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Article ; Online: ASO Author Reflections: Neoadjuvant Therapy for Nonpancreatic Periampullary Adenocarcinoma.

Adam, Mohamed A / Glencer, Alexa C / Zureikat, Amir H

2022 Volume 30, Issue 1, Page(s) 175–176

MeSH term(s)	Humans ; Neoadjuvant Therapy ; Duodenal Neoplasms ; Adenocarcinoma/drug therapy
Language	English
Publishing date	2022-07-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12277-7
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Article ; Online: Reply to the Letter from Norman G. Nicolson and Jin He on Our Publication "Neoadjuvant Therapy Versus Upfront Resection for Nonpancreatic Periampullary Adenocarcinoma".

Adam, Mohamed Abdelgadir / AlMasri, Samer / Glencer, Alexa / Zureikat, Amer H

Annals of surgical oncology

2022

Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Letter
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12921-2
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Article ; Online: Assessing the role of robotic proctectomy in obese patients: a contemporary NSQIP analysis.

Glencer, Alexa C / Lin, Joseph A / Trang, Karen / Greenberg, Anya / Kirkwood, Kimberly S / Adam, Mohamed Abdelgadir / Sarin, Ankit

Journal of robotic surgery

2022 Volume 16, Issue 6, Page(s) 1391–1399

Abstract: Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by ... ...

Abstract	Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retrospective review of 2016-2018 National Surgery Quality Improvement Program (NSQIP) data to compare outcomes between patients who underwent robotic versus laparoscopic proctectomy, stratified by Body Mass Index (BMI) subgroups. We also compared outcomes of converted minimally invasive proctectomy to planned open operations. Four thousand four hundred eighteen (69.3%) patients underwent laparoscopic proctectomy, and 1956 (30.7%) patients underwent robotic proctectomy. Robotic proctectomy was associated with a significantly lower conversion rate compared to laparoscopic proctectomy (5.1% vs 12.3%; p = 0.002), and this relationship was maintained on an adjusted model. Obese (BMI > 30) patients were more likely to require conversion in both laparoscopic and robotic groups with the greatest difference in the conversion rate in the obese subgroup. Patients who underwent conversion had higher composite morbidity compared to patients who underwent planned open operations (50.8% vs 41.3%; p < 0.001). And among patients with rectal cancer, robotic proctectomy was associated with a greater incidence of positive radial tumor margins compared to laparoscopic proctectomy (8.0% vs 6.4%; p = 0.039), driven primarily by the obese subgroup. Our study demonstrates that robotic proctectomy is associated with a 7% lower conversion rate compared to laparoscopy and that obese patients are more likely to require conversion than non-obese patients. Among obese patients with rectal cancer, we identified an increased risk of positive radial margins with robotic compared to laparoscopic proctectomy.
MeSH term(s)	Humans ; Robotic Surgical Procedures/methods ; Quality Improvement ; Proctectomy ; Rectal Neoplasms/surgery ; Laparoscopy/adverse effects ; Retrospective Studies ; Margins of Excision ; Obesity/complications ; Obesity/surgery ; Treatment Outcome ; Postoperative Complications/etiology
Language	English
Publishing date	2022-02-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2268283-1
ISSN	1863-2491 ; 1863-2483
ISSN (online)	1863-2491
ISSN	1863-2483
DOI	10.1007/s11701-022-01380-2
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Article ; Online: The Evolution of Our Understanding of the Biology of Cancer Is the Key to Avoiding Overdiagnosis and Overtreatment.

Hewitt, Kelly / Son, Jennifer / Glencer, Alexa / Borowsky, Alexander D / Cooperberg, Matthew R / Esserman, Laura J

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology

2020 Volume 29, Issue 12, Page(s) 2463–2474

Abstract: There has been a tremendous evolution in our thinking about cancer since the 1880s. Breast cancer is a particularly good example to evaluate the progress that has been made and the new challenges that have arisen due to screening that inadvertently ... ...

