Potential barriers include institutional policies for testing, physician reluctance to change practice, problems in communication between members involved in perioperative care, and legal consequences of not ordering preoperative tests. Identification of reasons for overuse of testing is the first step toward changing practice. Once clear guidelines are developed, the creation of preoperative clinics that centralize preoperative care, or promoting the use of clinical pathways and/or checklists for determining appropriate tests, may improve the adequate use of preoperative tests. It will be critical for quality improvement measures to include surgeons, anesthesiologists, hospital administrators, and governing bodies such as the ASA and American College of Surgeons to achieve success.
- Jinkins, L. J., Parmar, A. D., Han, Y., Duncan, C. B., Sheffield, K. M., Brown, K. M., & Riall, T. S. (2013). Current trends in preoperative biliary stenting in patients with pancreatic cancer. Surgery, 154(2), 179-89.More infoSufficient evidence suggests that preoperative biliary stenting is associated with increased complication rates after pancreaticoduodenectomy.
- Parmar, A. D., Sheffield, K. M., Han, Y., Vargas, G. M., Guturu, P., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2013). Evaluating comparative effectiveness with observational data: endoscopic ultrasound and survival in pancreatic cancer. Cancer, 119(21), 3861-9.More infoA previous observational study reported that endoscopic ultrasound (EUS) is associated with improved survival in older patients with pancreatic cancer. The objective of this study was to reevaluate this association using different statistical methods to control for confounding and selection bias.
- Parmar, A. D., Sheffield, K. M., Vargas, G. M., Han, Y., Chao, C., & Riall, T. S. (2013). Quality of post-treatment surveillance of early stage breast cancer in Texas. Surgery, 154(2), 214-25.More infoOnly annual mammography and physical examination are recommended for the post-treatment surveillance of early stage breast cancer.
- Parmar, A. D., Sheffield, K. M., Vargas, G. M., Pitt, H. A., Kilbane, E. M., Hall, B. L., & Riall, T. S. (2013). Factors associated with delayed gastric emptying after pancreaticoduodenectomy. HPB : the official journal of the International Hepato Pancreato Biliary Association, 15(10), 763-72.More infoThe factors associated with delayed gastric emptying (DGE) after a pancreaticoduodenectomy (PD) are not definitively known.
- Riall, T. S., & Brown, K. M. (2013). Individualizing care for locoregional pancreatic cancer?. The Journal of surgical research, 179(1), 41-4.
- Riall, T. S., Sheffield, K. M., & Kuo, Y. (2013). Intraoperative cholangiography during cholecystectomy--reply. Journal of the American Medical Association, 310, 2674.
- Sheffield, K. M., Han, Y., Kuo, Y., Riall, T. S., & Goodwin, J. S. (2013). Potentially inappropriate screening colonoscopy in Medicare patients: variation by physician and geographic region. JAMA internal medicine, 173(7), 542-50.More infoInappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively.
- Sheffield, K. M., McAdams, P. S., Benarroch-Gampel, J., Goodwin, J. S., Boyd, C. A., Zhang, D., & Riall, T. S. (2013). Overuse of preoperative cardiac stress testing in medicare patients undergoing elective noncardiac surgery. Annals of surgery, 257(1), 73-80.More infoTo determine the frequency and predictors of cardiac stress testing before elective noncardiac surgery in Medicare patients with no indications for cardiovascular evaluation.
- Sheffield, K. M., Riall, T. S., Han, Y., Kuo, Y., Townsend, C. M., & Goodwin, J. S. (2013). Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. The Journal of the American Medical Association, 310(8), 812-20.More infoSignificant controversy exists regarding routine intraoperative cholangiography in preventing common duct injury during cholecystectomy.
- Singal, A. K., Lin, Y., Kuo, Y., Riall, T., & Goodwin, J. S. (2013). Primary care physicians and disparities in colorectal cancer screening in the elderly. Health services research, 48(1), 95-113.More infoTo examine whether having a primary care physician (PCP) is associated with reduced ethnic disparities for colorectal cancer (CRC) screening and whether clustering of minorities within PCPs contributes to the disparities.
- Vargas, G. M., Sheffield, K. M., Parmar, A. D., Han, Y., Brown, K. M., & Riall, T. S. (2013). Physician follow-up and observation of guidelines in the post treatment surveillance of colorectal cancer. Surgery, 154(2), 244-55.More infoGuidelines for post resection surveillance of colorectal cancer recommend a collection of the patient's history and physical examination, testing for carcinoembryonic antigen (CEA), and colonoscopy. No consistent guidelines exist for the use of abdominal computed tomography (CT) and position emission tomography (PET)/PET-CT. The goal of our study was to describe current trends, the impact of oncologic follow-up on guideline adherence, and the patterns of use of nonrecommended tests.
- Zimmermann, C. J., Sheffield, K. M., Duncan, C. B., Han, Y., Cooksley, C. D., Townsend, C. M., & Riall, T. S. (2013). Time trends and geographic variation in use of minimally invasive breast biopsy. Journal of the American College of Surgeons, 216(4), 814-24; discussion 824-7.More infoCurrent guidelines recommend minimally invasive breast biopsy (MIBB) as the gold standard for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas.
- Benarroch-Gampel, J., Lairson, D. R., Boyd, C. A., Sheffield, K. M., Ho, V., & Riall, T. S. (2012). Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity. Surgery, 152(3), 363-75.More infoControversy exists regarding the use of concurrent cholecystectomy during Roux-en-Y gastric bypass performed for morbid obesity.
- Benarroch-Gampel, J., Sheffield, K. M., Duncan, C. B., Brown, K. M., Han, Y., Townsend, C. M., & Riall, T. S. (2012). Preoperative laboratory testing in patients undergoing elective, low-risk ambulatory surgery. Annals of surgery, 256(3), 518-28.More infoRoutine preoperative laboratory testing for ambulatory surgery is not recommended.
- Benarroch-Gampel, J., Sheffield, K. M., Lin, Y., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2012). Colonoscopist and primary care physician supply and disparities in colorectal cancer screening. Health services research, 47(3 Pt 1), 1137-57.More infoOBJECTIVE. : To determine whether racial/ethnic disparities in colonoscopy use vary by physician availability. DATA SOURCE. : We used 100 percent Texas Medicare claims data for 2003-2007. STUDY DESIGN. : We identified beneficiaries aged 66-79 in 2007, examined racial/ethnic differences in colonoscopy use from 2003 to 2007, and estimated the percentage of white, black, and Hispanic beneficiaries who underwent colonoscopy by level of physician availability and area income. PRINCIPAL FINDINGS. : For the 974,879 beneficiaries, colonoscopy use was higher in whites (40.7 percent) compared to blacks (35.0 percent) and Hispanics (28.7 percent, p< .001). For whites, increasing availability of colonoscopists and primary care physicians (PCPs) was associated with higher colonoscopy use. For blacks and Hispanics, colonoscopy use was unchanged or decreased with increases in colonoscopist and PCP availability. In multilevel models, the odds of colonoscopy were 20 percent lower for blacks (OR 0.80, 95 percent CI 0.79-0.82) and 32 percent lower for Hispanics (OR 0.68, 95 percent CI 0.66-0.69) compared to whites; adjusting for availability of colonoscopists or PCPs did not attenuate racial/ethnic disparities. We found greater racial/ethnic disparities in areas with greater colonoscopist and PCP availability. CONCLUSIONS. : Greater area availability of colonoscopists and PCPs is associated with increased use of colonoscopy in whites but decreased use in minorities, resulting in larger racial/ethnic disparities.
- Boyd, C. A., & Riall, T. S. (2012). Unexpected gynecologic findings during abdominal surgery. Current problems in surgery, 49(4), 195-251.
- Boyd, C. A., Benarroch-Gampel, J., Kilic, G., Kruse, E. J., Weber, S. M., & Riall, T. S. (2012). Pancreatic neoplasms in pregnancy: diagnosis, complications, and management. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(5), 1064-71.More infoNeoplasms of the pancreas during pregnancy are rare, with less than 25 cases of benign and malignant tumors reported in the literature.
- Boyd, C. A., Benarroch-Gampel, J., Sheffield, K. M., Cooksley, C. D., & Riall, T. S. (2012). 415 patients with adenosquamous carcinoma of the pancreas: a population-based analysis of prognosis and survival. The Journal of surgical research, 174(1), 12-9.More infoAdenosquamous carcinoma of the pancreas is rare. Our understanding of the disease and its prognosis comes mainly from small retrospective studies.
- Boyd, C. A., Benarroch-Gampel, J., Sheffield, K. M., Han, Y., Kuo, Y., & Riall, T. S. (2012). The effect of depression on stage at diagnosis, treatment, and survival in pancreatic adenocarcinoma. Surgery, 152(3), 403-13.More infoDepression has been associated with delayed presentation, inadequate treatment, and poor survival in patients with cancer.
- Boyd, C. A., Branch, D. W., Sheffield, K. M., Han, Y., Kuo, Y., Goodwin, J. S., & Riall, T. S. (2012). Hospital and medical care days in pancreatic cancer. Annals of surgical oncology, 19(8), 2435-42.More infoLittle is known about resource utilization (number of days in the hospital or medical care) between diagnosis and death in patients with pancreatic cancer.
- Duncan, C. B., & Riall, T. S. (2012). Evidence-based current surgical practice: calculous gallbladder disease. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(11), 2011-25.More infoGallbladder disease is common and, if managed incorrectly, can lead to high rates of morbidity, mortality, and extraneous costs. The most common complications of gallstones include biliary colic, acute cholecystitis, common bile duct stones, and gallstone pancreatitis. Ultrasound is the initial imaging modality of choice. Additional diagnostic and therapeutic studies including computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are not routinely required but may play a role in specific situations.
- Riall, T. S. (2012). Introduction: personalized medicine in gastrointestinal cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 16(9), 1639-40.
- Riall, T. S., & Benarroch-Gampel, J. (2012). Reply. J Am Coll Surg, 214, 380-381.
- Sheffield, K. M., Crowell, K. T., Lin, Y., Djukom, C., Goodwin, J. S., & Riall, T. S. (2012). Surveillance of pancreatic cancer patients after surgical resection. Annals of surgical oncology, 19(5), 1670-7.More infoThere are no clear recommendations to guide posttreatment surveillance in patients with pancreatic cancer. Our goal was to describe the posttreatment surveillance patterns in patients undergoing curative-intent resection for pancreatic cancer.
- Sheffield, K. M., Han, Y., Kuo, Y., Townsend, C. M., Goodwin, J. S., & Riall, T. S. (2012). Variation in the use of intraoperative cholangiography during cholecystectomy. Journal of the American College of Surgeons, 214(4), 668-79; discussion 679-81.More infoThe role of intraoperative cholangiography (IOC) in prevention of common bile duct (CBD) injuries and the management of CBD stones is controversial, and current variation in use of IOC has not been well described.
- Benarroch-Gampel, J., Boyd, C. A., Sheffield, K. M., Townsend, C. M., & Riall, T. S. (2011). Overuse of CT in patients with complicated gallstone disease. Journal of the American College of Surgeons, 213(4), 524-30.More infoWhen compared with ultrasound, CT scans are more expensive, have substantial radiation exposure and lower sensitivity, specificity, positive, and negative predictive values for patients with gallstone disease.
- Conti, V. R., Riall, T. S., & Sheffield, K. M. (2011). Myocardial enzyme levels and mortality after coronary artery bypass graft surgery. JAMA, 306(1), 39; author reply 40.
- Goodwin, J. S., Singh, A., Reddy, N., Riall, T. S., & Kuo, Y. (2011). Overuse of screening colonoscopy in the Medicare population. Archives of internal medicine, 171(15), 1335-43.More infoAll relevant authorities recommend an interval of 10 years between normal screening colonoscopies. We assessed the timing of repeated colonoscopies after a negative screening colonoscopy finding in a population-based sample of Medicare patients.
- Riall, T. S., Sheffield, K. M., Kuo, Y., Townsend, C. M., & Goodwin, J. S. (2011). Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. Journal of the American Geriatrics Society, 59(4), 647-54.More infoTo evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection.
- Sheffield, K. M., Boyd, C. A., Benarroch-Gampel, J., Kuo, Y., Cooksley, C. D., & Riall, T. S. (2011). End-of-life care in Medicare beneficiaries dying with pancreatic cancer. Cancer, 117(21), 5003-12.More infoThe authors' goal was to characterize hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life.
- Sheffield, K. M., Ramos, K. E., Djukom, C. D., Jimenez, C. J., Mileski, W. J., Kimbrough, T. D., Townsend, C. M., & Riall, T. S. (2011). Implementation of a critical pathway for complicated gallstone disease: translation of population-based data into clinical practice. Journal of the American College of Surgeons, 212(5), 835-43.More infoEvidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies and quality initiative data from our institution demonstrated that only 40% to 75% of patients underwent cholecystectomy on index admission.
- Singh, A., Kuo, Y., Riall, T. S., Raju, G. S., & Goodwin, J. S. (2011). Predictors of colorectal cancer following a negative colonoscopy in the Medicare population. Digestive diseases and sciences, 56(11), 3122-8.More infoThe incidence of colorectal cancer following a normal colonoscopy in the Medicare population is not known.
- Trust, M. D., Sheffield, K. M., Boyd, C. A., Benarroch-Gampel, J., Zhang, D., Townsend, C. M., & Riall, T. S. (2011). Gallstone pancreatitis in older patients: Are we operating enough?. Surgery, 150(3), 515-25.More infoThe recommended therapy for mild gallstone pancreatitis is cholecystectomy on initial hospitalization.
- Zenilman, M. E., Chow, W. B., Ko, C. Y., Ibrahim, A. M., Makary, M. A., Lagoo-Deenadayalan, S., Dardik, A., Boyd, C. A., Riall, T. S., Sosa, J. A., Tummel, E., Gould, L. J., Segev, D. L., & Berger, J. C. (2011). New developments in geriatric surgery. Current problems in surgery, 48(10), 670-754.
- Benarroch-Gampel, J., & Riall, T. S. (2010). Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas. World journal of gastrointestinal surgery, 2(10), 363-7.More infoOver the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms (IPMNs). Additional malignancies have been identified in 10%-52% of patients with IPMNs. The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN. The gastrointestinal tract is most commonly involved in secondary malignancies, with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries. Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms, gastrointestinal stromal tumors, carcinoid tumors, hepatobiliary cancers, breast cancers, prostate cancers, and lung cancers. There is no clear etiology for the development of secondary malignancies in patients with IPMN. Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients, both have reached the same conclusion: there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population. This finding has significant clinical implications for both the initial evaluation and the subsequent long-term follow-up of patients with IPMNs. If a patient has not had recent colonoscopy, this should be performed during the evaluation of a newly diagnosed IPMN. Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease. Routine screening studies (breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.
- Riall, T. S., Townsend, C. M., Kuo, Y., Freeman, J. L., & Goodwin, J. S. (2010). Dissecting racial disparities in the treatment of patients with locoregional pancreatic cancer: a 2-step process. Cancer, 116(4), 930-9.More infoPrevious studies have demonstrated that black patients with pancreatic cancer are less likely to undergo resection and have worse overall survival compared with white patients. The objective of this study was to determine whether these disparities occur at the point of surgical evaluation or after evaluation has taken place.
- Riall, T. S., Zhang, D., Townsend, C. M., Kuo, Y., & Goodwin, J. S. (2010). Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. Journal of the American College of Surgeons, 210(5), 668-77, 677-9.More infoCholecystectomy during initial hospitalization is the current recommended therapy for acute cholecystitis. The rate of cholecystectomy and subsequent health care trajectory in elderly patients with acute cholecystitis has not been evaluated.
- Bowen, K. A., Silva, S. R., Johnson, J. N., Doan, H. Q., Jackson, L. N., Gulhati, P., Qiu, S., Riall, T. S., & Evers, B. M. (2009). An analysis of trends and growth factor receptor expression of GI carcinoid tumors. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 13(10), 1773-80.More infoThe purpose of our study was twofold: (1) to determine the incidence, patient and tumor characteristics, and outcome of patients with gastrointestinal carcinoid tumors using the Surveillance, Epidemiology and End Results (SEER) database, and (2) to delineate the expression pattern of growth factor receptors (GFRs) in carcinoid tumors.
- Nealon, W. H., Bhutani, M., Riall, T. S., Raju, G., Ozkan, O., & Neilan, R. (2009). A unifying concept: pancreatic ductal anatomy both predicts and determines the major complications resulting from pancreatitis. Journal of the American College of Surgeons, 208(5), 790-9; discussion 799-801.More infoPrecepts about acute pancreatitis, necrotizing pancreatitis, and pancreatic fluid collections or pseudocyst rarely include the impact of pancreatic ductal injuries on their natural course and outcomes. We previously examined and established a system to categorize ductal changes. We sought a unifying concept that may predict course and direct therapies in these complex patients.
- Reddy, D. M., Townsend, C. M., Kuo, Y., Freeman, J. L., Goodwin, J. S., & Riall, T. S. (2009). Readmission after pancreatectomy for pancreatic cancer in Medicare patients. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 13(11), 1963-74; discussion 1974-5.More infoThe objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer.
- Fan, X., Kwan, C., Riall, T. S., & Sellin, J. (2008). A gastric ulcer at the anastomosis site perforated into the liver 3 years after Roux-en-Y gastric bypass surgery. Gastrointestinal endoscopy, 68(4), 769; discussion 769.
- Gómez, V., Riall, T. S., & Gómez, G. A. (2008). Outcomes in bariatric surgery in the older patient population in Texas. The Journal of surgical research, 147(2), 270-5.More infoThe prevalence of morbid obesity is still increasing. Whether the safety of bariatric operations can span over a broad range of age groups is uncertain. This study evaluated the outcomes in gastric bypass operations for morbid obesity in Texas from 1999 to 2005 in persons or =55 y of age.
- Qayum, A., Riall, T. S., Srinivasan, R., & Salazar, F. A. (2008). A patient with synovial cell sarcoma primary to the gallbladder and common bile duct. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 12(3), 609-11.
- Riall, T. S., Nealon, W. H., Goodwin, J. S., Townsend, C. M., & Freeman, J. L. (2008). Outcomes following pancreatic resection: variability among high-volume providers. Surgery, 144(2), 133-40.More infoA strong volume-outcome relationship has been demonstrated for pancreatic resection, and regionalization of care to high-volume centers (>11 resections/year) has been recommended. However, it is unclear if volume alone should be the sole criteria for regionalization. The objective of this study is to evaluate variability in outcomes among high-volume hospitals (>11 resections/year).
- Riall, T. S., Reddy, D. M., Nealon, W. H., & Goodwin, J. S. (2008). The effect of age on short-term outcomes after pancreatic resection: a population-based study. Annals of surgery, 248(3), 459-67.More infoTo use a large population-based cohort to determine age-dependent short-term outcomes after pancreatic resection.
