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Article ; Online: Reply.

Van Buren, George

2016 Volume 45, Issue 7, Page(s) e34–5

Language	English
Publishing date	2016
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	632831-3
ISSN	1536-4828 ; 0885-3177
ISSN (online)	1536-4828
ISSN	0885-3177
DOI	10.1097/MPA.0000000000000627
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Article ; Online: The Landmark Series: Mitigation of the Postoperative Pancreatic Fistula.

Van Buren, George / Vollmer, Charles M

Annals of surgical oncology

2020 Volume 28, Issue 2, Page(s) 1052–1059

Abstract: Pancreatic fistula has been the defining complication and challenge of pancreatic surgery. Better awareness and mitigation of postoperative pancreatic fistulas has led to significant improvements in morbidity and mortality of pancreatic surgery. The ... ...

Abstract	Pancreatic fistula has been the defining complication and challenge of pancreatic surgery. Better awareness and mitigation of postoperative pancreatic fistulas has led to significant improvements in morbidity and mortality of pancreatic surgery. The definition and management of pancreatic fistulas has sequentially progressed over the last three decades; the literature ranges from retrospective, observational studies to prospective multicenter randomized controlled trials. The landmark literature contributions driving the perioperative management of pancreatic fistulas are detailed in this article.
MeSH term(s)	Humans ; Pancreas ; Pancreatic Fistula/etiology ; Pancreatic Fistula/prevention & control ; Postoperative Complications/prevention & control ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2020-10-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-09251-6
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Article ; Online: Interobserver Variability and Challenges in Intraoperative Frozen Section Evaluation of Pancreatic Margins in Pancreatectomy Specimens.

Dhingra, Sadhna / Taggart, Melissa W / Foo, Wai Chin / Rashid, Asif / Heredia, Maria Luisa Machado / May, Sarah B / Van Buren, George / Fisher, William E / Wang, Huamin

Annals of clinical and laboratory science

2024 Volume 53, Issue 6, Page(s) 847–860

Abstract: Objective: Frozen-section evaluation of the pancreatic margin is challenging. We aimed to determine interobserver variability among gastrointestinal pathologists for the assessment of frozen sections of pancreatic margins with marked chronic ... ...

Abstract	Objective: Frozen-section evaluation of the pancreatic margin is challenging. We aimed to determine interobserver variability among gastrointestinal pathologists for the assessment of frozen sections of pancreatic margins with marked chronic pancreatitis and to determine the challenging histological features in discrepant cases. Methods: We identified 45 patients who underwent pancreas resection for pancreatic ductal adenocarcinoma and showed marked chronic pancreatitis at pancreatic margin. Deidentified first levels of frozen-sections of the pancreatic margins from all cases were independently reviewed by 5 experienced gastrointestinal pathologists for the presence of carcinoma and/or high-grade dysplasia. Results: Interobserver agreement among pathologists was calculated as kappa coefficients ([Formula: see text]). A consensus diagnosis for discordant cases was obtained after group review and discussion. Interobserver agreement for adenocarcinoma diagnosis was 87%, and there was "substantial agreement" (Fleiss [Formula: see text]=0.78, Conclusions: We showed excellent interobserver agreement among gastrointestinal pathologists for diagnosis of adenocarcinoma on frozen sections of pancreatic margins with marked chronic pancreatitis. Missed adenocarcinoma at the margin was mainly caused by freezing or cautery artifacts or by overlooking a tiny focus of perineural invasion in a background of marked chronic pancreatitis. The evaluation of deeper levels led to perfect agreement.
MeSH term(s)	Humans ; Frozen Sections ; Observer Variation ; Pancreatectomy ; Pancreas/surgery ; Pancreatitis, Chronic/surgery ; Pancreatic Neoplasms/surgery ; Adenocarcinoma/surgery ; Carcinoma, Pancreatic Ductal/surgery
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	193092-8
ISSN	1550-8080 ; 0091-7370 ; 0095-8905
ISSN (online)	1550-8080
ISSN	0091-7370 ; 0095-8905
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Article ; Online: Microbiome changes associated with acute and chronic pancreatitis: A systematic review.

Brubaker, L / Luu, S / Hoffman, Kl / Wood, A / Navarro Cagigas, M / Yao, Q / Petrosino, Jf / Fisher, W / Van Buren, G

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.