Abstract	There has been a tremendous evolution in our thinking about cancer since the 1880s. Breast cancer is a particularly good example to evaluate the progress that has been made and the new challenges that have arisen due to screening that inadvertently identifies indolent lesions. The degree to which overdiagnosis is a problem depends on the reservoir of indolent disease, the disease heterogeneity, and the fraction of the tumors that have aggressive biology. Cancers span the spectrum of biological behavior, and population-wide screening increases the detection of tumors that may not cause harm within the patient's lifetime or may never metastasize or result in death. Our approach to early detection will be vastly improved if we understand, address, and adjust to tumor heterogeneity. In this article, we use breast cancer as a case study to demonstrate how the approach to biological characterization, diagnostics, and therapeutics can inform our approach to screening, early detection, and prevention. Overdiagnosis can be mitigated by developing diagnostics to identify indolent disease, incorporating biology and risk assessment in screening strategies, changing the pathology rules for tumor classification, and refining the way we classify precancerous lesions. The more the patterns of cancers can be seen across other cancers, the more it is clear that our approach should transcend organ of origin. This will be particularly helpful in advancing the field by changing both our terminology for what is cancer and also by helping us to learn how best to mitigate the risk of the most aggressive cancers.
MeSH term(s)	Early Detection of Cancer/methods ; Humans ; Neoplasms/epidemiology ; Overtreatment/prevention & control ; Risk Assessment
Language	English
Publishing date	2020-10-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1153420-5
ISSN	1538-7755 ; 1055-9965
ISSN (online)	1538-7755
ISSN	1055-9965
DOI	10.1158/1055-9965.EPI-20-0110
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Article ; Online: Neoadjuvant Therapy Versus Upfront Resection for Nonpancreatic Periampullary Adenocarcinoma.

Adam, Mohamed Abdelgadir / Glencer, Alexa / AlMasri, Samer / Winters, Sharon / Bahary, Nathan / Singhi, Aatur / Lee, Kenneth K / Paniccia, Alessandro / Zureikat, Amer H

Annals of surgical oncology

2022 Volume 30, Issue 1, Page(s) 165–174

Abstract: Background: In contrast to pancreatic ductal adenocarcinoma (PDAC), neoadjuvant therapy (NAT) for periampullary adenocarcinomas is not well studied, with data limited to single-institution retrospective reviews with small cohorts. We sought to compare ... ...

Abstract	Background: In contrast to pancreatic ductal adenocarcinoma (PDAC), neoadjuvant therapy (NAT) for periampullary adenocarcinomas is not well studied, with data limited to single-institution retrospective reviews with small cohorts. We sought to compare outcomes of NAT versus upfront resection (UR) for non-PDAC periampullary adenocarcinomas. Patients and methods: Using the National Cancer Database (NCDB), we identified patients who underwent surgery for extrahepatic cholangiocarcinoma, ampullary adenocarcinoma, or duodenal adenocarcinoma from 2006 to 2016. We compared outcomes between NAT versus UR groups for each tumor subtype with 1:3 propensity score matching. Cox regression was used to identify predictors of survival. Results: Among 7656 patients who underwent resection for non-PDAC periampullary adenocarcinoma, the proportion of patients who received NAT increased from 6 to 11% for cholangiocarcinoma (p < 0.01), 1 to 4% for ampullary adenocarcinoma (p = 0.01), and 5 to 8% for duodenal adenocarcinoma (p = 0.08). Length of stay, readmission, and 30-day mortality were comparable between NAT and UR. All tumor subtypes were downstaged following NAT (p < 0.01). The R0 resection rate was significantly higher in patients with extrahepatic cholangiocarcinoma who received NAT, and these patients had improved median overall survival (38 vs 26 months, p < 0.001). After adjustment for clinicopathologic factors and adjuvant chemotherapy, use of NAT was associated with improved survival in patients with cholangiocarcinoma [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.54-0.89, p = 0.004] but not duodenal or ampullary adenocarcinoma. The survival advantage for cholangiocarcinoma persisted after propensity matching. Conclusion: This national cohort analysis suggests, for the first time, that neoadjuvant therapy is associated with improved survival in patients with extrahepatic cholangiocarcinoma.
MeSH term(s)	Humans ; Neoadjuvant Therapy ; Retrospective Studies ; Neoplasms
Language	English
Publishing date	2022-08-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12257-x
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Article: Multidisciplinary Management of Postoperative Pancreatic Fistula

Glencer, Alexa / Kirkwood, Kim / Schwertner, Adam / Keller, Cody / Arain, Mustafa / Avila, Patrick / Hovsepian, David M.

Digestive Disease Interventions

(Endoscopy)

2021 Volume 05, Issue 01, Page(s) 55–69

Abstract: Postoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary ... ...

Series title	Endoscopy
Abstract	Postoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.
Keywords	postoperative complications ; pancreas ; pancreatic fistula ; pancreatic leak
Language	English
Publishing date	2021-02-17
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	2472-873X ; 2472-8721
ISSN (online)	2472-873X
ISSN	2472-8721
DOI	10.1055/s-0040-1721785
Database	Thieme publisher's database

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Article ; Online: Unifying the Hepatopancreatobiliary Surgery Fellowship Curriculum via Delphi Consensus.