- Wisnoski, N. C., Townsend, C. M., Nealon, W. H., Freeman, J. L., & Riall, T. S. (2008). 672 patients with acinar cell carcinoma of the pancreas: a population-based comparison to pancreatic adenocarcinoma. Surgery, 144(2), 141-8.More infoAcinar cell carcinoma (ACC) is a rare cancer of the pancreas accounting for approximately 1% of nonendocrine tumors. Because no large series of patients with ACC exist, our understanding of this disease comes mainly from small retrospective reports and anecdotal experience.
- Hughes, M. A., Frassica, D. A., Yeo, C. J., Riall, T. S., Lillemoe, K. D., Cameron, J. L., Donehower, R. C., Laheru, D. A., Hruban, R. H., & Abrams, R. A. (2007). Adjuvant concurrent chemoradiation for adenocarcinoma of the distal common bile duct. International journal of radiation oncology, biology, physics, 68(1), 178-82.More infoTo examine the effect of adjuvant chemoradiation for adenocarcinoma of the distal common bile duct (DCBD) after pancreaticoduodenectomy (PD) on local control and survival.
- Infante, J. R., Matsubayashi, H., Sato, N., Tonascia, J., Klein, A. P., Riall, T. A., Yeo, C., Iacobuzio-Donahue, C., & Goggins, M. (2007). Peritumoral fibroblast SPARC expression and patient outcome with resectable pancreatic adenocarcinoma. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 25(3), 319-25.More infoSPARC (secreted protein acidic and rich in cysteine) is a protein involved in cell matrix interactions, wound repair, and cell migration, and has been reported to inhibit cancer growth. SPARC undergoes epigenetic silencing in many pancreatic cancers, but stromal fibroblasts adjacent to infiltrating pancreatic adenocarcinomas frequently express SPARC. We evaluated the prognostic significance of tumor and peritumoral SPARC expression in patients with pancreatic adenocarcinoma.
- Larson, S. D., Jackson, L. N., Riall, T. S., Uchida, T., Thomas, R. P., Qiu, S., & Evers, B. M. (2007). Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k/Akt pathway. Journal of the American College of Surgeons, 204(5), 764-73; discussion 773-5.More infoThe link between inflammation and cancer is well-established, but the link between Hashimoto thyroiditis (HT) and thyroid cancer remains controversial. The purpose of our study was to determine the incidence of patients with thyroid cancer and associated HT at our institution, to correlate our patient population demographics with the Surveillance, Epidemiology and End Results (SEER) database, and to assess the expression of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway in patients with HT.
- Riall, T. S., & Lillemoe, K. D. (2007). Underutilization of surgical resection in patients with localized pancreatic cancer. Annals of surgery, 246(2), 181-2.
- Riall, T. S., Eschbach, K. A., Townsend, C. M., Nealon, W. H., Freeman, J. L., & Goodwin, J. S. (2007). Trends and disparities in regionalization of pancreatic resection. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 11(10), 1242-51; discussion 1251-2.More infoThe current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.
- Riall, T. S., Stager, V. M., Nealon, W. H., Townsend, C. M., Kuo, Y., Goodwin, J. S., & Freeman, J. L. (2007). Incidence of additional primary cancers in patients with invasive intraductal papillary mucinous neoplasms and sporadic pancreatic adenocarcinomas. Journal of the American College of Surgeons, 204(5), 803-13; discussion 813-4.More infoRecent small studies have reported an incidence of 23% to 39% for additional primary cancers in patients with intraductal papillary mucinous neoplasms (IPMN) of the pancreas. There have been no population-based studies evaluating this incidence rate.
- Swartz, M. J., Hughes, M. A., Frassica, D. A., Herman, J., Yeo, C. J., Riall, T. S., Lillemoe, K. D., Cameron, J. L., Donehower, R. C., Laheru, D. A., Hruban, R. H., & Abrams, R. A. (2007). Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum. Archives of surgery (Chicago, Ill. : 1960), 142(3), 285-8.More infoAdjuvant chemoradiation improves local control and survival in patients with node-positive duodenal adenocarcinoma treated with pancreaticoduodenectomy.
- Allen, J. G., Riall, T. S., Cameron, J. L., Askin, F. B., Hruban, R. H., & Campbell, K. A. (2006). Abdominal lymphangiomas in adults. Journal of Gastrointestinal Surgery, 10(5), 746-51.More infoAbdominal lymphangiomas are rare benign cystic tumors that can become locally invasive and often require resection. They arise in all ages and have a variable presentation. We performed a retrospective review of a single institution surgical experience with this lesion in adults. The pathology prospective database was reviewed to identify patients with surgically resected abdominal lymphangiomas from January 1986 to May 2004. Retrospective review and follow-up was performed for each patient. The six patients with abdominal lymphangiomas ranged in age from 38 to 66 years. They presented with a variety of signs and symptoms. All underwent CT scan that demonstrated a cystic lesion, but in only one third was the diagnosis made preoperatively. Tumors were located in the retroperitoneum, small bowel mesentery, liver, and pancreas. Five of the six tumors were completely resected. Two of the six required resection of adjacent or involved organs. Follow-up ranged between 6 months and 18 years. All had symptomatic relief after resection, and no patient showed evidence of recurrence in this time period. Abdominal lymphangiomas are rare. The correct diagnosis often remains elusive until tissue is obtained. The treatment of choice is complete surgical resection. When completely resected, these lesions seem not to recur, and the overall prognosis is excellent.
- Cameron, J. L., Riall, T. S., Coleman, J., & Belcher, K. A. (2006). One thousand consecutive pancreaticoduodenectomies. Annals of surgery, 244(1), 10-5.More infoTo trace the evolution of pancreaticoduodenectomy from the decade of the 1960s through the first decade of the new Millenium, through the experience of one surgeon doing 1000 consecutive operations.
- Emick, D. M., Riall, T. S., Cameron, J. L., Winter, J. M., Lillemoe, K. D., Coleman, J., Sauter, P. K., & Yeo, C. J. (2006). Hospital readmission after pancreaticoduodenectomy. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(9), 1243-52; discussion 1252-3.More infoData exist on the morbidity and mortality of patients undergoing pancreaticoduodenectomy (PD), but there are few reports about hospital readmissions after this procedure. Our aim was to evaluate the number of and reasons for readmission after PD and the factors influencing readmission. We reviewed the initial hospitalization and readmissions for 1643 patients undergoing PD compared patients requiring readmission to patients that did not require readmission. Twenty-six percent of patients were readmitted a total of 678 times after PD. Patients readmitted were younger than those not readmitted (61.8 versus 64.6 years, P < 0.0001). Vessel resection, abscess formation, wound infection, postoperative percutaneous biliary stents, estimated blood loss >1000 ml, and age < or =65 years were independently associated with readmission. The length of stay for all patients decreased over time, from 10.5 days in 1996 to 7 days in 2003. The percentage of patients being readmitted also decreased from 33% in 1996 to 20% (P = 0.004) in 2003. The readmission rate after PD was 26%. Younger age, blood loss, postoperative complications, and vessel resection were independent risk factors for readmission. The early hospital readmission rate has not increased in association with a decreased LOS, supporting the idea that reduction in LOS did not lead to increased readmission rates.
- Grelotti, D. J., Riall, T. S., & Williams, C. G. (2006). A palpable, obstructing carcinoma of the colon incarcerated within a large ventral hernia. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(7), 1092-4.More infoUncovering the etiology of a bowel obstruction in a patient with a hernia represents a diagnostic dilemma. Although the hernia is often initially the presumptive cause of the bowel obstruction, obstructive carcinoma or another pathological process hidden by the hernia are important considerations. Here we describe a case of a man with an obstructing neoplasm of the colon within a large ventral hernia, whose constipation was initially attributed to incarceration of the hernia.
- Makary, M. A., Winter, J. M., Cameron, J. L., Campbell, K. A., Chang, D., Cunningham, S. C., Riall, T. S., & Yeo, C. J. (2006). Pancreaticoduodenectomy in the very elderly. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(3), 347-56.More infoIt is estimated that by 2050, there will be a 300% increase in the elderly population (> or =65 years) and a corresponding increase in elderly patients presenting for surgical evaluation. Surgical decision-making in this population can be difficult because outcomes in the elderly are poorly defined. We reviewed 2698 consecutive pancreaticoduodenectomies (PDs) at our institution over a 35-year period (April 1970 through March 2005), with the last 1000 resections being done in the last 4 years. Data collected included surgical indication, mortality (defined as 30-day or in-hospital mortality), complications, and survival. Patients were divided by age into three groups ( or =90 years) and evaluated using multiple logistic regression. Two hundred seven patients > or =80 years old underwent a PD (7.7% of 2698). Patients 80-89 years of age had a mortality rate of 4.1% (8 of 197) and a complication rate of 52.8% (99 of 197), whereas patients < or =79 years of age had a mortality of 1.7% and a complication rate of 41.6% (P < 0.05). There were no perioperative deaths among the 10 patients > or =90 years of age, and their complication rate was 50% (5 of 10). One-year survival for patients 80-89 years of age was 59.1%, and that for patients > or =90 years was 60%. Age was not an independent risk factor for perioperative mortality and morbidity following PD after adjusting for preoperative comorbidities. We demonstrate that PD can be safely performed in patients over 80 years of age and conclude that age alone should not be a contraindication to pancreatic resection. The advent of improved surgical outcomes and an aging population will likely result in a significant increase in the number of PDs performed in the next few decades.
- Moparty, B., Chaya, C. T., Riall, T. S., & Bhutani, M. S. (2006). EUS findings of 2 large enteric submucosal masses in a patient with choledochocele. Gastrointestinal endoscopy, 64(3), 436-7; discussion 437.
- Riall, T. S., Cameron, J. L., Lillemoe, K. D., Winter, J. M., Campbell, K. A., Hruban, R. H., Chang, D., & Yeo, C. J. (2006). Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery, 140(5), 764-72.More infoMany studies have reported 5-year survival data after pancreaticoduodenectomy for periampullary adenocarcinoma. This study evaluates 10-year survival in patients surviving 5 years after initial surgery.
- Riall, T. S., Cameron, J., Lillemoe, K., Campbell, K., Winter, J., Hruban, R., & Yeo, C. (2006). Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10- year follow-up. Surgery, 140(5), 764-72.
- Riall, T. S., Nealon, W. H., Goodwin, J. S., Zhang, D., Kuo, Y., Townsend, C. M., & Freeman, J. L. (2006). Pancreatic cancer in the general population: Improvements in survival over the last decade. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(9), 1212-23; discussion 1223-4.More infoIt is unknown whether the improved survival seen at high-volume centers has been translated to all patients with pancreatic cancer.
- Riall, T. S., Stager, V., Townsend, C., Nealon, W., Kuo, Y., Goodwin, J., & Freeman, J. (2007). Incidence of additional primary cancers in patients with IPMNs and other primary pancreatic neoplasms. Journal of the American College of Surgeons, 204, 803-13.
- Williams, C. G., Haut, E. R., Ouyang, H., Riall, T. S., Makary, M., Efron, D. T., & Cornwell, E. E. (2006). Video-assisted thoracic surgery removal of foreign bodies after penetrating chest trauma. Journal of the American College of Surgeons, 202(5), 848-52.
- Winter, J. M., Cameron, J. L., Campbell, K. A., Arnold, M. A., Chang, D. C., Coleman, J., Hodgin, M. B., Sauter, P. K., Hruban, R. H., Riall, T. S., Schulick, R. D., Choti, M. A., Lillemoe, K. D., & Yeo, C. J. (2006). 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(9), 1199-210; discussion 1210-1.More infoPancreaticoduodenectomy (PD) with the possible addition of neoadjuvant or adjuvant therapy is the standard of care in the United States for adenocarcinoma originating in the pancreatic head, neck, and uncinate process. We reviewed 1423 patients who underwent a PD for a malignancy originating in the pancreas at our institution between 1970 and 2006. We examined 1175 PDs for ductal adenocarcinomas in greater detail. Eighteen different histological types of pancreatic cancer were identified; the most common diagnoses included ductal adenocarcinoma, neuroendocrine carcinoma, and IPMN with invasive cancer. Patients with ductal adenocarcinoma were analyzed in detail. The median age was 66 years, with patients in the present decade significantly older (68 years), on average, than patients in the three prior decades (e.g., 60 years in 1970, P = 0.02). The median tumor diameter was 3 cm; 42% of the resections had positive margins and 78% had positive lymph nodes. The perioperative morbidity was 38%. The median postoperative stay declined over time, from 16 days in the 1980s to 8 days in the 2000s (P < 0.001). The perioperative mortality declined from 30% in the 1970s to 1% in the 2000s (P < 0.001). The median survival for all patients with ductal adenocarcinoma was 18 months (1-year survival = 65 %, 2-year survival = 37%, 5-year survival = 18%). In a Cox proportional hazards model, pathological factors having a significant impact on survival included tumor diameter, resection margin status, lymph node status, and histologic grade. This is the largest single-institution experience with PD for pancreatic cancer. Patients who have cancers with favorable pathological features have a statistically significant improved long-term survival.
- Winter, J. M., Cameron, J. L., Campbell, K. A., Chang, D. C., Riall, T. S., Schulick, R. D., Choti, M. A., Coleman, J., Hodgin, M. B., Sauter, P. K., Sonnenday, C. J., Wolfgang, C. L., Marohn, M. R., & Yeo, C. J. (2006). Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of a prospective randomized trial. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 10(9), 1280-90; discussion 1290.More infoPancreatic duct stenting remains an attractive strategy to reduce the incidence of pancreatic fistulas following pancreaticoduodenectomy (PD) with encouraging results in both retrospective and prospective studies. We performed a prospective randomized trial to test the hypothesis that internal pancreatic duct stenting reduces the development of pancreatic fistulas following PD. Two hundred thirty-eight patients were randomized to either receive a pancreatic stent (S) or no stent (NS), and stratified according to the texture of the pancreatic remnant (soft/normal versus hard). Four patients were excluded from the study; in three instances due to a pancreatic duct that was too small to cannulate and in the other instance because a total pancreatectomy was performed. Patients who randomized to the S group had a 6-cm-long segment of a plastic pediatric feeding tube used to stent the pancreaticojejunostomy anastomosis. In patients with a soft pancreas, 57 randomized to the S group and 56 randomized to the NS group. In patients with a hard pancreas, 58 randomized to the S group and 63 randomized to the NS group. The S and NS groups for the entire study population, as well as for the subgroup of high-risk patients with soft pancreata, were similar as regard to demographics, past medical history, preoperative symptoms, preoperative procedures, and intraoperative data. The pancreatic fistula rate for the entire study population was 9.4%. The fistula rates in the S and NS subgroups with hard pancreata were similar, at 1.7% and 4.8% (P = 0.4), respectively. The fistula rates in the S and NS subgroups with soft pancreata were also similar, at 21.1% and 10.7% (P = 0.1), respectively. A nonstatistically significant increase in the pancreatic fistula rate in the S group persisted after adjusting for the operating surgeon and technical details of the operation (e.g., anastomotic technique, anastomotic orientation, pancreatic duct size, and number of intra-abdominal drains placed). In patients with soft pancreata, 63% percent of the pancreatic fistulas in stented patients required adjustment to the clinical pathway (including two deaths), compared to 47% of the pancreatic fistulas in patients in the NS group (P = 0.3). Internal pancreatic duct stenting does not decrease the frequency or the severity of postoperative pancreatic fistulas.
- Winter, J. M., Cameron, J. L., Lillemoe, K. D., Campbell, K. A., Chang, D., Riall, T. S., Coleman, J., Sauter, P. K., Canto, M., Hruban, R. H., Schulick, R. D., Choti, M. A., & Yeo, C. J. (2006). Periampullary and pancreatic incidentaloma: a single institution's experience with an increasingly common diagnosis. Annals of surgery, 243(5), 673-80; discussion 680-3.More infoWhile incidental masses in certain organs have received particular attention, periampullary and pancreatic incidentalomas (PIs) remain poorly characterized.
- Hustinx, S. R., Fukushima, N., Zahurak, M. L., Riall, T. S., Maitra, A., Brosens, L., Cameron, J. L., Yeo, C. J., Offerhaus, G. J., Hruban, R. H., & Goggins, M. (2005). Expression and prognostic significance of 14-3-3sigma and ERM family protein expression in periampullary neoplasms. Cancer biology & therapy, 4(5), 596-601.More infoAberrant gene expression in pancreatic ductal adenocarcinomas contributes to the dismal outcome of patients who develop this disease. The 5' region of 14-3-3sigma (stratifin) is hypomethylated in pancreatic adenocarcinomas and is associated with gene overexpression. In multiple experimental systems, ezrin (ERM, Radixin, Moesin) has been identified as being important in the metastatic behavior of pancreatic and other cancers. We investigated the prognostic significance of aberrant expression of 14-3-3sigma and the ERM proteins (Ezrin, radixin, Moesin) in a series of invasive periampullary adenocarcinomas including 300 infiltrating pancreatic adenocarcinomas, 54 ampullary adenocarcinomas, and 33 noninvasive intraductal papillary mucinous neoplasms from patients who underwent pancreaticoduodenal resection at The Johns Hopkins Hospital, Baltimore, MD, between 1991 and 2003. Two-hundred fourty-four (82%) primary infiltrating adenocarcinomas of the pancreas demonstrated positive expression of the 14-3-3sigma, 45 (15%) showed weak immunolabelling, and 9 (3%) were negative. 201 (68%) showed positive immunolabeling of the ERM proteins, 75 (25%) demonstrated weak expression and 20 (7%) no expression. A similar proportion of ampullary cancers showed 14-3-3sigma and ERM protein expression. Expression of 14-3-3sigma and ERM protein was more likely in poorly differentiated cancers (p = 0.00005), and their expression was associated with poor survival in univariate analysis (p = 0.09). By multivariate analysis, patients whose cancers expressed 14-3-3sigma, but not ERM tended to have a poorer prognosis (Hazard ratio, 1.4; 0.9-2.2, p = 0.14). Aberrant expression of 14-3-3sigma may contribute to the outcome of patients with pancreatic ductal adenocarcinoma.
- Matsubayashi, H., Skinner, H. G., Iacobuzio-Donahue, C., Abe, T., Sato, N., Riall, T. S., Yeo, C. J., Kern, S. E., & Goggins, M. (2005). Pancreaticobiliary cancers with deficient methylenetetrahydrofolate reductase genotypes. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 3(8), 752-60.More infoMethyl group deficiency might promote carcinogenesis by inducing DNA breaks and DNA hypomethylation. We hypothesized that deficient methylenetetrahydrofolate reductase (MTHFR) genotypes could promote pancreatic cancer development.
- Riall, T. S., Cameron, J. L., Lillemoe, K. D., Campbell, K. A., Sauter, P. K., Coleman, J., Abrams, R. A., Laheru, D., Hruban, R. H., & Yeo, C. J. (2005). Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma--part 3: update on 5-year survival. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 9(9), 1191-204; discussion 1204-6.More infoThe study objective was to update the survival analysis at the 5-year mark of patients undergoing standard versus radical (extended) pancreaticoduodenectomy (PD) for periampullary adenocarcinoma (cancers of the pancreas, ampulla, common bile duct, and duodenum). A prospective randomized trial was performed (April 1996 through June 2001) comparing survival after pylorus-preserving PD resection (standard) to survival after PD with distal gastrectomy and retroperitoneal lymphadenectomy (radical). An interim report (Ann Surg 1999;229:613) and report after closing the trial (Ann Surg 2002;236:355) showed no differences in survival between the standard and radical groups. Two hundred ninety-nine patients were randomized to either the standard or radical group. Five patients were excluded from final analysis because final pathology failed to reveal adenocarcinoma. The 5-year survival of the two groups was evaluated. The median live patient follow-up is now 64 months (5.33 years). For all periampullary cancer patients, those undergoing standard resection had 1- and 5-year survival rates of 78% and 25%, respectively, compared with 76% and 31% (P = 0.57) for those patients in the radical group. For pancreatic adenocarcinoma patients, the 1- and 5-year survival rates in the standard group were 75% and 13%, respectively, compared with 73% and 29% in the radical group (P = 0.13). The increased morbidity rate, longer operative time, and similar survival for radical PD led us to conclude that pylorus-preserving PD without retroperitoneal lymphadenectomy should be the procedure of choice for most patients with resectable periampullary adenocarcinoma. While there is an intriguing trend toward improved survival in patients with pancreatic adenocarcinoma in the radical group, this trend may be largely accounted for by the higher incidence of microscopically margin positive resections in the standard resection group (21%) compared with a 5% incidence in the radical group (P = 0.002).
- Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Sohn, T. A., Campbell, K. A., Sauter, P. K., Coleman, J., Abrams, R. A., & Hruban, R. H. (2005). Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Journal of Gastrointestinal Surgery, 9, 1191-1206.More infoTo evaluate, in a prospective, randomized single-institution trial, the end points of operative morbidity, operative mortality, and survival in patients undergoing standard versus radical (extended) pancreaticoduodenectomy.
- Cunningham, S. C., Ryu, B., Sohn, T. A., & Kern, S. E. (2004). Non-specific enhancement of gene expression by compounds identified in high-throughput cell-based screening. BioTechniques, 37(1), 120-2.
- Lin, J. W., Cameron, J. L., Yeo, C. J., Riall, T. S., & Lillemoe, K. D. (2004). Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 8(8), 951-9.More infoA significant fraction of patients undergoing pancreaticoduodenectomy develop a postoperative pancreaticocutaneous fistula. To identify risk factors for this complication and to delineate its impact on patient outcomes, we conducted a retrospective review of 1891 patients undergoing pancreaticoduodenectomy between 1981 and 2002. Overall, 216 patients (11.4%) developed a postoperative pancreaticocutaneous fistula. In univariate analysis, gender, coronary disease, diabetes mellitus, operative times, blood loss, radical lymphadenectomy, gland texture, and specimen pathology correlated with fistula rates. In a multivariate model, however, only gland texture and coronary disease were statistically predictive. A soft gland was associated with a 22.6% fistula rate, a 20.4-fold increase in fistula risk over those patients with a medium or firm gland (95% confidence interval, 4.7-90.9). No patient with a firm gland developed a fistula. Although 30-day postoperative mortality was not different between those patients with and those without fistula (1.4% versus 1.5%), the mean length of stay was longer (26.0 days versus 13.2 days) and the rates of certain complications were increased in those patients with fistula. In this single-institution experience, pancreaticocutaneous fistula was most strongly predicted by pancreatic texture. Choice of anastomotic technique did not correlate with fistula rates. Pancreaticocutaneous fistula increases postoperative length of stay and morbidity but was not directly associated with increased postoperative mortality.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Hruban, R. H., Fukushima, N., Campbell, K. A., & Lillemoe, K. D. (2004). Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Annals of surgery, 239(6), 788-97; discussion 797-9.More infoTo update the authors' experience with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.
- Abraham, S. C., Wilentz, R. E., Yeo, C. J., Sohn, T. A., Cameron, J. L., Boitnott, J. K., & Hruban, R. H. (2003). Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all 'chronic pancreatitis'?. The American journal of surgical pathology, 27(1), 110-20.More infoPancreaticoduodenectomy (Whipple resection) has evolved into a safe procedure in major high-volume medical centers for the treatment of pancreatic adenocarcinoma and refractory chronic pancreatitis. However, some Whipple resections performed for a clinical suspicion of malignancy reveal only benign disease on pathologic examination. We evaluated the frequency of such Whipple resections without tumor in a large series of pancreaticoduodenectomies and classified the diverse pancreatic and biliary tract diseases present in these specimens. Of 442 Whipple resections performed during 1999-2001, 47 (10.6%) were negative for neoplastic disease and, in 40 cases, had been performed for a clinical suspicion of malignancy. Most Whipple resections revealed benign pancreatic disease, including 8 (17%) alcohol-associated chronic pancreatitis, 4 (8.5%) gallstone-associated pancreatitis, 1 (2.1%) pancreas divisum, 6 (12.8%) "ordinary" chronic pancreatitis of unknown etiology, and 11 (23.4%) lymphoplasmacytic sclerosing pancreatitis. In particular, patients with lymphoplasmacytic sclerosing pancreatitis were all thought to harbor malignancy, whereas only 13 of 19 (68.4%) of Whipple resections showing histologically "ordinary" forms of chronic pancreatitis were performed for a clinical suspicion of malignancy. Benign biliary tract disease, including three cases of primary sclerosing cholangitis, two cases of choledocholithiasis-associated chronic biliary tract disease, and four fibroinflammatory strictures isolated to the intrapancreatic common bile duct, was a common etiology for clinically suspicious Whipple resections (22.5% of cases). Pancreatic intraepithelial neoplasia (PanIN) was a common finding among all pancreata, whether involved by pancreatitis or histologically normal. Overall, PanIN 1A/1B was present in 68.1%, PanIN 2 in 40.4%, and PanIN 3 in just 2.1%. These findings indicate that "benign but clinically suspicious" Whipple resections are relatively common in high-volume centers (9.2%) and reveal a diverse group of clinicopathologically distinctive pancreatic and biliary tract disease.
- Hardacre, J. M., Iacobuzio-Donahue, C. A., Sohn, T. A., Abraham, S. C., Yeo, C. J., Lillemoe, K. D., Choti, M. A., Campbell, K. A., Schulick, R. D., Hruban, R. H., Cameron, J. L., & Leach, S. D. (2003). Results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis. Annals of surgery, 237(6), 853-8; discussion 858-9.More infoTo compare the presentation and short-term results of pancreaticoduodenectomy for lymphoplasmacytic sclerosing pancreatitis (LPSP) and pancreatic adenocarcinoma (PA) and to provide long-term follow-up on patients undergoing resection for LPSP.
- Nguyen, T. C., Sohn, T. A., Cameron, J. L., Lillemoe, K. D., Campbell, K. A., Coleman, J., Sauter, P. K., Abrams, R. A., Hruban, R. H., & Yeo, C. J. (2003). Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. Journal of Gastrointestinal Surgery, 7(1), 1-11.More infoThis study was designed to assess the health-related quality of life (QOL) of patients who had been randomly assigned to either standard or radical pancreaticoduodenectomy for periampullary adenocarcinoma. Pancreaticoduodenectomy has been performed in increasing numbers for periampullary adenocarcinoma. The appropriate extent of resection (standard vs. radical [extended]) remains controversial, particularly as concerns survival benefit. Past reports comparing standard vs. radical resection have suggested that the more extensive resection is attended by negative functional outcomes (diarrhea and weight loss) and poorer QOL, diminishing the impact of any possible survival advantage of the radical resection. A prospective, randomized single-institution trial comparing standard pancreaticoduodenectomy (pylorus preservation preferred) to radical pancreaticoduodenectomy (including distal gastrectomy and retroperitoneal lymphadenectomy) evaluated 299 patients with periampullary adenocarcinoma between April 1996 and June 2001. A standard Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) QOL survey designed for hepatobiliary cancer was sent to 150 of these patients surviving pancreaticoduodenectomy. QOL and functional status were assessed via a series of subscale scores for physical, social, emotional, and functional well-being. A total of 105 QOL surveys (70%) were returned and analyzed, with 55 of the patients having been randomized to the standard group and 50 to the radical group. The patients were evaluated at a mean of 2.2 years after pancreaticoduodenectomy. The two groups were statistically similar with regard to multiple parameters including age at operation (64.6 years), race, intraoperative blood transfusions, pathologic diagnosis and staging, and perioperative complications. The radical group had a significantly higher percentage of men (66% vs. 44%; P = 0.02), a longer operative time (369 minutes vs. 327 minutes; P < 0.001), and a longer postoperative length of hospital stay (13.6 days vs. 10.1 days; P < 0.01). The FACT-Hep total QOL scores were similar between the standard and radical groups: 143.5 vs. 147.3, respectively. Additionally, the individual FACT-G subscale scores evaluating physical (22.1 vs. 23.3), social (24.5 vs. 24.4), emotional (19.2 vs. 19.6), and functional well-being (20.6 vs. 22.4) were comparable between the standard and radical groups. Subgroup analyses based on pathologic diagnosis (pancreatic, ampullary, distal bile duct, etc.) failed to reveal any differences in QOL assessment between the standard and radical pancreaticoduodenectomy groups. Finally, QOL measures were similar when comparing time since operation (65 years). This is the largest report comparing QOL assessment in survivors of pancreaticoduodenectomy randomized between standard and radical resection. These data demonstrate no differences in long-term QOL between standard and radical resection. These results imply that no negative long-term QOL measures are associated with radical pancreaticoduodenectomy (as performed in this study) for periampullary adenocarcinoma.
- Rosty, C., Geradts, J., Sato, N., Wilentz, R. E., Roberts, H., Sohn, T., Cameron, J. L., Yeo, C. J., Hruban, R. H., & Goggins, M. (2003). p16 Inactivation in pancreatic intraepithelial neoplasias (PanINs) arising in patients with chronic pancreatitis. The American journal of surgical pathology, 27(12), 1495-501.More infoPatients with long-standing chronic pancreatitis are thought to be at increased risk of developing pancreatic ductal adenocarcinoma, but the mechanism for this increased risk is unknown. Since increasing evidence supports the notion that infiltrating pancreatic ductal adenocarcinomas arise from pancreatic intraepithelial lesions (PanINs), we sought to determine if patients with chronic pancreatitis harbor PanINs with alterations in tumor suppressor genes that are associated with infiltrating pancreatic ductal adenocarcinoma. We identified 122 patients with a diagnosis of chronic pancreatitis and 29 patients with a well-differentiated pancreatic endocrine tumor that underwent pancreatic surgery at the Johns Hopkins Hospital from 1985 to 1999. PanINs from each resection specimen were identified, graded, counted, and correlated with smoking and alcohol history. The expression patterns of p16 and Smad4 were determined in a subset of PanINs by immunohistochemistry, and the pattern of labeling compared with that seen in PanINs associated with infiltrating adenocarcinoma of the pancreas as identified in prior studies, and to PanINs associated with pancreatic endocrine tumor. Duct lesions were present in 80 of the 122 pancreata with chronic pancreatitis (66%). Of 405 duct lesions identified in the chronic pancreatitis group, 7.6% were reactive changes, 65.5% were PanIN-1A, 18% were PanIN-1B, 7.4% were PanIN-2, and 1.5% were PanIN-3. Within the pancreatic endocrine tumor group, 22 PanINs were identified: 15 PanIN-1A, 4 PanIN-1B, and 3 PanIN-2. There were significantly fewer high-grade PanINs in the pancreata with chronic pancreatitis than in pancreata with pancreatic adenocarcinoma (P < 0.0001). Within the chronic pancreatitis group, the 80 patients with PanINs were significantly older than the 42 patients without PanINs (mean age 57.0 +/- 14.1 years vs. 50.9 +/- 14.7 years, P = 0.01). Smoking history was not associated with PanIN prevalence or grade, but patients who reported a history of excessive alcohol consumption had fewer PanINs (25 of 44 harbored PanINs, 57%) than those who did not (54 of 74, 73%, P = 0.07). In the chronic pancreatitis group, 0% of PanIN-1A, 11% of the PanIN-1B, 16% of the PanIN-2, and 40% of the PanIN-3 lesions showed loss of p16 expression, whereas all of the PanINs from patients with an pancreatic endocrine tumor retained p16 expression. All of the PanINs analyzed from patients with chronic pancreatitis retained normal Smad4 expression. We conclude that a significant minority of PanINs arising in patients with chronic pancreatitis show loss of p16 expression. This alteration, common to pancreatic cancer-associated PanINs, may contribute to the predisposition of patients with chronic pancreatitis to develop pancreatic ductal adenocarcinoma.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Geschwind, J. F., Mitchell, S. E., Venbrux, A. C., & Lillemoe, K. D. (2003). Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications. Journal of Gastrointestinal Surgery, 7(2), 209-19.More infoAlthough the mortality rate after pancreaticoduodenectomy has decreased, the morbidity rate remains high. Major morbidity is often managed with the aid of interventional radiologists. The objective of this study was to evaluate the cooperative roles of interventional radiologists and pancreatic surgeons in complex pancreatic surgery, specifically pancreaticoduodenectomy. Our pancreaticoduodenectomy database was reviewed for all patients undergoing pancreaticoduodenectomy between January 1, 1995 and December 31, 2000. The interventional radiologic procedures for each patient were evaluated. A total of 1061 patients underwent pancreaticoduodenectomy. The overall mortality and morbidity rates were 2.3% and 35%, respectively. Five hundred ninety patients (56%) had no interventional radiologic procedures, whereas 471 patients (44%) had interventional radiologic procedures. Of those, 342 (32%) had preoperative biliary drainage (PBD) and 129 (12%) required postoperative interventional radiologic procedures. Percutaneous aspiration/catheter drainage was required in 84 patients for intra-abdominal abscess, biloma, or lymphocele, with 24 requiring two or more abscess drains. Thirty-nine patients underwent postoperative PBD for bile leaks due to anastomotic disruption, undrained biliary segments, or T-tube/bile stent dislodgment. Eighteen patients had hemobilia/gastrointestinal bleeding treated by angiography with embolization. The reoperation rate for the entire cohort of 1061 patients was 4.1% (n = 43). Nineteen of the 129 patients (15%) requiring postoperative radiologic intervention required reoperation. Although 4 of 18 patients who required embolization for bleeding subsequently required surgical intervention for the same reason, only 4 of 84 patients undergoing abscess drainage later required operation for anastomotic disruption or unsuccessful percutaneous drainage. As would be expected, the patients who required postoperative radiologic intervention (n = 129) had a higher incidence of postoperative complications including pancreatic fistula (20% vs. 6%, P < 0.01), bile leakage (22% vs. 1%, P < 0.01), and wound infection (16% vs. 8%, P < 0.01). With the complications in these 129 patients, the postoperative mortality rate was only 6.2% compared to 1.7% in patients who did not require radiologic intervention (n = 932, P < 0.01). The median postoperative length of stay was 15 days in those patients requiring postoperative radiologic intervention, 10 days in those not requiring intervention (P < 0.01; postoperative interventional radiology vs. no postoperative interventional radiology), and 29.5 days for patients needing reoperation. Interventional radiologists play a critical role in the management of some patients undergoing pancreaticoduodenectomy. Although complications such as anastomotic leaks, abscess formation, and bleeding can result in increased mortality and a longer hospital stay, the skills of the interventional radiology team provide expert management of some life-threatening complications, thus avoiding reoperation, speeding recovery times, and minimizing morbidity.
- Barreiro, C. J., Lillemoe, K. D., Koniaris, L. G., Sohn, T. A., Yeo, C. J., Coleman, J., Fishman, E. K., & Cameron, J. L. (2002). Diagnostic laparoscopy for periampullary and pancreatic cancer: what is the true benefit?. Journal of Gastrointestinal Surgery, 6(1), 75-81.More infoThe role of diagnostic laparoscopy in patients with periampullary and pancreatic malignancies is controversial. A retrospective review was performed including all patients (n = 188) with a periampullary or pancreatic malignancy who underwent both CT and laparotomy at our institution between January 1997 and December 1999. The overall resectability rate for all periampullary cancers was 67.3% (115 of 171 patients). This compared favorably with the resectability rate for cancers of the pancreatic body and tail (3 of 17 patients, 17.6%; P < 0.01 vs. periampullary cancers). Fifty percent of patients with periampullary cancers were unresectable because of metastatic disease, whereas metastatic disease precluded resection in 64.3% of patients with cancers of the pancreatic body and tail. After patients undergoing operative palliation were eliminated, a nontherapeutic laparotomy would have been precluded by the use of diagnostic laparoscopy in only 2.3% of patients with periampullary cancers (4 of 171 patients). In contrast, 6 (35.3%) of 17 patients with cancers of the pancreatic body and tail underwent a nontherapeutic laparotomy (P < 0.01 vs. periampullary cancers). One hundred fifty-eight (84%) of the 188 CT reports reviewed could be definitively categorized as either "likely to be resectable" or "likely to be unresectable." The remaining 16% were equivocal. Of the 107 patients categorized as likely to be resectable, 89 were actually resected (83.2%). In contrast, only 10 of the 51 patients categorized as likely to be unresectable could be resected (19.6%).
- Maitra, A., Ashfaq, R., Gunn, C. R., Rahman, A., Yeo, C. J., Sohn, T. A., Cameron, J. L., Hruban, R. H., & Wilentz, R. E. (2002). Cyclooxygenase 2 expression in pancreatic adenocarcinoma and pancreatic intraepithelial neoplasia: an immunohistochemical analysis with automated cellular imaging. American journal of clinical pathology, 118(2), 194-201.More infoWe immunohistochemically examined material from 36 pancreata (adenocarcinomas, 30 lesions; pancreatic intraepithelial neoplasia [PanIN], 65; normal pancreatic ducts, 30) for cyclooxygenase 2 (COX-2) with an automated platform. We analyzed 7 to 10 discrete foci and generated an average percentage of positive cells and average staining intensity for each lesion. These 2 values were then multiplied to create an overall "HistoScore" for each lesion. COX-2 demonstrated considerable heterogeneity of expression between and within cases. The overall average percentage of positive cells in adenocarcinomas was 47.3%; in PanINs, 36.3%; and in normal ducts, 19.2%. COX-2 was expressed in more than 20% of cells in 23 adenocarcinomas (77%), 42 PanINs (65%), and 12 normal ducts (40%). The overall average HistoScore for adenocarcinomas was 6.1; for PanINs, 5.4; and for normal ducts, 3.5. Significant differences in COX-2 expression were demonstrable in adenocarcinomas vs normal ducts, PanINs vs normal ducts, and PanIN 2/3 vs PanIN 1a/1b. In general, the pattern of COX-2 expression increased from normal to PanIN to adenocarcinoma. The up-regulation of COX-2 in a subset of noninvasive precursor lesions makes it a potential target for chemoprevention with selective COX-2 inhibitors.