Park, Keon Min / Rashidian, Nikdokht / Mohamedaly, Sarah / Brasel, Karen J / Conroy, Patricia / Glencer, Alexa C / He, Jin / Passeri, Michael J / Katariya, Nitin N / Alseidi, Adnan

Journal of the American College of Surgeons

2021 Volume 233, Issue 3, Page(s) 395–414

Abstract: Background: Hepatopancreatobiliary (HPB) Fellowship training in the Americas consists of 3 distinctive routes with variable curricula: Surgical Oncology Fellowship via the Society of Surgical Oncology (SSO), Abdominal Transplant Surgery Fellowship via ... ...

Abstract	Background: Hepatopancreatobiliary (HPB) Fellowship training in the Americas consists of 3 distinctive routes with variable curricula: Surgical Oncology Fellowship via the Society of Surgical Oncology (SSO), Abdominal Transplant Surgery Fellowship via the American Society of Transplant Surgeons (ASTS), and HPB Fellowship via the Americas Hepato-Pancreato-Biliary Association (AHPBA). Our objective was to establish a pan-American consensus among HPB surgeons, surgical oncologists, abdominal transplant surgeons, and general surgery residency program directors (GSPDs) on a core knowledge curriculum for HPB fellowship, and to identify topics appropriate for general surgery residency and subspecialty beyond HPB fellowship. Study design: A 3-round modified Delphi process was used. Baseline statements were developed by the Education and Training Committee of the AHPBA, in collaboration with representatives of the SSO, ASTS, and GSPDs. The expert panel, consisting of members of the 3 societies together with GSPDs, rated the statements on a 5-point Likert scale and suggested editing or adding new statements. A statement was included in the final curriculum when Cronbach's alpha value was ≥ 0.8 and ≥ 80% of the panel agreed on inclusion. Results: The response rate was 100% for the first round, and 98% for the second and third rounds. Eighty-nine of 138 proposed statements were included in the final HPB fellowship curriculum. Curricula for general surgery residency and subspecialty beyond HPB fellowship included 50 and 29 statements, respectively. Conclusions: A multinational consensus on core knowledge for an HPB fellowship curriculum was achieved via the modified Delphi method. This core curriculum may be used to standardize HPB fellowship training across different pathways in the Americas.
MeSH term(s)	Biliary Tract Diseases/surgery ; Consensus ; Curriculum/standards ; Delphi Technique ; Digestive System Surgical Procedures/education ; Education, Medical, Graduate/standards ; Fellowships and Scholarships ; Gastroenterology/education ; Humans ; United States
Language	English
Publishing date	2021-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1016/j.jamcollsurg.2021.06.004
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Article ; Online: Identifying Good Candidates for Active Surveillance of Ductal Carcinoma

Glencer, Alexa C / Miller, Phoebe N / Greenwood, Heather / Maldonado Rodas, Cristian K / Freimanis, Rita / Basu, Amrita / Mukhtar, Rita A / Brabham, Case / Kim, Paul / Hwang, E Shelley / Rosenbluth, Jennifer M / Hirst, Gillian L / Campbell, Michael J / Borowsky, Alexander D / Esserman, Laura J

Cancer research communications

2022 Volume 2, Issue 12, Page(s) 1579–1589

Abstract: Ductal carcinoma : Significance: A retrospective analysis of 71 patients with DCIS who did not undergo upfront surgery demonstrated that breast MRI features after short-term exposure to endocrine therapy identify those at high (68.2%), intermediate ( ... ...

Abstract	Ductal carcinoma Significance: A retrospective analysis of 71 patients with DCIS who did not undergo upfront surgery demonstrated that breast MRI features after short-term exposure to endocrine therapy identify those at high (68.2%), intermediate (20.0%), and low risk (8.7%) of IDC. With 7.4 years mean follow-up, 52.1% of patients remain on active surveillance. A period of active surveillance offers the opportunity to risk-stratify DCIS lesions and guide decisions for operative management.
MeSH term(s)	Humans ; Female ; Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging ; Retrospective Studies ; Carcinoma, Ductal, Breast/pathology ; Neoadjuvant Therapy ; Watchful Waiting ; Breast Neoplasms/diagnostic imaging
Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
ISSN	2767-9764
ISSN (online)	2767-9764
DOI	10.1158/2767-9764.CRC-22-0263
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Article: Modulation of the immune microenvironment of high-risk ductal carcinoma in situ by intralesional pembrolizumab injection.