- Maitra, A., Iacobuzio-Donahue, C., Rahman, A., Sohn, T. A., Argani, P., Meyer, R., Yeo, C. J., Cameron, J. L., Goggins, M., Kern, S. E., Ashfaq, R., Hruban, R. H., & Wilentz, R. E. (2002). Immunohistochemical validation of a novel epithelial and a novel stromal marker of pancreatic ductal adenocarcinoma identified by global expression microarrays: sea urchin fascin homolog and heat shock protein 47. American journal of clinical pathology, 118(1), 52-9.More infoWe extended the results of a previous microarray analysis by immunohistochemical validation of differential protein expression in a series of 57 surgically resected infiltrating ductal pancreatic adenocarcinomas. Two representative genes were examined: sea urchin fascin homolog (overexpressed in both cell lines and primary tumors) and heat shock protein 47 (HSP47; overexpressed in primary tumors only). Protein expression also was evaluated in the precursor lesions of pancreatic cancer pancreatic intraepithelial neoplasia (PanIN), and normal ductal epithelium. Fascin expression was seen in the neoplastic cells of 54 (95%) of 57 ductal adenocarcinomas but not in 49 (94%) of 52 adjacent nonneoplastic epithelium. In the multistep pathogenesis of ductal adenocarcinomas, fascin expression seemed to be a late event, usually present in PanINs 2 and 3. HSP47 expression was almost universal and most intense in the ductal adenocarcinoma-associated stromal desmoplasia (57/57), although 37 cases (65%) also expressed HSP47 in the neoplastic epithelium. HSP47 expression was absent in the majority of nonneoplastic pancreata (46 [88%]). Fascin and HSP47 are novel tumor markers with potential diagnostic and therapeutic implications for pancreatic carcinoma. These results establish the usefulness of global expression platforms to identify novel tumor markers.
- Seidel, G., Zahurak, M., Iacobuzio-Donahue, C., Sohn, T. A., Adsay, N. V., Yeo, C. J., Lillemoe, K. D., Cameron, J. L., Hruban, R. H., & Wilentz, R. E. (2002). Almost all infiltrating colloid carcinomas of the pancreas and periampullary region arise from in situ papillary neoplasms: a study of 39 cases. The American journal of surgical pathology, 26(1), 56-63.More infoColloid carcinomas of organs such as the breast, colon, and prostate have been well characterized. However, up until now there have been only a few studies of colloid carcinomas of the pancreas and periampullary region, and the number of colloid carcinomas in these studies has been limited. A search of our files revealed 39 resections for pancreatic and periampullary carcinomas with colloid differentiation. All neoplasms were extensively sampled. "Carcinomas with colloid differentiation" were defined as tumors associated with abundant extracellular mucin containing free-floating mucinous epithelial cells. Cases with >50% colloid differentiation were classified as "colloid carcinomas," whereas those with less were termed "carcinomas with focal colloid features." Cases with no colloid differentiation at all were designated "carcinomas without colloid differentiation." Of the 39 carcinomas, 31 were colloid carcinomas, and eight were carcinomas with focal colloid features. Twenty-seven were centered in the pancreas, seven were in the duodenum, and five were in the ampulla of Vater. Remarkably, 38 of the 39 carcinomas (97%) arose in association with an intraductal papillary mucinous neoplasm or a tubular/tubulovillous adenoma. Of the patients with colloid carcinomas, the 2-and 5-year actuarial survival rates were 69% and 29%, respectively. There was no significant difference in survival rates between patients with colloid carcinomas and patients with adenocarcinomas without colloid differentiation, whether or not the latter arose in association with intraductal papillary mucinous neoplasms or tubular/tubulovillous adenomas. In a multivariate model colloid differentiation was not an independent predictor of patient survival, while other factors such as tumor location, perineural invasion, vascular invasion, and margin status after resection independently influenced patient survival. Most colloid carcinomas of the pancreas and periampullary region arise in association with a well-defined in situ papillary neoplasm. The diagnosis of a pancreatic or periampullary colloid carcinoma should encourage the pathologist to search for an associated low-grade in situ component. In addition, colloid carcinomas of the pancreas and periampullary region do not necessarily have a better prognosis than carcinomas without colloid differentiation. Instead, other factors such as tumor location, perineural invasion, vascular invasion, and margin status after resection are far more important.
- Sohn, T. A. (2002). The molecular genetics of pancreatic ductal carcinoma. Minerva chirurgica, 57(5), 561-74.More infoPancreatic ductal carcinoma remains the 4th leading cause of cancer death in both men and women in the United States, with an overall 5-year survival of less than 3%. Over the last decade, significant advances have been made in our understanding of the molecular biology of pancreatic ductal carcinoma, with pancreatic cancer now considered one of the better characterized neoplasms at the genetic level. The advances in the understanding of the molecular genetics of pancreatic cancer initially focused on events that occur in the development and early genetic progression of the disease. This progression has been associated with the accumulation of multiple genetic alterations in various cancer-causing genes, leading to the development of a histological and genetic progression model. In the model, pancreatic cancer develops from non-invasive intraepithelial precursor lesions termed pancreatic intraepithelial neoplasias, with each progressive stage associated with accumulated mutations in oncogenes, tumor-suppressor genes, and mismatch repair genes. Other aspects of the development of pancreatic ductal carcinoma, such as tumor invasion, tumor-stromal interaction, metastasis, and chemotherapeutic resistance are more poorly understood. Recent studies utilizing global gene expression methodologies have provided insight into some of these processes and have allowed for the development of potential tumor markers which could be used for early detection and diagnosis of this difficult disease. In order to improve the survival of patients with pancreatic carcinoma, we need to better understand the fundamental changes that occur in pancreatic ductal carcinoma. The following article reviews the genetic mutations and syndromes known to be associated with pancreatic ductal carcinoma as well as recent advances in the study of global gene expression.
- Sohn, T. A., Bansal, R., Su, G. H., Murphy, K. M., & Kern, S. E. (2002). High-throughput measurement of the Tp53 response to anticancer drugs and random compounds using a stably integrated Tp53-responsive luciferase reporter. Carcinogenesis, 23(6), 949-57.More infoHuman Tp53 is normally a short-lived protein. Tp53 protein is stabilized and levels are increased in response to a variety of cellular stresses, including those induced by genotoxic anticancer drugs and environmental exposures. To engineer an efficient assay based on this property, we constructed and integrated a Tp53-specific reporter system into human cancer cells, termed p53R cells. We tested a range of conventional chemotherapeutic agents as well as over 16 000 diverse small compounds. Ionizing radiation and two-thirds of conventional chemotherapeutic agents, but only 0.2% of diverse compounds activated Tp53 activity by two-fold or greater, consistent with the presumptive genotoxic activation of Tp53 function. Cytotoxicity was independent of TP53 genetic status when paired, syngeneic wild-type TP53 and TP53-null cells in culture were treated with compounds that activated Tp53. From the unbiased survey of random compounds, Tp53 activation was strongly induced by an analog of AMSA, an investigational anti-cancer agent. Tp53 was also strongly induced by an N-oxide of quinoline and by dabequine, an experimental antimalarial evaluated in humans; dabequine was reported to be negative in other screens of mutagenicity and clastogenicity but carcinogenic in animal studies. Further exploration of antimalarial compounds identified the common medicinals chloroquine, quinacrine, and amodiaquine as Tp53-inducers. Flavonoids are known to have DNA topoisomerase activity, a Tp53-inducing activity that is confirmed in the assay. A reported clinical association of Tp53 immunopositive colorectal cancers with use of the antihypertensive agents was extended by the demonstration of hydralazine and nifedipine as Tp53-inducers. p53R cells represent an efficient Tp53 functional assay to identify chemicals and other agents with interesting biologic properties, including genotoxicity. This assay may have utility in the identification of novel chemotherapeutic agents, as an adjunct in the pharmaceutical optimization of lead compounds, in the exploration of environmental exposures, and in chemical probing of the Tp53 pathway.
- Yeo, T. P., Hruban, R. H., Leach, S. D., Wilentz, R. E., Sohn, T. A., Kern, S. E., Iacobuzio-Donahue, C. A., Maitra, A., Goggins, M., Canto, M. I., Abrams, R. A., Laheru, D., Jaffee, E. M., Hidalgo, M., & Yeo, C. J. (2002). Pancreatic cancer. Current Problems in Cancer, 26(4), 176-275.
- Argani, P., Shaukat, A., Kaushal, M., Wilentz, R. E., Su, G. H., Sohn, T. A., Yeo, C. J., Cameron, J. L., Kern, S. E., & Hruban, R. H. (2001). Differing rates of loss of DPC4 expression and of p53 overexpression among carcinomas of the proximal and distal bile ducts. Cancer, 91(7), 1332-41.More infoBiliary tract carcinomas are clinically heterogeneous. It is not known if molecular heterogeneity underlies the clinical differences.
- Ryu, B., Song, J., Sohn, T., Hruban, R. H., & Kern, S. E. (2001). Frequent germline deletion polymorphism of chromosomal region 8p12-p21 identified as a recurrent homozygous deletion in human tumors. Genomics, 72(1), 108-12.More infoA number of carcinomas show high frequency of loss of heterozygosity (LOH) at chromosome 8p, suggesting that putative tumor suppressor genes are present in this region. While searching for homozygous deletions in a panel of pancreatic and biliary tumors, we discovered a homozygous deletion at the microsatellite AFMa224wh5 in chromosome region 8p12-p21. We applied a six-step algorithm comprising germline analysis, breakpoint sequencing, population screening, online gene mapping, allelic discrimination of tumor-associated LOH, and family history analysis. The results indicated that the deletion was likely due to a normal 102-bp deletion polymorphism present in nearly 10% of the study population, not likely to involve a recessive cancer-associated gene. Researchers need to be aware that germline insertion/deletion polymorphisms can affect the results of positional cloning efforts in human neoplasms. This problem would be accentuated in studies of cell lines where a paired sample of constitutional DNA is often unavailable.
- Sohn, T. A., Su, G. H., Ryu, B., Yeo, C. J., & Kern, S. E. (2001). High-throughput drug screening of the DPC4 tumor-suppressor pathway in human pancreatic cancer cells. Annals of Surgery, 233(5), 696-703.More infoTo screen a library of small chemicals for compounds that activate the DPC4 signal transduction pathway in a human pancreatic cancer cell line.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Iacobuzio-Donahue, C. A., Hruban, R. H., & Lillemoe, K. D. (2001). Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Annals of surgery, 234(3), 313-21; discussion 321-2.More infoTo assess the authors' experience with intraductal papillary mucinous neoplasms of the pancreas (IPMNs).
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Nakeeb, A., & Lillemoe, K. D. (2001). Renal cell carcinoma metastatic to the pancreas: results of surgical management. Journal of Gastrointestinal Surgery, 5(4), 346-51.More infoMetastatic tumors to the pancreas are uncommon. Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas. The purpose of the current report is to evaluate the surgical management and long-term outcome of patients with metastatic renal cell carcinoma. A retrospective review of patients undergoing pancreatic resection for renal cell carcinomas metastatic to the pancreas or periampullary region between April 1989 and May 1999, inclusive, was performed. Time from initial presentation, other metastatic sites, surgical outcomes, and long-term survival were evaluated. During the 10-year time period, 10 patients underwent pancreatic resection for renal cell carcinoma metastases. Of those, six underwent pancreaticoduodenectomy and two underwent distal pancreatectomy, whereas the two remaining patients underwent total pancreatectomy for extensive tumor involvement throughout the entire gland. The mean time from nephrectomy for resection of the primary tumor to reoperation for periampullary recurrence was 9.8 years (median 8.5 years). The range was 0 to 28 years, with one patient presenting with a synchronous metastasis. The mean age of the patients was 61.2 years with 60% of patients being male and 90% being white. Pathologic findings included histologically negative lymph nodes and negative surgical margins in all patients. One patient had tumor involving the retroperitoneal soft tissue, but final margins were negative. The mean live patient follow-up was 30 months (median = 15 months), with eight patients remaining alive. The Kaplan-Meier actuarial 5-year survival was 75%, with the longest survivor still alive 117 months following resection. The patient with retroperitoneal soft tissue involvement died 4 months after resection. The pancreas is an uncommon site of metastasis for renal cell carcinoma, typically occurring years after treatment of the primary tumor. When the metastatic focus is isolated and the tumor can be resected in its entirety, patients can experience excellent 5-year survival rates. The current report suggests that pancreatic metastases from renal cell carcinoma should be managed aggressively with complete resection when possible.
- Tascilar, M., Offerhaus, G. J., Altink, R., Argani, P., Sohn, T. A., Yeo, C. J., Cameron, J. L., Goggins, M., Hruban, R. H., & Wilentz, R. E. (2001). Immunohistochemical labeling for the Dpc4 gene product is a specific marker for adenocarcinoma in biopsy specimens of the pancreas and bile duct. American journal of clinical pathology, 116(6), 831-7.More infoWe immunohistochemically labeled 72 biopsy specimens from the extrahepatic biliary tree and pancreas for Dpc4 protein and correlated expression with histologic diagnosis and patient follow-up. Specimens were classified histologically as follows: nonneoplastic, 35; neoplastic, 22; atypical, 15. Loss of expression of Dpc4 protein was identified in 12 specimens; 11 were histologically diagnostic of carcinoma. The 12th specimen was from a patient whose biopsy specimen initially was diagnosed as "atypical," but clinical follow-up revealed adenocarcinoma. Of the 12 atypical biopsy specimens with intact expression for Dpc4, follow-up later revealed that 10 were adenocarcinoma. Loss of expression of Dpc4 protein was never identified in a benign specimen. Immunohistochemical labeling for the Dpc4 gene product is a specific marker of carcinoma in biopsy specimens of the pancreas and extrahepatic bile ducts and is marginally helpful in classifying atypical specimens. The sensitivity for carcinoma is low. This latter finding is not unexpected, because the DPC4 tumor suppressor gene is inactivated in only about half of pancreatic and biliary malignant neoplasms. Importantly, loss of Dpc4 expression has been reported in in situ carcinomas, suggesting that loss of expression should not be equated with invasive carcinoma.
- Tascilar, M., Skinner, H. G., Rosty, C., Sohn, T., Wilentz, R. E., Offerhaus, G. J., Adsay, V., Abrams, R. A., Cameron, J. L., Kern, S. E., Yeo, C. J., Hruban, R. H., & Goggins, M. (2001). The SMAD4 protein and prognosis of pancreatic ductal adenocarcinoma. Clinical cancer research : an official journal of the American Association for Cancer Research, 7(12), 4115-21.More infoSMAD4 (also called Dpc4) is a tumor suppressor in the TGF-beta signaling pathway that is genetically inactivated in approximately 55% of all pancreatic adenocarcinomas. We investigated whether prognosis after surgical resection for invasive pancreatic adenocarcinoma is influenced by SMAD4 status.
- Udelsman, R., Westra, W. H., Donovan, P. I., Sohn, T. A., & Cameron, J. L. (2001). Randomized prospective evaluation of frozen-section analysis for follicular neoplasms of the thyroid. Annals of surgery, 233, 716-22.More infoTo evaluate the clinical utility of frozen section in patients with follicular neoplasms of the thyroid in a randomized prospective trial.
- Huang, J. J., Yeo, C. J., Sohn, T. A., Lillemoe, K. D., Sauter, P. K., Coleman, J., Hruban, R. H., & Cameron, J. L. (2000). Quality of life and outcomes after pancreaticoduodenectomy. Annals of surgery, 231(6), 890-8.More infoTo assess the quality of life (QOL) and functional outcome of patients after pancreaticoduodenectomy.
- Iacobuzio-Donahue, C. A., Klimstra, D. S., Adsay, N. V., Wilentz, R. E., Argani, P., Sohn, T. A., Yeo, C. J., Cameron, J. L., Kern, S. E., & Hruban, R. H. (2000). Dpc-4 protein is expressed in virtually all human intraductal papillary mucinous neoplasms of the pancreas: comparison with conventional ductal adenocarcinomas. The American journal of pathology, 157(3), 755-61.More infoDPC4 (MADH4, SMAD4) encodes a nuclear transcription factor shown to be genetically inactivated in over one-half of conventional infiltrating ductal adenocarcinomas of the pancreas. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been suggested to be distinct neoplasms with a significantly less aggressive course than conventional ductal adenocarcinomas of the pancreas, but molecular comparisons of these tumor types have previously been impaired by technical difficulties. Recently, immunohistochemical labeling for the DPC4 gene product has been shown to be an extremely sensitive and specific marker for DPC4 gene alterations in pancreatic adenocarcinomas. Therefore, we analyzed the immunohistochemical expression of Dpc4 protein in 79 IPMNs using a previously characterized monoclonal antibody. Twenty-nine of the IPMNs also had an associated infiltrating adenocarcinoma available for analysis. The labeling patterns observed were compared to those we have previously reported for conventional ductal carcinomas. All 79 of the intraductal components of the IPMNs strongly expressed Dpc4 protein. In 77 of the 79 cases (97%), the labeling was diffusely positive, and in 2 of the 79 (3%) the labeling was focally positive. Dpc4 expression was seen in 28 (97%) of the associated 29 invasive cancers. The one infiltrating carcinoma that showed loss of Dpc4 expression was associated with an intraductal component which showed focal loss of Dpc4 expression. The strong and almost universal expression of Dpc4 in IPMNs contrasts sharply with the loss of Dpc4 expression seen in approximately 30% of in situ adenocarcinomas of the pancreas (so-called pancreatic intraepithelial neoplasms, grade 3; P: < 0.001) and in 55% of pancreatic duct carcinomas (P: < 0.0001). Differences in Dpc4 expression between IPMNs and ductal carcinomas suggest a fundamental genetic difference in tumorigenesis, which may relate to the significantly better clinical outcomes observed for IPMNs.
- Sohn, T. A., & Lillemoe, K. D. (2000). Surgical palliation of pancreatic cancer. Advances in surgery, 34, 249-71.
- Sohn, T. A., & Yeo, C. J. (2000). The molecular genetics of pancreatic ductal carcinoma: a review. Surgical Oncology, 9(3), 95-101.More infoIn the last several years, numerous advances in the field of molecular genetics have been applied to pancreatic ductal carcinoma- the 5th leading cause of cancer death in the United States. This review summaries the current knowledge about adenocarcinoma of the pancreas.
- Sohn, T. A., Campbell, K. A., Pitt, H. A., Sauter, P. K., Coleman, J. A., Lillemo, K. D., Yeo, C. J., & Cameron, J. L. (2000). Quality of life and long-term survival after surgery for chronic pancreatitis. Journal of Gastrointestinal Surgery, 4(4), 355-64; discussion 364-5.More infoThe objective of this study was to evaluate the short-term and long-term outcome as well as quality of life in patients undergoing surgical management of chronic pancreatitis. Between January 1980 and December 1996, a total of 255 patients underwent surgery for chronic pancreatitis at The Johns Hopkins Hospital. The etiology of the disease, indications for surgery, patient characteristics, and long-term survival were analyzed. A visual analog quality-of-life questionnaire containing 23 items graded on a scale of 0 to 10 (0 = worst and 10 = best) was sent to patients postoperatively. Visual analog responses relating to before and after the chronic pancreatitis surgery were compared using a paired t test. During the17-year review period, 263 operations were performed for chronic pancreatitis in 255 patients. The most common presenting symptoms were abdominal pain (88%), weight loss (36%), nausea/vomiting (30%), jaundice (14%), and diarrhea (12%). The cause of the pancreatitis was resumed to be alcohol in 43%, idiopathic in 38%, pancreas divisum in 5%, ampullary abnormality in 4%, and gallstones in 3%. Pancreaticoduodenectomy was the most common procedure in 96 patients (37%), followed by distal pancreatectomy in 67 (25%), Puestow procedure in 52 (19%), sphincteroplasty in 37 (14%), and Duval procedure in five (2%). The overall mortality and morbidity rates were 1.9% and 35%, respectively. Two hundred twenty-seven (89%) of the 255 patients were alive at last follow-up. For the entire cohort of patients, the 5- and 10-year actuarial survivals were 88% and 82%, respectively. One hundred six (47%) of the 227 living patients responded to the visual analog quality-of-life questionnaire. Patients reported improvements in all aspects of the quality-of-life survey including enjoyment out of life, satisfaction with life, pain, number of hospitalizations, feelings of usefulness, and overall health (P < 0.005). In addition to improved quality of life after surgery, narcotic use was decreased (41% vs. 21%, P < 0.01) and alcohol use was decreased (59% vs. 33%, P < 0.001). However, patients often became insulin-dependent diabetics (12% vs. 41%, P < 0.0001) and required pancreatic enzyme supplementation (34% vs. 55%, P < 0.01) after surgical intervention. These data suggest that surgery for patients with chronic pancreatitis can be performed safely with minimal morbidity and excellent long-term survival. Moreover, this study evaluates quality of life in a standardized analog fashion, with highly significant improvement reported in all quality-of-life measures. We conclude that surgery remains an excellent option for patients with chronic pancreatitis.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Koniaris, L., Kaushal, S., Abrams, R. A., Sauter, P. K., Coleman, J., Hruban, R. H., & Lillemoe, K. D. (2000). Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. Journal of Gastrointestinal Surgery, 4(6), 567-79.More infoThis large-volume, single-institution review examines factors influencing long-term survival after resection in patients with adenocarcinoma of the head, neck, uncinate process, body, or tail of the pancreas. Between January 1984 and July 1999 inclusive, 616 patients with adenocarcinoma of the pancreas underwent surgical resection. A retrospective analysis of a prospectively collected database was performed. Both univariate and multivariate models were used to determine the factors influencing survival. Of the 616 patients, 526 (85%) underwent pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas, 52 (9%) underwent distal pancreatectomy for adenocarcinoma of the body or tail, and 38 (6%) underwent total pancreatectomy for adenocarcinoma extensively involving the gland. The mean age of the patients was 64.3 years, with 54% being male and 91% being white. The overall perioperative mortality rate was 2.3%, whereas the incidence of postoperative complications was 30%. The median postoperative length of stay was 11 days. The mean tumor diameter was 3.2 cm, with 72% of patients having positive lymph nodes, 30% having positive resection margins, and 36% having poorly differentiated tumors. Patients undergoing distal pancreatectomy for left-sided lesions had larger tumors (4.7 vs. 3.1 cm, P < 0.0001), but fewer node-positive resections (59% vs. 73%, P = 0.03) and fewer poorly differentiated tumors (29% vs. 36%, P < 0.001), as compared to those undergoing pancreaticoduodenectomy for right-sided lesions. The overall survival of the entire cohort was 63% at 1 year and 17% at 5 years, with a median survival of 17 months. For right-sided lesions the 1- and 5-year survival rates were 64% and 17%, respectively, compared to 50% and 15% for left-sided lesions. Factors shown to have favorable independent prognostic significance by multivariate analysis were negative resection margins (hazard ratio [HR] = 0.64, confidence interval [CI] = 0.50 to 0.82, P = 0.0004), tumor diameter less than 3 cm (HR = 0.72, CI = 0.57 to 0.90, P = 0.004), estimated blood loss less than 750 ml (HR = 0.75, CI = 0.58 to 0.96, P = 0.02), well/moderate tumor differentiation (HR = 0.71, CI = 0.56 to 0.90, P = 0.005), and postoperative chemoradiation (HR = 0.50, CI = 0.39 to 0.64, P < 0.0001). Tumor location in head, neck, or uncinate process approached significance in the final multivariate model (HR = 0.60, CI = 0.35 to 1.0, P = 0.06). Pancreatic resection remains the only hope for long-term survival in patients with adenocarcinoma of the pancreas. Completeness of resection and tumor characteristics including tumor size and degree of differentiation are important independent prognostic indicators. Adjuvant chemoradiation is a strong predictor of outcome and likely decreases the independent significance of tumor location and nodal status.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Pitt, H. A., & Lillemoe, K. D. (2000). Do preoperative biliary stents increase postpancreaticoduodenectomy complications?. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 4(3), 258-67; discussion 267-8.More infoIt has been suggested that the placement of endoscopic or percutaneous biliary stents prior to pancreaticoduodenectomy increases postoperative morbidity. A retrospective review of a prospectively collected database was performed. Patients undergoing preoperative biliary stenting were compared with patients who did not undergo stenting. In addition, outcomes after endoscopic and percutaneous stenting were compared. Patients who had undergone operative biliary bypass prior to pancreaticoduodenectomy were excluded from the analysis. Between January 1994 and December 1997, 567 patients underwent pancreaticoduodenectomy without prior operative biliary bypass. Preoperative biliary stenting was performed in 408 patients (72%), whereas the remaining 159 patients (28%) did not undergo biliary stenting. In the stented group, 64% had stents placed via a percutaneous approach and 36% had stents placed endoscopically. The stented patients were older (mean 63.1 years vs. 61.4 years; P = 0.05) and were more likely to be white (92% vs. 82%; P = 0.005). Those who had stents placed were more likely to have jaundice (67% vs. 38%; P
- Su, G. H., Sohn, T. A., Ryu, B., & Kern, S. E. (2000). A novel histone deacetylase inhibitor identified by high-throughput transcriptional screening of a compound library. Cancer research, 60(12), 3137-42.More infoLibraries of compounds are increasingly becoming commercially available for the use of individual academic laboratories. A high-throughput system based on a stably integrated transcriptional reporter was used to screen a library of random compounds to identify agents that conferred robust augmentation of a signal transduction pathway. A novel histone deacetylase (HDAC) inhibitor, termed scriptaid, conferred the greatest effect, a 12- to 18-fold augmentation. This facilitation of transcriptional events was generally applicable to exogenous gene constructs, including viral and cellular promoters, different cell lines and reporter genes, and stably integrated and transiently introduced sequences. Scriptaid did not interfere with a further induction provided by stimulation of the cognate signal transduction pathway (transforming growth factor beta/Smad4), which implied the functional independence of ligand-stimulated transcriptional activation and histone acetylation states in this system. Additional insights into this and other signal transduction systems are likely to be afforded through the application of compound screening technologies.
- Ueki, T., Toyota, M., Sohn, T., Yeo, C. J., Issa, J. P., Hruban, R. H., & Goggins, M. (2000). Hypermethylation of multiple genes in pancreatic adenocarcinoma. Cancer research, 60(7), 1835-9.More infoHypermethylation of CpG islands is a common mechanism by which tumor suppressor genes are inactivated. We studied 45 pancreatic carcinomas and 14 normal pancreata for aberrant DNA methylation of CpG islands of multiple genes and clones using methylation-specific PCR (MSP) and bisulfite-modified sequencing. Using MSP, we detected aberrant methylation of at least one locus in 60% of carcinomas. The genes analyzed included RARbeta (methylated in 20%), p16 (18%), CACNA1G (16%), TIMP-3 (11%), E-cad (7%), THBS1 (7%), hMLH1 (4%), DAP kinase (2%), and MGMT (0%). In addition, aberrant methylation was found in three CpG islands (MINT31, -1, and -2) in 38, 38, and 14% of carcinomas, respectively. Hypermethylation was largely confined to the carcinomas with only three loci (E-cad, DAP kinase, and MINT2) harboring methylation in some normal pancreata (36, 21, and 14%, respectively). Simultaneous methylation of at least four loci was observed in 5 of 36 (14%) pancreatic adenocarcinomas. We defined this subgroup of pancreatic adenocarcinomas as "CpG island-methylator-phenotype positive (CIMP+)." Two of four carcinomas with microsatellite instability harbored promoter hypermethylation of hMLH1, and both cases were CIMP+. Thus, we conclude that many pancreatic carcinomas hypermethylate a small percentage of genes, whereas a subset displays a CIMP+ phenotype.
- Wilentz, R. E., Goggins, M., Redston, M., Marcus, V. A., Adsay, N. V., Sohn, T. A., Kadkol, S. S., Yeo, C. J., Choti, M., Zahurak, M., Johnson, K., Tascilar, M., Offerhaus, G. J., Hruban, R. H., & Kern, S. E. (2000). Genetic, immunohistochemical, and clinical features of medullary carcinoma of the pancreas: A newly described and characterized entity. The American journal of pathology, 156(5), 1641-51.More infoMedullary carcinomas of the pancreas are a recently described, histologically distinct subset of poorly differentiated adenocarcinomas that may have a unique pathogenesis and clinical course. To further evaluate these neoplasms, we studied genetic, pathological, and clinical features of 13 newly identified medullary carcinomas of the pancreas. Nine (69%) of these had wild-type K-ras genes, and one had microsatellite instability (MSI). This MSI medullary carcinoma, along with three previously reported MSI medullary carcinomas, were examined immunohistochemically for Mlh1 and Msh2 expression, and all four expressed Msh2 but did not express Mlh1. In contrast, all of the medullary carcinomas without MSI expressed both Msh2 and Mlh1. Remarkably, the MSI medullary carcinoma of the pancreas in the present series arose in a patient with a synchronous but histologically distinct cecal carcinoma that also had MSI and did not express Mlh1. The synchronous occurrence of two MSI carcinomas suggests an inherited basis for the development of these carcinomas. Indeed, the medullary phenotype, irrespective of MSI, was highly associated with a family history of cancer in first-degree relatives (P < 0.001). Finally, one medullary carcinoma with lymphoepithelioma-like features contained Epstein-Barr virus-encoded RNA-1 by in situ hybridization. Therefore, because of medullary carcinoma's special genetic, immunohistochemical, and clinical features, recognition of the medullary variant of pancreatic adenocarcinoma is important. Only by classifying medullary carcinoma as special subset of adenocarcinoma can we hope to further elucidate its unique pathogenesis.
- Wilentz, R. E., Su, G. H., Dai, J. L., Sparks, A. B., Argani, P., Sohn, T. A., Yeo, C. J., Kern, S. E., & Hruban, R. H. (2000). Immunohistochemical labeling for dpc4 mirrors genetic status in pancreatic adenocarcinomas : a new marker of DPC4 inactivation. The American journal of pathology, 156(1), 37-43.More infoDPC4 (MADH4, SMAD4) is a tumor suppressor gene inactivated by allelic loss in approximately 55% of pancreatic adenocarcinomas. Unfortunately, it can be technically very difficult to detect the inactivation of DPC4 at the genetic level because genetic analyses require the microdissection of relatively pure samples of neoplastic and normal tissues. This is especially true for pancreatic adenocarcinomas, which elicit vigorous, non-neoplastic, stromal responses. Immunohistochemical labeling can overcome this hurdle because it preserves morphological information. We therefore studied the expression of the DPC4 gene product in 46 cancers, including 5 cancer cell lines by Western blot analysis and 41 primary periampullary adenocarcinomas by immunohistochemistry. The status of exons 1-11 of the DPC4 gene in all 46 of the cancers had been previously characterized at the molecular level, allowing us to correlate Dpc4 expression directly with gene status. Three cell lines had wild-type DPC4 genes, and Dpc4 expression was detected in all three by Western blot. The two cell lines with homozygously deleted DPC4 genes did not show Dpc4 protein by Western blot analysis. Immunohistochemical labeling revealed that 17 (94%) of the 18 primary adenocarcinomas with wild-type DPC4 genes expressed the DPC4 gene product, whereas 21 (91%) of 23 primary adenocarcinomas with inactivated DPC4 genes did not. Cases in which there was discordance between the immunohistochemical labeling and the genetic analyses were reanalyzed genetically, and we identified a deletion in exon 0 of DPC4 in one of these cases. This is the first report of a mutation in exon 0 of DPC4 in a pancreatic cancer. The contrast between the strong expression of Dpc4 by normal tissues and the loss of expression in the carcinomas was highlighted in several cases in which an infiltrating cancer was identified growing into a benign duct. These observations suggest that immunohistochemical labeling for the DPC4 gene product is an extremely sensitive and specific marker for DPC4 gene alterations in pancreatic carcinomas. The sensitivity and specificity of immunohistochemical labeling for Dpc4 in other periampullary carcinomas has yet to be determined.
- Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Sauter, P. K., Coleman, J., Sohn, T. A., Campbell, K. A., & Choti, M. A. (2000). Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Annals of surgery, 232(3), 419-29.More infoTo evaluate the endpoints of complications (specifically pancreatic fistula and total complications) and death in patients undergoing pancreaticoduodenectomy.
- Abrams, R. A., Grochow, L. B., Chakravarthy, A., Sohn, T. A., Zahurak, M. L., Haulk, T. L., Ord, S., Hruban, R. H., Lillemoe, K. D., Pitt, H. A., Cameron, J. L., & Yeo, C. J. (1999). Intensified adjuvant therapy for pancreatic and periampullary adenocarcinoma: survival results and observations regarding patterns of failure, radiotherapy dose and CA19-9 levels. International journal of radiation oncology, biology, physics, 44(5), 1039-46.More infoPrimary endpoints were 1. To determine if, in the context of postoperative adjuvant therapy of pancreatic and nonpancreatic periampullary adenocarcinoma, continuous infusion (C.I.) 5-fluorouracil (5-FU) and leucovorin (Lv), combined with continuous-course external-beam radiotherapy (EBRT) to liver (23.4-27.0 Gy), regional lymph nodes (50.4-54.0 Gy) and tumor bed (50.4-57.6 Gy), followed by 4 months of C.I. 5-FU/Lv without EBRT could be given with acceptable toxicity. 2. To determine an estimate of disease-free and overall survival (DFS, OS) with this treatment in this context. Secondary endpoints were 1. To observe the effects of therapy at two different dose levels of irradiation, and 2. To observe for correlations among DFS, OS and CA 19-9 levels during therapy.
- Lillemoe, K. D., Cameron, J. L., Hardacre, J. M., Sohn, T. A., Sauter, P. K., Coleman, J., Pitt, H. A., & Yeo, C. J. (1999). Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Annals of surgery, 230(3), 322-8; discussion 328-30.More infoThis prospective, randomized, single-institution trial was designed to evaluate the role of prophylactic gastrojejunostomy in patients found at exploratory laparotomy to have unresectable periampullary carcinoma.
- Lillemoe, K. D., Kaushal, S., Cameron, J. L., Sohn, T. A., Pitt, H. A., & Yeo, C. J. (1999). Distal pancreatectomy: indications and outcomes in 235 patients. Annals of surgery, 229(5), 693-8; discussion 698-700.More infoDistal pancreatectomy is performed for a variety of benign and malignant conditions. In recent years, significant improvements in perioperative results have been observed at high-volume centers after pancreaticoduodenectomy. Little data, however, are available concerning the current indications and outcomes after distal pancreatectomy. This single-institution experience reviews the recent indications, complications, and outcomes after distal pancreatectomy.
- Riall, T. S., Yeo, C., Lillemoe, K., & Cameron, J. (1999). Response to letter to the editor. Ann Surg, 220, 736-737.
- Sohn, T. A., Lillemoe, K. D., Cameron, J. L., Huang, J. J., Pitt, H. A., & Yeo, C. J. (1999). Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. Journal of the American College of Surgeons, 188(6), 658-66; discussion 666-9.More infoAdvances in the nonoperative staging and palliation of periampullary carcinoma have dramatically changed the management of this disease. Currently, surgical palliation is used primarily for patients found to be unresectable at the time of laparotomy performed for the purpose of determining resectability.
- Sohn, T. A., Lillemoe, K. D., Cameron, J. L., Pitt, H. A., Huang, J. J., Hruban, R. H., & Yeo, C. J. (1999). Reexploration for periampullary carcinoma: resectability, perioperative results, pathology, and long-term outcome. Annals of surgery, 229(3), 393-400.More infoThis single-institution experience retrospectively reviews the outcomes of patients undergoing reexploration for periampullary carcinoma at a high-volume center.
- Yeo, C. J., Cameron, J. L., Sohn, T. A., Coleman, J., Sauter, P. K., Hruban, R. H., Pitt, H. A., & Lillemoe, K. D. (1999). Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Annals of surgery, 229(5), 613-22; discussion 622-4.More infoThis prospective, randomized, single-institution trial was designed to evaluate the end points of mortality, morbidity, and survival in patients undergoing standard versus radical (extended) pancreaticoduodenectomy (including distal gastrectomy and retroperitoneal lymphadenectomy).