Glencer, Alexa C / Wong, Jasmine M / Hylton, Nola M / Krings, Gregor / McCune, Emma / Rothschild, Harriet T / Loveday, Tristan A / Alvarado, Michael D / Esserman, Laura J / Campbell, Michael J

NPJ breast cancer

2021 Volume 7, Issue 1, Page(s) 59

Abstract: Ductal carcinoma in situ (DCIS) is a risk factor for the subsequent development of invasive breast cancer. High-risk features include age ... 5 cm, high-grade, palpable mass, hormone receptor negativity, and HER2 positivity. We have ... ...

Abstract	Ductal carcinoma in situ (DCIS) is a risk factor for the subsequent development of invasive breast cancer. High-risk features include age <45 years, size >5 cm, high-grade, palpable mass, hormone receptor negativity, and HER2 positivity. We have previously shown that immune infiltrates are positively associated with these high-risk features, suggesting that manipulating the immune microenvironment in high-risk DCIS could potentially alter disease progression. Patients with high-risk DCIS were enrolled in this 3 × 3 phase 1 dose-escalation pilot study of 2, 4, and 8 mg intralesional injections of the PD-1 immune checkpoint inhibitor, pembrolizumab. Study participants received two intralesional injections, three weeks apart, prior to surgery. Tissue from pre-treatment biopsies and post-treatment surgical resections was analyzed using multiplex immunofluorescence (mIF) staining for various immune cell populations. The intralesional injections were easily administered and well-tolerated. mIF analyses demonstrated significant increases in total T cell and CD8
Language	English
Publishing date	2021-05-25
Publishing country	United States
Document type	Journal Article
ISSN	2374-4677
ISSN	2374-4677
DOI	10.1038/s41523-021-00267-z
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Article ; Online: Everolimus and its role in hormone-resistant and trastuzumab-resistant metastatic breast cancer.

Keck, Sara / Glencer, Alexa C / Rugo, Hope S

Future oncology (London, England)

2012 Volume 8, Issue 11, Page(s) 1383–1396

Abstract: Advances in targeted therapies have improved progression-free and overall survival in women with metastatic breast cancer; however, regardless of efficacy, resistance almost always occurs eventually. Upregulation of the PI3K/AKT/mTOR pathway, which ... ...

Abstract	Advances in targeted therapies have improved progression-free and overall survival in women with metastatic breast cancer; however, regardless of efficacy, resistance almost always occurs eventually. Upregulation of the PI3K/AKT/mTOR pathway, which promotes cell growth and proliferation, is a means of escaping responsiveness to hormone therapy in hormone receptor-positive disease, or trastuzumab in HER2-positive disease. Everolimus, an inhibitor of mTOR, has shown promise in early clinical trials in metastatic breast cancer and is currently being studied in larger Phase II and III clinical trials, combined with hormone therapy or trastuzumab with or without cytotoxic chemotherapy. In this article, we discuss the mechanistic and preclinical data for everolimus, efficacy and safety results of clinical trials, and the landscape looking forward.
MeSH term(s)	Animals ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antineoplastic Agents/adverse effects ; Antineoplastic Agents/pharmacology ; Antineoplastic Agents/therapeutic use ; Breast Neoplasms/drug therapy ; Breast Neoplasms/metabolism ; Breast Neoplasms/pathology ; Clinical Trials as Topic ; Drug Evaluation, Preclinical ; Drug Resistance, Neoplasm ; Everolimus ; Female ; Humans ; Neoplasm Metastasis ; Phosphatidylinositol 3-Kinases/metabolism ; Receptor, ErbB-2/metabolism ; Signal Transduction/drug effects ; Sirolimus/adverse effects ; Sirolimus/analogs & derivatives ; Sirolimus/pharmacology ; Sirolimus/therapeutic use ; TOR Serine-Threonine Kinases/metabolism ; Trastuzumab ; Treatment Outcome
Chemical Substances	Antibodies, Monoclonal, Humanized ; Antineoplastic Agents ; Everolimus (9HW64Q8G6G) ; Phosphatidylinositol 3-Kinases (EC 2.7.1.-) ; TOR Serine-Threonine Kinases (EC 2.7.1.1) ; Receptor, ErbB-2 (EC 2.7.10.1) ; Trastuzumab (P188ANX8CK) ; Sirolimus (W36ZG6FT64)
Language	English
Publishing date	2012-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2184533-5
ISSN	1744-8301 ; 1479-6694
ISSN (online)	1744-8301
ISSN	1479-6694
DOI	10.2217/fon.12.143
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