- Goggins, M., Offerhaus, G. J., Hilgers, W., Griffin, C. A., Shekher, M., Tang, D., Sohn, T. A., Yeo, C. J., Kern, S. E., & Hruban, R. H. (1998). Pancreatic adenocarcinomas with DNA replication errors (RER+) are associated with wild-type K-ras and characteristic histopathology. Poor differentiation, a syncytial growth pattern, and pushing borders suggest RER+. The American journal of pathology, 152(6), 1501-7.More infoThe clinical and pathological features of carcinomas of the pancreas with DNA replication errors (RER+) have not been characterized. Eighty-two xenografted carcinomas of the pancreas were screened for DNA replication errors using polymerase chain reaction amplification of microsatellite markers. Cases with microsatellite instability in at least two markers of a minimum of five tested were considered RER+. RER status was correlated with histological appearance, karyotype of the carcinomas when available, K-ras mutational status, and patient outcome. Three (3.7%) of the eighty-two carcinomas were RER+. In contrast to typical gland-forming adenocarcinomas of the pancreas, all three RER+ carcinomas were poorly differentiated and had expanding borders and a prominent syncytial growth pattern. Neither a Crohn's-like lymphoid infiltrate nor extracellular mucin production were prominent. Ductal adenocarcinomas of the pancreas typically contain a mutant K-ras gene, yet all three RER+ carcinomas had wild-type K-ras. One of the three RER+ carcinomas was karyotyped and showed a near diploid pattern. All three of the RER+ tumors were removed via Whipple resection. One of the three patients is free of disease 16 months after pancreaticoduodenectomy, one is alive and free of tumor at 52 months but developed two colon carcinomas during this period, and the third died of pancreatic cancer at 4 months. None of the three patients had a family history of colorectal carcinoma. A review of the K-ras wild-type carcinomas in a previously characterized series of pancreatic carcinomas with known K-ras mutational status identified two additional cancers with poor differentiation, a syncytial growth pattern, and pushing borders. Both of the cancers were diploid and both patients were longterm survivors (over 5 years). The inclusion of such patients in previous prognostic studies of pancreas cancer may explain the failure of histological grade to be a predictor of prognosis. These data suggest that DNA replication errors occur in a small percentage of resected carcinomas of the pancreas and that wild-type K-ras gene status and a medullary phenotype characterized by poor differentiation, and expanding pattern of invasion, and syncytial growth should suggest the possibility of DNA replication errors in carcinomas of the pancreas.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Talamini, M., Hruban, R., Sauter, P., Coleman, J., Ord, S., Grochow, L., Abrams, R., & Pitt, H. (1998). Should octogenarians with operable cancers in the region of the head of the pancreas undergo pancreaticoduodenectomy?. Major abdominal surgery in the aged.
- Sohn, T. A., Lillemoe, K. D., Cameron, J. L., Pitt, H. A., Kaufman, H. S., Hruban, R. H., & Yeo, C. J. (1998). Adenocarcinoma of the duodenum: factors influencing long-term survival. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2(1), 79-87.More infoThis single-institution retrospective analysis reviews the management and outcome of patients with surgically treated adenocarcinoma of the duodenum. Between February 1984 and August 1996, fifty-five patients with adenocarcinoma of the duodenum underwent surgery at The Johns Hopkins Hospital. Univariate analysis was performed to identify possible prognostic indicators. Curative resection was performed in 48 patients (87%): 35 of these patients (73%) underwent a pancreaticoduodenectomy (PD), whereas 27% (n = 13) underwent a pancreas-sparing duodenectomy (PSD). Patients undergoing PD were comparable to those undergoing PSD with respect to demographic factors, presenting symptoms, and tumor pathology. The remaining 13% of patients (n = 7) were deemed unresectable at the time of surgery and underwent biopsy and/or palliative bypass. PD was associated with an increase in postoperative complications when compared to PSD (57% vs. 30%), but this difference was not statistically significant. One perioperative death occurred following PD (mortality 2.9%). The overall 5-year survival rate for the 48 patients undergoing potentially curative resection was 53%. Negative resection margins (P
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Talamini, M. A., Hruban, R. H., Sauter, P. K., Coleman, J., Ord, S. E., Grochow, L. B., Abrams, R. A., & Pitt, H. A. (1998). Should pancreaticoduodenectomy be performed in octogenarians?. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2(3), 207-16.More infoAs the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%) distal bile duct adenocarcinoma (n = 5; 11%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma; (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 454; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy.
- Wilentz, R. E., Chung, C. H., Sturm, P. D., Musler, A., Sohn, T. A., Offerhaus, G. J., Yeo, C. J., Hruban, R. H., & Slebos, R. J. (1998). K-ras mutations in the duodenal fluid of patients with pancreatic carcinoma. Cancer, 82(1), 96-103.More infoMany patients with carcinoma of the pancreas die because their disease is not detected until late in its course. Methods that detect these cancers earlier will improve patient outcome. Over 80% of pancreatic carcinomas contain mutations in codon 12 of the K-ras gene. Screening duodenal fluid for these mutations may lead to early detection of these cancers and assist in establishing a diagnosis of pancreatic carcinoma.
- Yeo, C. J., Sohn, T. A., Cameron, J. L., Hruban, R. H., Lillemoe, K. D., & Pitt, H. A. (1998). Periampullary adenocarcinoma: analysis of 5-year survivors. Annals of surgery, 227(6), 821-31.More infoThis single-institution experience retrospectively reviews the outcomes in a group of patients treated 5 or more years ago by pancreaticoduodenectomy for periampullary adenocarcinoma.
- Hruban, R. H., Sturm, P. D., Slebos, R. J., Wilentz, R. E., Musler, A. R., Yeo, C. J., Sohn, T. A., van Velthuysen, M. L., & Offerhaus, G. J. (1997). Can K-ras codon 12 mutations be used to distinguish benign bile duct proliferations from metastases in the liver? A molecular analysis of 101 liver lesions from 93 patients. The American journal of pathology, 151(4), 943-9.More infoIt can be difficult to distinguish benign bile duct proliferations (BDPs) from well-differentiated metastatic peripancreatic adenocarcinomas on histological grounds alone. Most peripancreatic carcinomas harbor activating point mutations in codon 12 of the K-ras oncogene, suggesting that K-ras mutational status may provide a molecular basis for distinguishing BDPs from liver metastases. The ability of tests for mutations in codon 12 of K-ras to make this distinction was examined in a two-part study. In the first part we determined the K-ras mutational status of 56 liver lesions and 48 primary peripancreatic adenocarcinomas obtained from 48 patients. In the second part of this study an additional 45 liver lesions were studied. In the first 48 patients, activating point mutations in codon 12 of K-ras were detected in 28 (61%) of the 46 primary carcinomas, in 8 (100%) of 8 liver metastases, in 2 (6.5%) of 31 BDPs, and in none (0%) of 14 liver granulomas. Three BDPs and two primary carcinomas did not amplify. To further estimate the prevalence of K-ras mutations in BDPs we analyzed an additional series of 45 mostly incidental BDPs for K-ras mutations. Three (6.7%) of these 45 harbored K-ras mutations. These results suggest that K-ras mutations may be useful in distinguishing BDPs from metastases in the liver; however, there is some overlap in the mutational spectra of BDPs and pancreatic carcinomas.
- Lillemoe, K. D., Cameron, J. L., Yeo, C. J., Sohn, T. A., Nakeeb, A., Sauter, P. K., Hruban, R. H., Abrams, R. A., & Pitt, H. A. (1997). Pancreaticoduodenectomy and palliation in pancreatic carcinoma. Gastroenterology, 112(3), 1046-8.
- Rozenblum, E., Schutte, M., Goggins, M., Hahn, S. A., Panzer, S., Zahurak, M., Goodman, S. N., Sohn, T. A., Hruban, R. H., Yeo, C. J., & Kern, S. E. (1997). Tumor-suppressive pathways in pancreatic carcinoma. Cancer research, 57(9), 1731-4.More infoDuring tumorigenesis, positive selection is exerted upon those tumor cells that alter rate-limiting regulatory pathways. A corollary of this principle is that mutation of one gene abrogates the need for alteration of another gene in the same pathway and also that the coexistence in a single tumor of mutations in different genes implies their involvement in distinct tumor-suppressive pathways. We studied 42 pancreatic adenocarcinomas for genetic alterations in the K-ras oncogene and the p16, p53, and DPC4 tumor suppressor genes. All of them had the K-ras gene mutated. Thirty-eight % of the tumors had four altered genes, another 38% had three altered genes, 15% had two altered genes, and 8% of the tumors had one altered gene. Interestingly, we noted a high concordance of DPC4 and p16 inactivations (P = 0.007), suggesting that the genetic inactivation of p16 increases the selective advantage of subsequent mutation in DPC4. No statistically significant association was identified between the alteration of these cancer genes and pathological or clinical parameters. This type of multigenic analysis in human tumors may serve to substantiate experimental tumor models and thus increase our understanding of the truly physiologically relevant tumor-suppressive pathways that are abrogated during human tumorigenesis.
- Talamini, M. A., Moesinger, R. C., Pitt, H. A., Sohn, T. A., Hruban, R. H., Lillemoe, K. D., Yeo, C. J., & Cameron, J. L. (1997). Adenocarcinoma of the ampulla of Vater. A 28-year experience. Annals of surgery, 225(5), 590-9; discussion 599-600.More infoThe aim of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients.
- Yeo, C. J., Abrams, R. A., Grochow, L. B., Sohn, T. A., Ord, S. E., Hruban, R. H., Zahurak, M. L., Dooley, W. C., Coleman, J., Sauter, P. K., Pitt, H. A., Lillemoe, K. D., & Cameron, J. L. (1997). Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Annals of surgery, 225(5), 621-33; discussion 633-6.More infoThis study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocol to those of no adjuvant therapy.
- Yeo, C. J., Cameron, J. L., Sohn, T. A., Lillemoe, K. D., Pitt, H. A., Talamini, M. A., Hruban, R. H., Ord, S. E., Sauter, P. K., Coleman, J., Zahurak, M. L., Grochow, L. B., & Abrams, R. A. (1997). Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Annals of surgery, 226(3), 248-57; discussion 257-60.More infoThe authors reviewed the pathology, complications, and outcomes in a consecutive group of 650 patients undergoing pancreaticoduodenectomy in the 1990s.
- Lillemoe, K. D., Cameron, J. L., Yeo, C. J., Sohn, T. A., Nakeeb, A., Sauter, P. K., Hruban, R. H., Abrams, R. A., & Pitt, H. A. (1996). Pancreaticoduodenectomy: Does it have a role in the palliation of pancreatic cancer?. Annals of surgery, 223(6), 718-25; discussion 725-8.More infoThe authors define the role of palliative pancreaticoduodenectomy in patients with pancreatic carcinoma.
- Nakeeb, A., Pitt, H. A., Sohn, T. A., Coleman, J., Abrams, R. A., Piantadosi, S., Hruban, R. H., Lillemoe, K. D., Yeo, C. J., & Cameron, J. L. (1996). Cholangiocarcinoma: A spectrum of intrahepatic, perihilar, and distal tumors. Annals of surgery, 224(4), 463-73; discussion 473-5.More infoThe objective of this article is to introduce a simple method for classifying cholangiocarcinomas and to apply this system to analyze a large number of patients from a single institution.
Presentations
- Riall, T. S. (2023). Leadership and Wellbeing in Uncertain Times. David W. Eisele, MD Endowed Lecture, Johns Hopkins.
- Riall, T. S. (2023). More than Grit: Leveraging Emotional Intelligence Competencies to Navigate Surgical Residency. 18th Annual Academic Surgical Congress. Houston, Texas.
- Riall, T. S. (2023). Wellbeing and Resiliency. The University of Arizona Department of Urology Grand Rounds.
- Riall, T. S. (2023). Controversies and Advances in the Management of Pancreatic Cancer. Congress of Gastroenterology. Cancun, Mexico.
- Riall, T. S. (2023). Surgical Career Longevity: Wellbeing, Resilience, and Perspective. Keck Medicine of USC Grand RoundsUniversity of Southern California - Los Angeles.
- Sohal, D., Kharofa, J., Olowokure, O. O., Rojan, A., Patel, S. H., Wilson, G. C., Sussman, J. J., Moreland, K., Patra, K., Bogdanov, V., Riall, T. S., Zavros, Y., Shroff, R., & Ahmed, S. A. (2023). An adaptive approach to neoadjuvant therapy to maximize resection rates for pancreatic adenocarcinoma: A phase II trial. 2023 ASCO Gastrointestinal Cancers Symposium.
- Jie, T., Heimark, R. L., Riall, T. S., & Rheinheimer, B. A. (2019, March). Pancreatic Mixed Acinar Cell Carcinoma: Genomic Analysis and Characterization of a Patient-derived Organoid Culture. 2019 The Americas Hepato-Pancreato-Biliary Association.
- KHREISS, M., Brown, S., Villalvazo, Y., & Riall, T. S. (2022, May 2-5). Pancreatic Neuroendocrine Tumor Lymph Node Resection: A New Calculation of Number of Lymph Nodes Required. 2022 Digestive Disease Week. San Diego, CA.
- Riall, T. S. (2020, December 2). Maintaining the Fire: Wellbeing, Resilience, and Intentional Culture. Society of Urologic Oncology: Young Urologic Oncologists Program. Schaumburg, IL (Virtual).
- Riall, T. S. (2022, August 13). Physician Wellbeing: Reflection, Resiliency, and Career Longevity. The University of Arizona, Department of Medical Imaging Resident Conference. Tucson, AZ.
- Riall, T. S. (2022, February 8). Resiliency, Refelction, and Career Longevity. MetroHealth Grand Rounds. Virutal.
- Riall, T. S. (2022, July 28). Coaching Wellbeing to Acheive High Performance. Buidling Well-bing in Surgical Teams - Advances in Surgery (AIS) Channel. Virtual.
- Riall, T. S. (2022, March 16). Strategic Diet, Exercise, and Sleep to Optimize Performance. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2022 Annual Meeting. Denver, CO.
- Riall, T. S. (2022, March 21). Incorporating Wellness into Your Practice. The Socity for Surgery of the Alimentary Tract (SSAT) Professional Development of the Modern Surgeon. Virutal.
- Riall, T. S. (2022, October 14). Leadership and Wellbeing in Uncertain Times. The Scott Mubarak Surgical Grand Rounds. San Diego, CA.
- Riall, T. S. (2022, September 24). Leadership and Wellbeing in Uncertain Time. Sierra Sacramento Valley Medical Society Annual Joy of Medicine Summit.
- Riall, T. S. (2021, August 26). Surgical Career Longevity: Resilency, Reflection, and Intentional Culture. Western Reserve Health Education Grand Rounds.
- Riall, T. S. (2021, February 4). Litigation, Leaderhip and Longevity: How to Prepare?. Academic Surgical Congress. Virtual.
- Riall, T. S. (2021, January 20). Engaging Leadership. ACS Re-framing Surgeon Well-Being Webinar. Virtual.
- Riall, T. S. (2021, January 27). Resilience, Leadership, and Career Longevity. UH Cleveland WiSe (Women in Surgery) Meeting - University Hospitals Cleveland Medical Center. Virtual.
- Riall, T. S. (2021, July 14). Transitioning to Your First Job. The University of Texas MD Anderson Cancer Center Workshop. Virtual.
- Riall, T. S. (2021, July 16). Resiliency, Reflection, and Career Longevity. The University of Texas MD Anderson Cancer Center Grand Rounds. Virtual.
- Riall, T. S. (2021, July 29). Surgical Career Longevity: Resiliency, Reflection and Career Longevity. Johns Hopkins Urology Grand Rounds. Virtual.
- Riall, T. S. (2021, March 11). Helping Surgeons Go the Distance: Resilience, Leadership and Career Longevity. Western Reserve Health Education Grand Rounds. Virtual.
- Riall, T. S. (2021, March 2). Resident Wellbeing: Leadership, Resilience, and intentional Culture. Lankenau Medical Center Grand Rounds. Virtual.
- Riall, T. S. (2021, March 23). Physician Wellness Across the Continuum. Academy of Master Surgeon Educators Grand Rounds. Virtual.
- Riall, T. S. (2021, March 3). Helping Surgeons Go the Distance: Resilience, Leadership, and Career Longevity. Baylor College of Medicine Grand Rounds. Virtual.
- Riall, T. S. (2021, May 12). Energy Leadership: How Skillfully Can You Lead in Your Every Day Life?. Ohio State University Wexner Medical Center Webinar. Virtual.
- Riall, T. S. (2021, October 20). Leadership in Uncertain Times: Strategies for Success. Annual Lahey in Surgery Virtual Event. Virtual.
- Riall, T. S. (2021, September 15). Going the Distance: Emotional Intelligence, Wellbeing and Resilience. Johns Hopkins All Children’s Hospital Grand Rounds.
- Arrington, A. K., O’Grady, C. L., Khreiss, M., & Riall, T. S. (2020, April 15-18). Significance of Lymph Node Rsection After Neoadjuvant Therapy In Pancreatic, Gastric and Rectal Cancers. 140th American Surgical Association Meeting. Washington, DC.More info**CANCELLED DUE TO COVID 19 Pandemic**
- Arrington, A. K., O’Grady, C. L., Khreiss, M., & Riall, T. S. (2020, May 2-5). A Tale of Two Cancer: Do Lymph Node Resections Truly Mean the Same in Colon and Rectal Cancers?. 2020 Digestive Disease Week. Chicago, IL.More info**CANCELLED DUE TO COVID 19 Pandemic**
- Arrington, A. K., O’Grady, C. L., Khreiss, M., & Riall, T. S. (2020, May 2-5). Dispartities in Receipt of Neoadjuvant Theraphy for Gastric and Pancreatic Cancers: The Selection Bias is Real. 2020 Digestive Disease Week. Chicago, IL.More info**CANCELLED DUE TO COVID 19 Pandemic**
- Morris-Wiseman, L., Riall, T. S., O'Grady, C., Nfonsam, V. N., Tang, A., Arora, T., Romero Arenas, M., & Del Sol Driesen, A. (2020, May). Do General Surgery Residency Program Websites Feature Diversity?. Association of Program Directors in Surgery, Surgical Education Week. Virtual: Association of Program Directors in Surgery.
- Riall, T. S. (2020, November 12). Improving Surgeon Wellbeing: Personal, Cultural, and Organizational Factors. Resilience Wellness Initiatives (Keynote Speaker): Kaiser Permanente 2020 Annual Surgical Services Physician Summit. Orange County, CA (Virtual).
- Riall, T. S. (2020, Sept 12 / Oct 3). Strength in Diversity. AWS 2020 Conference. Virtual.
- Riall, T. S. (2019, June 25-26). Enjoy the Journey. 47th Annual Meeting of the Surgical Research Society of Southern Africa. Pretoria, South Africa: Society of University Surgeons.
- Riall, T. S. (2019, Nov). Implementing a Resident Well-being Program: Outcomes and Lessons Learned. Surgical Research Society Conference. Melbourne VIC, Australia: Royal Australasian College of Surgeons.
- Riall, T. S. (2019, Nov). Lessons from Winston. Indiana Chapter of the American College of Surgeons. Indianapolis, IN: American College of Surgeons.
- Riall, T. S. (2019, Nov). Wellbeing, Resilience and Intentional Culture. Keynote Speaker, Academy of Surgical Education. Melbourne VIC, Australia: Royal Australasian College of Surgeons.
- Riall, T. S. (2019, Sept 2019). The Cutting Edge in Surgery. The Best of DDW 2019, Southwest Regional Advances in Digestive Diseases. Tucson, AZ: University of Arizona.
- Riall, T. S., Morris-Wiseman, L., Nfonsam, V. N., Aullery, A., Arrington, A., Coverley, C., & Price, E. (2019, Apr 2019). Qualitative Assessment of a Wellbeing and Resiliency Program for General Surgery Residents: Are we making an impact?. 2019 Association for Surgical Education (ASE) Annual Meeting. Chicago, IL: Association for Surgical Education.
- Golisch, K. B., Price, E. T., Arrington, A., & Riall, T. S. (2018, December 5). Pancreatic Cancer Lymph Node Resection Revisited: A Novel Calculation of the Number of Lymph Nodes Required. 2018 Annual Meeting of the Southern Surgical Association. Palm Beach, FL: Southern Surgical Association.
- Riall, T. S. (2018, April). Gallstone Disease in Older Patients - The Right Treatment for the Right Patient. Society of University Surgeons Presidential Lecture, 118th Annual Congress of Japan Surgical Society. Tokyo, Japan: Japan Surgical Society / Society of University Surgeons.
- Riall, T. S. (2018, Feb). Maintaining the Fire: Physician Wellbeing, Resilience, and Intentional Culture. ACS North Texas Chapter Meeting (The Harry M. Spence Memorial Lectureship). Dallas, TX: American College of Surgeons.
- Riall, T. S. (2018, May). Cessation of Smoking. Quality & Safety with Surgical Directors Session, Royal Australasian College of Surgeons 87th Annual Scientific Congress with the American College of Surgeons. Sydney, Australia: Royal Australasian College of Surgeons.
- Riall, T. S. (2018, May). Communication: The real work of leadership. Plenary Session, Royal Australasian College of Surgeons 87th Annual Scientific Congress with the American College of Surgeons. Sydney, Australia: Royal Australasian College of Surgeons.
- Riall, T. S. (2018, May). Maintaining the Fire: Self-awareness, Resilience, and Intentional Culture in Surgeon Wellbeing. Ernestine Hambrick, MD Lectureship, Annual Scientific Meeting of the American Society of Colon & Rectal Surgeons. Nashville, TN: American Society of Colon & Rectal Surgeons.
- Riall, T. S. (2018, May). Maintaining the fire: wellbeing, resilience and intentional culture. Plenary Session, Royal Australasian College of Surgeons 87th Annual Scientific Congress with the American College of Surgeons. Sydney, Australia: Royal Australasian College of Surgeons.
- Riall, T. S., & Telem, D. (2018, October 20). Biliary Injury and Disease Factors. State of the Art Consensus Development Conference on Prevention of Bile Duct Injury (BDI) During Cholecystectomy. Boston, MA: American College of Surgeons.
- Riall, T. S. (2017, August 17). Future of Surgery in USA. Annual Scientific Meeting of the New Zealand National Board of the Royal Australasian College of Surgeons. New Zealand: Royal Australasian College of Surgeons.
- Riall, T. S. (2017, August 17). Right Treatment, Patient and Setting. Annual Scientific Meeting of the New Zealand National Board of the Royal Australasian College of Surgeons. New Zealand: Royal Australasian College of Surgeons.
- Riall, T. S. (2017, August 18). Achieve Your Potential Through Wellbeing. Annual Scientific Meeting of the New Zealand National Board of the Royal Australasian College of Surgeons. New Zealand: Royal Australasian College of Surgeons.
- Riall, T. S. (2017, December 4-6). The Current Tokyo Guidelines are not Clinically Relevant for the Diagnosis and Management of Cholecystitis. Western Surgical Association 125th Scientific Session. Scottsdale, AZ: Western Surgical Association.
- Riall, T. S. (2017, July 22). ACS NSQIP Collaboratives: Harnessing Extended Data Fields to Enhance the Power of ACS NSQIP Research In Hepato-pancreato-biliary (HPB) Surgery. American College of Surgeons (ACS) Quality and Safety Conference. New York, NY: American College of Surgeons (ACS).
- Riall, T. S. (2017, October 22). Leadership Coaching: Who Needs a Coach and When?. American College of Surgeons Clinical Congress, SSC/AASA Joint Session. San Diego, CA: American College of Surgeons.
- Riall, T. S. (2017, October 24). The Role of Percutaneous Cholecystectomy Tubes; When, How, and What to do Afterward? Decision Making on Subsequent Cholecystectomy - When, Why and How?. American College of Surgeons Clinical Congress. San Diego, CA: American College of Surgeons.
- Riall, T. S. (2017, October 25). Energy Leadership: Emotional Intelligence and Responding vs. Reacting to Your Environment. American College of Surgeons Clinical Congress. San Diego, CA: American College of Surgeons.
- Riall, T. S., Tieman, J. S., McClafferty, H., Leighn, T., & Nfonsam, V. N. (2017, December 4-6). Maintaining the fire but Avoiding Burnout: Implementation and Evaluation of a Resident wellbeing program. 129th Annual Southern Surgical Association Meeting. Hot Springs, VA: Southern Surgical Association.
- Dimou, F., Adhikari, D., Mehta, H., & Riall, T. S. (2016, December 5). Outcomes in Older Patients with Grade III Cholecystitis and Cholecystostomy Tube Placement: A Propensity Score Analysis. 128th Annual Southern Surgical Association Meeting. Palm Beach, FL: Southern Surgical Association.
- Riall, T. S. (2016, February 4). Hot Topic: The role of professional coaching in developing emotional intelligence and preventing burnout in surgery. Academic Surgical Congress. Jacksonville, FL.
- Riall, T. S. (2016, Nov). Prevention and Treatment of Burnout in Surgeons: The Role of Mindfulness and Emotional Intelligence. 2016 Annual Scientific Meeting, Arizona Chapter of the American College of Surgeons. Tucson, AZ: American College of Surgeons.
- Riall, T. S. (2016, October 18). Acute Pancreatitis: What’s New and What’s Changing?. American College of Surgeons Clinical Congress. Washington D.C.: American College of Surgeons.
- Riall, T. S. (2016, October 19). Strategies for the Resident and Surgeon Facing Burnout. American College of Surgeons Clinical Congress. Washington D.C.: American College of Surgeons.
- Dimou, F., Adhikari, D., Mehta, H., Tamiria, N., & Riall, T. S. (2015, December 7). Trends in follow-up of patients presenting to the Emergency Departments with symptomatic cholelithiasis. 127th Annual Southern Surgical Association MeetingSouthern Surgical Association.
- Dimou, F., Mehta, H., Riall, T. S., Adhikari, D., Tamirisa, N., & Brown, K. (2015, May 17). Management and natural history of older patients requiring cholecystectomy tube drainage for acute gallbladder disease. 56th Annual Society for Surgery of the Alimentary Tract in conjunction with Digestive Disease Week. Washington, DC: Society for Surgery of the Alimentary Tract.
- Dimou, F., Sineshaw, H., Parmar, A., Tamirisa, N., Jupiter, D., Jemal, A., & Riall, T. S. (2015, May 15). Trends in receipt and timing of multimodality therapy in early stage pancreatic cancer. 56th Annual Society for Surgery of the Alimentary Tract in conjunction with Digestive Disease Week. Washington, DC: Society for Surgery of the Alimentary Tract.
- Heimark, R. L., Riall, T. S., Rheinheimer, B. A., & Jie, T. (2019, February). Genomic Analysis of a Patient-Derived Organoid Model of Mixed Acinar/Neuroendocrine Cell Carcinoma. 2019 Academic Surgical Congress.
- Riall, T. S. (2012, May). Cystic tumors of the pancreas: To operate or not?. Digestive Disease Week 2012, Meet-the-Professor Luncheon session. San Diego, CA: Society for Surgery of the Alimentary Tract.
- Riall, T. S. (2015, October 6). Reducing Perioperative Risk: What’s the Evidence? Preoperative Risk Assessment. American College of Surgeons Clinical Congress. Chicago, Illinois: American College of Surgeons.
- Tamirisa, N., Kandalam, A., Linder, S., Weller, S., Turrubiate, S., Silva, C., & Riall, T. S. (2015, February 7-9). The current status of shared decision making in cancer: Patient and physician views. 10th Annual Academic Surgical Congress. Las Vegas, NV: Academic Surgical Congress.
- Williams, T., Adhikari, D., Bargerstock, J., Kimbrough, T., & Riall, T. S. (2015, February 7-9). Hospital readmission after an initial emergency department visit for symptomatic cholelithiasis. 10th Annual Academic Surgical Congress. Las Vegas, NV: Academic Surgical Congress.
- Riall, T. S. (2014, February 27). The challenges of translating health services research into clinical practice. Center for Surgery and Public Health, Brigham and Women’s Hospital, Invited Talk. Boston, MA.
- Riall, T. S. (2014, January 24). Fast track recovery from surgery. American Society of Anesthesiologists Practice Management Conference. Dallas, TX: American Society of Anesthesiologists.
- Riall, T. S. (2014, March 27). Using Instrumental Variable Analysis to Control for Unmeasured Confounding in Observational Studies: The Comparative Effectiveness of Intraoperative Cholangiography in Prevention of Bile Duct Injury. Surgical Outcomes Club/Association of Academic Surgery Didactic Conference.
- Riall, T. S. (2014, November 14). Pancreatic cancer: translation of outcomes research into practice. Surgical Research Society of Australasia. Adelaide, South Australia.
- Riall, T. S. (2014, October 28). IPMN: What is behind the letters?. American College of Surgeons Clinical Congress. San Francisco, CA: American College of Surgeons.
- Riall, T. S., Adhikari, D., Parmar, A., Linder, S., Dimou, F., Crowell, W., Tamirisa, N., Townsend, C., & Goodwin, J. (2014, December 3). The risk paradox: Use of elective cholecystectomy in older patients is independent of their risk of developing complications. 126th Annual Meeting of the Southern Surgical Association. West Palm Beach, FL.
- Riall, T. S., Parmar, A., Vargas, G., Tamirisa, N., & Sheffield, K. (2014, February 6). Trajectory of care and use of multimodality therapy in older patients with pancreatic adenocarcinoma. 9th Annual Academic Surgical Congress. San Diego, CA.
- Riall, T. S., Vargas, G., Parmar, A., Sheffield, K., Tamirisa, N., & Brown, K. (2014, February 6). Management of synchronous liver metastases in colorectal cancer patients. 9th Annual Academic Surgical Congress. San Diego, CA.
- Riall, T. S. (2013, May 20). Cysts of the Pancreas: Observe, Respect, or Drain-How To Pick The Right Option For Every Patient…The First Time. The Society for Surgery of the Alimentary Tract 54th Annual Meeting. Lake Buena Vista, FL.
- Riall, T. S. (2013, May 20). Preoperative Therapy Toxicity Prevents Resection in Some Patients; When Adjusted for This and Other Factors, Outcomes Are Equivalent to an Adjuvant Approach. The Society for Surgery of the Alimentary Tract 54th Annual Meeting. Lake Buena Vista, FL.
- Riall, T. S. (2013, May). Cysts of the Pancreas: Observe, Respect, or Drain-How To Pick The Right Option For Every Patient…The First Time. The Society for Surgery of the Alimentary Tract 54th Annual Meeting. Lake Buena Vista, FL: Society for Surgery of the Alimentary Tract.
- Riall, T. S. (2013, May). Preoperative Therapy Toxicity Prevents Resection in Some Patients; When Adjusted for This and Other Factors, Outcomes Are Equivalent to an Adjuvant Approach. The Society for Surgery of the Alimentary Tract 54th Annual Meeting. Lake Buena Vista, FL: Society for Surgery of the Alimentary Tract.
- Riall, T. S. (2013, November 13). Emerging trends in surgical research. Section of Academic Surgery, Surgical Research Society of Australasia. Adelaide, South Australia: Society of University Surgeons.
- Riall, T. S. (2013, Sept). Implementation of Critical Pathway for Complicated Gallbladder Disease. 52nd Annual Meeting of Georgia Surgical Society. St. Simon Island, GA: Georgia Surgical Society.
- Riall, T. S. (2013, September 13). Individualized Care in Early Pancreatic Cancer: Neoadjuvant Therapy vs Resection. 52nd Annual Meeting of Georgia Surgical Society Invited Guest Speaker. Simon Island, GA.
- Riall, T. S. (2013, September 25). Pancreatic cancer. Gastrointestinal Nutrition Course. Galveston, TX: University of Texas Medical Branch.
- Riall, T. S., Parmar, A., Sheffield, K., Vargas, G., Han, Y., & Chao, C. (2013, February 5-7). Post-treatment surveillance in locoregional breast cancer: guideline adherence and patterns in use of non-recommended testing. 8th Annual Academic Surgical Congress. Orleans, LA.
- Riall, T. S., Vargas, G., Sheffield, K., Han, Y., Parmar, A., Townsend, C., Goodwin, J., & Brown, K. (2013, October 8). Timing of chemotherapy and primary tumor resection in patients with stage IV colon cancer. American College of Surgeons 2013 Clinical Congress. Washington, DC.
- Riall, T. S., Vargas, G., Sheffield, K., Parmar, A., Han, Y., & Brown, K. (2013, February 5-7). Physician follow-up and guideline adherence in post-treatment surveillance of colorectal cancer. 8th Annual Academic Surgical Congress. New Orleans, LA.
- Riall, T. S. (2012, July 22). Use of preoperative testing in geriatric patients. National Surgical Quality Improvement Program. Salt Lake City, UT: American College of Surgeons.
- Riall, T. S. (2012, July). Use of preoperative testing in geriatric patients. National Surgical Quality Improvement Program. Salt Lake City, UT: American College of Surgeons.
- Riall, T. S. (2012, May 19). Gallstone and Gallbladder Disease. Digestive Disease Week 2012. Society for Surgery of the Alimentary Tract Postgraduate Maintenance of Certification course. San Diego, CA.
- Riall, T. S. (2012, May 21). Cystic tumors of the pancreas: To operate or not?. Digestive Disease Week 2012 Meet-the-Professor Luncheon session. San Diego, CA.
- Riall, T. S. (2012, October 12). Variation in the use of preoperative testing for older patients undergoing ambulatory surgery in Texas. Semi-Annual Fall Meeting of the Texas Surgical Society. San Antonio, TX.
- Riall, T. S. (2012, September 10). Statement on Quality Improvement. American College of Surgeons (ACS) Surgical Health Care Quality Forum Houston. Houston, TX: American College of Surgeons (ACS).
- Riall, T. S. (2012, September 24). Pancreatic cancer. Gastrointestinal Nutrition Course. Galveston, TX: University of Texas Medical Branch.
- Riall, T. S. (2012, September 26). Becoming a Surgeon. Women’s Surgical Society. Galveston, TX: University of Texas Medical Branch.
- Riall, T. S. (2012, September 28). Using observational studies to evaluate comparative effectiveness. Association for Academic Surgery, Fundamentals of Surgical Research. Chicago, IL.
- Riall, T. S., Benarroch-Gampel, J., Ho, V., Boyd, C., Sheffield, K., & Merrell, D. (2012, February 14). Cost-comparison analysis of cholecystectomy during bariatric surgery. Academic Surgical Congress Meeting. Las Vegas, NV.
- Riall, T. S., Boyd, C., Benarroch-Gampel, J., Sheffield, K., Han, Y., Kuo, Y., & Goodwin, J. (2012, February 14). The effect of depression on diagnosis, treatment and survival in pancreatic cancer. Academic Surgical Congress Meeting. Las Vegas, NV.
- Riall, T. S., Djukom, C., Han, Y., Sheffield, K., & Chao, C. (2012, February 14). Pancreatic neuroendocrine tumors (PNET): Population-based study of treatment and outcomes for stage IV disease. Academic Surgical Congress Meeting. Las Vegas, NV.
- Riall, T. S., Parmar, A., Sheffield, K., Vargas, G., Han, Y., & Chao, C. (2012, October 25). Quality of post-treatment surveillance of early stage breast cancer in Texas. Cancer Prevention and Research Institute of Texas New Innovations Meeting. Austin, TX.
- Riall, T. S., Zimmerman, C., Sheffield, K., Han, Y., Cooksley, C., Duncan, C., Benarroch-Gampel, J., & Townsend, C. (2012, December 5). Time trends and geographic variation in the use of minimally invasive breast biopsy. 124th Annual Southern Surgical Association Meeting. West Palm Beach, Florida.
- Riall, T. S. (2011, July 27). Example of quality improvement for gallstone disease. Conference Scheduling for Emergency General Surgery Collaborative. Houston, TX.
- Riall, T. S. (2011, June 11). Pancreatic cystic neoplasms and pancreatic cancer. 1st Annual DDW Highlights ConferenceTexas Gulf Coast Gastroenterological Society.
- Riall, T. S. (2011, March 12). Sphincterotomy alone for common bile duct stones: When should it be considered. American Hepato-Pancreato-Biliary Association. Miami Beach, FL.
- Riall, T. S. (2011, May 9). Debate: Moderate complexity gastrointestinal surgery should be performed at high-volume (HV) hospitals by experienced surgeons. Society for Surgery of the Alimentary Tract. Chicago, IL.
- Riall, T. S. (2011, Nov). Debate: Open approach to pancreatectomy. 3rd Worldwide Conference Clinical Robotic Surgical Association. Houston, TX: Clinical Robotic Surgical Association.
- Riall, T. S. (2011, November 4). Debate: Open approach to pancreatectomy. 3rd Worldwide Conference Clinical Robotic Surgical Association. Houston, TX.
- Riall, T. S. (2011, October 21). Databases and clinical trials. Association for Academic Surgery, Fundamentals of Surgical Research. San Francisco, CA.
- Riall, T. S. (2011, September 21). Pancreatic Cancer. Gastrointestinal Nutrition Course. Galveston, TX: University of Texas Medical Branch.
- Riall, T. S., & Boyd, C. (2011, March 11). Pancreatic neoplasms in pregnancy: a case report and review of the literature. American Hepato-Pancreatobiliary Association Annual Meeting. Miami, FL.
- Riall, T. S., Boyd, C., Sheffield, K., & Benarroch-Gampel, J. (2011, February 1-3). 415 patients with adenosquamous carcinoma of the pancreas: a population-based analysis of prognosis and survival. Academic Surgical Congress Annual Meeting. Huntington Beach, CA.
- Riall, T. S., Sheffield, K., Benarroch-Gampel, J., Boyd, C., Townsend, C., & Goodwin, J. (2011, December). Variation in the use of intraoperative cholangiography during cholecystectomy. 122nd Annual Southern Surgical Association Meeting. Hot Springs, VA.
- Riall, T. S., Trust, M., Sheffield, K., Benarroch-Gampel, J., Boyd, C., Zhang, D., & Townsend, C. (2011, February 1). Gallstone pancreatitis in older patients: are we operating enough?. Academic Surgical Congress Annual Meeting. Huntington Beach, CA.
- Riall, T. S., Kuo, Y., Townsend, C., Freeman, J., Nealon, W., & Goodwin, J. (2009, February 4). The impact of age on surgical resection rates and long-term survival in patients with locoregional pancreatic cancer. University Surgeons 4th Academic Surgical Congress. Ft. Myers, FL.
- Riall, T. S., Zhang, D., Townsend, C., Kuo, Y., & Goodwin, J. (2009, December 8). Failure to perform cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. 121st Annual Southern Surgical Association Meeting. Hot Springs, VA.
- Riall, T. S. (2008, Oct). Cystic neoplasms of the pancreas: When to operate and what operation to do. American College of Surgeons Clinical Congress. San Francisco, CA: American College of Surgeons.
- Riall, T. S., Nealon, W., Goodwin, J., Townsend, C., & Freeman, J. (2008, February 13). Outcomes following pancreatic resection: Variability among high-volume providers. 3rd Annual Academic Surgical Congress. Huntington Beach, CA.
- Riall, T. S., Reddy, D., Nealon, W., & Goodwin, J. (2008, April 25). The effect of age on short-term outcomes after pancreatic resection: A population-based study. 128th Annual American Surgical Association Meeting. New York, NY.
- Riall, T. S., Eschbach, K., Townsend, C., Nealon, W., Freeman, J., & Goodwin, J. (2007, May 21). Trends and disparities in regionalization of pancreatic resection. 48th Annual Society for Surgery of the Alimentary Tract Meeting. Chicago, IL.
- Riall, T. S., Freeman, J., Townsend, C., Goodwin, J., Kuo, Y., Zhang, D., & Nealon, W. (2006, May 22). Pancreatic cancer in the general population: Improvements in survival over the last decade. 47th Annual Society for Surgery of the Alimentary Tract. Los Angeles, CA.
- Riall, T. S., Stager, V., Townsend, C., Nealon, W., Kuo, Y., Goodwin, J., & Freeman, J. (2006, December 5). Incidence of additional primary cancers in patients with IPMNs and other primary pancreatic neoplasms. 118th Southern Surgical Association Meeting. Palm Beach, FL.
- Riall, T. S., Cameron, J., Lillemoe, K., Campbell, K., Sauter, P., Coleman, J., Abrams, R., Laheru, D., Hurban, R., & Yeo, C. (2005, May 18). Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 3: Update on 5-year survival. 46th Annual Society for Surgery of the Alimentary Tract. Chicago, IL.
- Riall, T. S., Yeo, C., Cameron, J., Hruban, R., Fukushima, N., Campbell, K., & Lillemoe, K. (2004, May 16). Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Pancreas Club. New Orleans, LA.
- Riall, T. S., Yeo, C., Cameron, J., Hruban, R., Fukushima, N., Campbell, K., & Lillemoe, K. (2003, December 2). Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. 115th Annual Meeting of the Southern Surgical Society. Hot Springs, VA.
- Riall, T. S., Nguyen, T., Yeo, C., Cameron, J., Lillemoe, K., Campbell, K., Coleman, J., Sauter, P., Abrams, R., & Hruban, R. (2002, May 21). Standard versus radical pancreaticoduodenectomy for periampullary adenocarcinoma: Evaluation of quality of life in pancreaticoduodenectomy survivors. 42nd Annual Society for Surgery of the Alimentary Tract. San Francisco, CA.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Geschwind, J., Mitchell, S., & Venbrux, A. (2002, May 19). Pancreaticoduodenectomy: The role of interventional radiologists in patient management. Pancreas Club. San Francisco, CA.
- Riall, T. S., Campbell, K., Schulick, R., Yeo, C., Lillemoe, K., Hruban, R., & Cameron, J. (2001, February 22-25). Gallbladder cancer: Complete resection can provide long-term survival in advanced T-stage tumors. Third Biennial AHPBA Congress. Miami Beach, FL.
- Riall, T. S., Su, G., Ryu, B., Yeo, C., & Kern, S. (2001, May 20). High-throughput drug screening of the DPC4 tumor-suppressor pathway in human pancreatic cancer cells. Pancreas Club. Atlanta, GA.
- Riall, T. S., Yeo, C., Cameron, J., Iacobuzio-Donahue, C., Hruban, R., & Lillemoe, K. (2001, April 26-28). Intraductal papillary mucinous neoplasms of the pancreas: A commonly recognized clinical entity in the 1990s. 121st annual American Surgical Association Meeting. Colorado Springs, CO.
- Riall, T. S., Yeo, C., Lillemoe, K., Koniaris, L., Kaushal, S., Sauter, P., Coleman, J., Hruban, R., & Cameron, J. (2000, May). Resected adenocarcinoma of the pancreas - 616 patients: Results, outcomes, and prognostic indicators. 40th Annual Society for Surgery of the Alimentary Tract and Ross Resident’s Research Conference. San Diego, CA.
- Riall, T. S., Yeo, C., Cameron, J., Pitt, H., & Lillemoe, K. (1999, May). Preoperative biliary stents in patients undergoing pancreaticoduodenectomy (PD): Increased risk of postoperative complications?. 39th Annual Society for Surgery of the Alimentary Tract, Pancreas Club, and Ross Resident’s Research Conference. Orlando, FL.
- Riall, T. S., Huang, J., Cameron, J., Yeo, C., Pitt, H., & Lillemoe, K. (1998, October). Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. ACS Clinical Congress. Orlando, FL.
- Riall, T. S., Lillemoe, K., Cameron, J., Pitt, H., Huang, J., Hruban, R., & Yeo, C. (1998, May). Reexploration for periampullary carcinoma: Resectability, perioperative results and long-term outcome. Ross Resident‘s Research Conference. Gulfport, MS.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., & Pitt, H. (1998, May). Periampullary adenocarcinoma: Analysis of 5-year survivors. Pancreas Club. New Orleans, LA.
- Riall, T. S., Lillemoe, K., Cameron, J., Pitt, H., Kaufman, H., Hruban, R., & Yeo, C. (1997, May). Adenocarcinoma of the duodenum: Factors influencing long-term survival. 38th Annual Society for Surgery of the Alimentary Tract. Washington, D.C.
Poster Presentations
- Riall, T. S., Duncan, C., Branch, D., Sheffield, K., Han, Y., Kuo, Y., & Goodwin, J. (2013, May 17). Hospital and medical care days in pancreatic cancer. 47th Annual Meeting of the Pancreas Club. Lake Buena Vista, FL.
- Riall, T. S., & Lewis, C. (2012, October 25). Head and neck cancer in Texas: a population-based study. Cancer Prevention and Research Institute of Texas New Innovations Meeting. Austin, TX,.
- Riall, T. S., Benarroch-Gampel, J., Gajjar, A., Boyd, C., & Sheffield, K. (2012, May 22). Never too old for abdominal surgical repair of rectal prolapse. Society for Surgery of the Alimentary Tract. San Diego, CA.
- Riall, T. S., Duncan, C., Benarroch-Gampel, J., Sheffield, K., Han, Y., & Kuo, Y. (2012, May 18). The effect of depression on diagnosis, treatment and survival in pancreatic cancer. Pancreas Club Annual Meeting. San Diego, CA.
- Riall, T. S., Parmar, A., Sheffield, K., Vargas, G., Han, Y., & Chao, C. (2012, October 25). Quality of post-treatment surveillance of early stage breast cancer in Texas. Cancer Prevention and Research Institute of Texas New Innovations Meeting. Austin, TX.
- Riall, T. S., Vargas, G., Sheffield, K., Parmar, A., Han, Y., & Brown, K. (2012, October 24). Physician follow-up and guideline adherence in post-treatment surveillance of colon cancer in Texas. Cancer Prevention and Research Institute of Texas New Innovations Meeting. Austin, TX.
- Riall, T. S., Evans, P., Bauer, V., & Al-Zoubaidi, M. (2011, October 24-27). Excessive crystalloid increases surgical infection in elective colectomy. American College of Surgeons 97th Annual Clinical Congress Meeting. San Francisco, CA.
- Riall, T. S., Sheffield, K., Benarroch-Gampel, J., Boyd, C., Zhang, D., & Townsend, C. (2011, June 12-14). Hospital and surgeon volume and operative mortality following pancreatic resection. Academy Health Annual Research Meeting. Seattle, WA.
- Riall, T. S., Benarroch-Gampel, J., Boyd, C., Sheffield, K., Dallefeld, S., & Townsend, C. J. (2010, May 10). Overuse of computed tomography in patients with complicated gallstone disease. Society for Surgery of the Alimentary Tract Annual Meeting. Chicago, IL.
- Riall, T. S., Townsend, C., Kuo, Y., Nealon, W., & Freeman, J. (2009, February 4). Disparities in the evaluation and surgical resection rates of Medicare patients with locoregional pancreatic cancer. Society of University Surgeons New Members Poster Session. Myers, FL.
- Riall, T. S., Cameron, J., Lillemoe, K., Campbell, K., Winter, J., Hruban, R., & Yeo, C. (2008, February 9). Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10- year follow-up. First Academic Surgical Congress. San Diego, CA.
- Riall, T. S., Torres, M., Townsend, C., Kuo, Y., Nealon, W., & Freeman, J. (2007, February 7). Periampullary Adenocarcinoma: A Population-Based Analysis of Resection Rates and Long-term Survival. First Academic Surgical Congress. Phoenix, AZ.
- Riall, T. S., Lin, J., Cameron, J., Yeo, C., & Lillemoe, K. (2004, May 17). Risk factors and outcomes in post-pancreaticoduodenectomy pancreaticocutaneous fistula. 44th Annual Society for surgery of the Alimentary Tract. New Orleans, LA.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Campbell, K., Sauter, P., Coleman, J., Abrams, R., & Hruban, R. (2004, May 16). Do distal gastrectomy and retroperitoneal lymphadenectomy benefit patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma?: Update on long-term survival at 5 years. the Pancreas Club. New Orleans, LA.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Geschwind, J., Mitchell, S., & Venbrux, A. (2002, May 20). Pancreaticoduodenectomy: The role of interventional radiologists in patient management. 42nd Annual Society for Surgery of the Alimentary Tract. San Francisco, CA.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Campbell, K., Coleman, J., Sauter, P., Abrams, R., & Hruban, R. (2001, May 19). Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma – 2: Evaluation of survival, morbidity, mortality, and quality of life. the Pancreas Club. San Francisco, CA.
- Riall, T. S., Su, G., Ryu, B., Dai, J., & Kern, S. (2000, July). A novel histone deacetylase inhibitor identified by high-throughput transcriptionally screening of a compound library. GI SPORE meeting. Alexandria, VA.
- Riall, T. S., Yeo, C., Cameron, J., Nakeeb, A., & Lillemoe, K. (2000, May). Renal cell carcinoma metastatic to the pancreas: Results of surgical management. 41st Annual Society for Surgery of the Alimentary Tract. San Diego, CA.
- Riall, T. S., Lillemoe, K., Cameron, J., Pitt, H., Huang, J., Hruban, R., & Yeo, C. (1998, May). Reexploration for periampullary carcinoma: Resectability, perioperative results and long-term outcome. 39th Annual Society for Surgery of the Alimentary Tract. New Orleans, LA: Society for Surgery of the Alimentary Tract.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Talamini, M., Hruban, R., Sauter, P., Coleman, J., Ord, S., Grochow, L., Abrams, R., & Pitt, H. (1997, May). Should Pancreaticoduodenectomy be performed in octogenarians?. 38th Annual Society for Surgery of the Alimentary Tract. Washington, D.C.: Society for Surgery of the Alimentary Tract.
Others
- Riall, T. S. (2022, May 21). Session II (Moderator). The Society for Surgery of the Alimentary Tract (SSAT) Residents & Fellows Research Conference.
- Riall, T. S. (2022, May 21). Surveillance Strategies for Hereditary Pancreas Cancer Syndromes (Co-Moderator). Digestive Disease Week / The Society for Surgery of the Alimentary Tract (SSAT) 63rd Annual Meeting.
- Riall, T. S., High, E., Fornoff, A., & Carton, M. (2016, August). Well Beyond This Survivorship Care Plan Program Evaluation Study. IRB 1608774317.
- Mehta, H. B., Sieloff, E., Veeranki, S. P., Sura, S. D., Riall, T. S., Senagore, A. J., & Goodwin, J. S. (2017, Oct 2017). Risk Prediction Models for Hospital Readmission In Surgery: A Systematic Review. Journal of the American College of Surgeons; 2017 Oct 1;225(4):e113.
- Riall, T. S., Benarroch, J., Boyd, C., Sheffield, K., Dallefeld, S., & Townsend, C. J. (2011, Oct). Overuse of computed tomography in patients with complicated gallstone disease. Gastroenterology 140:S1046.
- Riall, T. S., & Malhorta, A. (2009, June). Descriptive epidemiology and outcome of patients with intraductal papillary neoplasms (IPMN): a population-based comparison to pancreatic adenocarcinoma. Gastroenterology 136:A230.
- Riall, T. S., Bowen, K., Silva, S., Doan, H., & Evers, B. (2009, June). Population-based analysis and growth factor receptor expression of GI carcinoid tumors. Gastroenterology 136:A880.
- Riall, T. S., Reddy, D., Townsend, C. J., Nealon, W., Kuo, Y., & Freeman, J. (2009, Nov). Readmission after pancreatectomy for pancreatic cancer in Medicare patients. Gastroenterology 136:A879.
- Riall, T. S., Emick, D., Cameron, J., Winter, J., Lillemoe, K., Coleman, J., Sauter, P., & Yeo, C. (2006, Nov). Hospital readmission following pancreaticoduodenectomy. Gastroenterology 130:A851.
- Riall, T. S., Freeman, J., Townsend, C. J., Goodwin, J., Kuo, Y., Zhang, D., & Nealon, W. (2006, Nov). Pancreatic cancer in the general population: Improvements in survival over the last decade. Gastroenterology 130:A853.
- Riall, T. S., Winter, J., Cameron, J., Campbell, K., Chang, D., Hruban, R., Schulick, R., Choti, M., Lillemoe, K., & Yeo, C. (2006, Nov). Pancreaticoduodenectomies for pancreatic cancer: A single institution experience. Gastroenterology 130:A857.
- Riall, T. S., Winter, J., Cameron, J., Campbell, K., Chang, D., Wolfgang, C., Sonnenday, C., Marohn, M., Schulick, R., Choti, M., & Yeo, C. (2006, Nov). Does pancreatic duct stenting decrease the rate of pancreatic fistula following pancreaticoduodenectomy? Results of prospective randomized trial. Gastroenterology 130:A853.
- Riall, T. S., Cameron, J., Lillemoe, K., Campbell, K., Sauter, P., Coleman, J., Abrams, R., Laheru, D., Hurban, R., & Yeo, C. (2005, Dec). Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 3: Update on 5-year survival. Gastroenterology 128: 738.
- Riall, T. S., Makary, M., Winter, J., Cameron, J., Cunningham, S., Chang, D., & Yeo, C. (2005, Nov). Outcomes of pancreaticoduodenectomy in octagenarians, nonogenarians, and a centenarian. Gastroenterology 128: M2056.
- Riall, T. S., Lin, J., Cameron, J., Yeo, C., & Lillemoe, K. (2004, Dec). Risk factors and outcomes in post-pancreaticoduodenectomy pancreaticocutaneous fistula. Gastroenterology 126: A8022.
- Riall, T. S., Tascilar, M., Skinner, H., Rosty, C., Atlink, R., Wilentz, R., Abrams, R., Cameron, J., Kern, S., Yeo, C., Hruban, R., & Goggins, M. (2001, Fall). Among pancreatic adenocarcinomas treated by whipple resection, an intact DPC4 portends a significantly improved patient survival. Gastroenterology 120:A1885.
- Riall, T. S., Yeo, C., Cameron, J., Nakeeb, A., & Lillemoe, K. (2001, Jul-Aug). Renal cell carcinoma metastatic to the pancreas: Results of surgical management. Gastroenterology; 118; 1044.
- Riall, T. S., Campbell, K., Pitt, H., Sauter, P., Coleman, J., Lillemoe, K., Yeo, C., & Cameron, J. (2000, Jul-Aug). Quality of life and long-term survival after surgery for chronic pancreatitis. Gastroenterology; 116; A1303.
- Riall, T. S., Huang, J., Yeo, C., Cameron, J., Sauter, P., Coleman, J., & Lillemoe, K. (2000, June). Quality of life and functional outcomes after pancreaticoduodenectomy. Surgical Forum 50:649-650.
- Riall, T. S., Yeo, C., Lillemoe, K., Koniaris, L., Kaushal, S., Sauter, P., Coleman, J., Hruban, R., & Cameron, J. (2000, Nov-Dec). Resected adenocarcinoma of the pancreas - 616 patients: Results, outcomes, and prognostic indicators. Gastroenterology 118:A1059.
- Riall, T. S., Lillemoe, K., Kaushal, S., Cameron, J., Pitt, H., & Yeo, C. (1999, May). Indications and outcomes of 235 distal pancreatectomy patients. Medical Updates 2:223-224.
- Riall, T. S., Yeo, C., Cameron, J., Lillemoe, K., Hruban, R., & Cameron, J. (1999, Fall). Periampullary adenocarcinoma in the fourth and fifth decades of life. Gastroenterology 116:A1372.
- Riall, T. S., Yeo, C., Cameron, J., Pitt, H., & Lillemoe, K. (1999, May-Jun). Preoperative biliary stents in patients undergoing pancreaticoduodenectomy (PD): Increased risk of postoperative complications?. Gastroenterology 116:A1371.
- Riall, T. S. (1998, June). Resectability, perioperative results and long-term outcome. Gastroenterology 114:A1427.
- Riall, T. S., Lillemoe, K., Cameron, J., Pitt, H., Huang, J., Hruban, R., & Yeo, C. (1998, May). Reexploration for periampullary carcinoma: Resectability, perioperative results and long-term outcome. Gastroenterology; 114; A1427.
- Riall, T. S., Lillemoe, K., Cameron, J., Pitt, H., Kaufman, H., Hruban, R., & Yeo, C. (1998, Jan-Feb). Adenocarcinoma of the duodenum: Factors influencing long-term survival. Gastroenterology 112:A1474.
- Riall, T. S., Yeo, C., Abrams, R., Grochow, L., Ord, S., Hruban, R., Zahurak, M., Dooley, W., Coleman, J., Sauter, P., Pitt, H., Lillemoe, K., & Cameron, J. (1998, Fall). Chemoradiation after pancreaticoduodenectomy for pancreatic adenocarcinoma: Is it of proven benefit?. HPB Surgery 11:198-200.
- Sohn, T. A., Yeo, C. J., Cameron, J. L., Lillemoe, K. D., Talamini, M. A., Hruban, R. H., Sauter, P. K., Coleman, J., Ord, S. E., Grochow, L. B., Abrams, R. A., & Pitt, H. A. (1998, May-Jun). Should pancreaticoduodenectomy be performed in octogenarians?. Gastroenterology; 112; A1475.
- Riall, T. S. (1997, June). Pancreaticoduodenectomy be performed in octogenarians?. Gastroenterology 112:A1475.
- Riall, T. S., Lillemoe, K., Cameron, J., Yeo, C., Nakeeb, A., Sauter, P., Hruban, R., Abrams, R., & Pitt, H. (1997, March). Pancreaticoduodenectomy and palliation in pancreatic carcinoma. Gastroenterology 112:1046-1048.