2020 Volume 21, Issue 1, Page(s) 1–14

Abstract: Background: Altered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with acute (AP) and chronic pancreatitis (CP), or whether these disease states ...

Abstract	Background: Altered intestinal microbiota has been reported in pancreatic disorders, however, it remains unclear whether these changes alter the course of disease in patients with acute (AP) and chronic pancreatitis (CP), or whether these disease states alter the environment to enable pathogenic microbial composition changes to occur. We undertook a systematic review to characterize the gut microbiome in pancreatitis patients. Methods: MEDLINE and EMBASE were searched for studies on microbiota in pancreatitis published from January 1, 2000 to June 5, 2020. Animal studies, reviews, case reports, and non-English articles were excluded. A frequency analysis was performed for outcomes reported in ≥2 studies and studies were analyzed for risk of bias and quality of evidence. Results: 22 papers met inclusion criteria; 15 included AP, 7 included CP. No studies were appropriately designed to assess whether alterations in the gut microbiome exacerbate pancreatitis or develop as a result of pancreatitis. We did identify several patterns of microbiome changes that are associated with pancreatitis. The gut microbiome demonstrated decreased alpha diversity in 3/3 A P studies and 3/3 C P studies. Beta diversity analysis revealed differences in bacterial community composition in the gut microbiome in 2/2 A P studies and 3/3 C P studies. Functionally, gut microbiome changes were associated with infectious pathways in AP and CP. Several studies suffered from high risk of bias and inadequate quality. Conclusions: Detecting differences in microbial composition associated with AP and CP may represent a diagnostic tool. Appropriately controlled longitudinal studies are needed to determine whether microbiome changes are causative or reactive in pancreatitis.
MeSH term(s)	Gastrointestinal Microbiome/physiology ; Humans ; Pancreatitis/metabolism ; Pancreatitis/microbiology ; Pancreatitis, Chronic/metabolism ; Pancreatitis, Chronic/microbiology
Language	English
Publishing date	2020-12-23
Publishing country	Switzerland
Document type	Journal Article ; Systematic Review
ZDB-ID	2056680-3
ISSN	1424-3911 ; 1424-3903
ISSN (online)	1424-3911
ISSN	1424-3903
DOI	10.1016/j.pan.2020.12.013
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Article ; Online: Factors associated with inability to return to intended oncologic treatment in pancreatic cancer.

Mickel, T Alston / Kutlu, Onur C / Silberfein, Eric J / Hsu, Cary / Chai, Christy Y / Fisher, William E / Van Buren, George / Camp, E Ramsay

American journal of surgery

2022 Volume 224, Issue 1 Pt B, Page(s) 635–640

Abstract: Background: Return to Intended Oncologic Treatment (RIOT) has been proposed as a quality metric in the care of cancer patients. We sought to define factors associated with inability to RIOT in Pancreatic Ductal Adenocarcinoma (PDAC) patients.: Methods! ...

Abstract	Background: Return to Intended Oncologic Treatment (RIOT) has been proposed as a quality metric in the care of cancer patients. We sought to define factors associated with inability to RIOT in Pancreatic Ductal Adenocarcinoma (PDAC) patients. Methods: The NCDB was queried for patients who underwent pancreaticoduodenectomy for pathologic stage IB, IIA, or IIB PDAC from 2010 to 2016. Multivariable binary logistic regression models identified factors associated with failure to RIOT, and Kaplan-Meier survival analysis and Cox multivariable regression models demonstrated the impact of failure to RIOT on survival. Results: Increasing age (p < .001), Hispanic race (p = .002), pathological stage IB (p = .004) and IIA (p = .001) as compared to IIB, increasing hospital stay (p < .001), and open surgical approach (p = .024) were associated with increased risk of inability to RIOT. Male sex (p < .001), Charlson-Deyo scores of 0 (p < .001) and 1 (p = .001) as compared to >2, negative surgical margins (p = .048), receiving care at academic institutions (p = .001), and increasing institutional case volume (p = .001) were associated with improved odds of RIOT. Conclusions: Patient features can impact RIOT and should be considered when designing multi-modality treatment strategies.
MeSH term(s)	Carcinoma, Pancreatic Ductal/surgery ; Humans ; Male ; Pancreatectomy ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Pancreatic Neoplasms
Language	English
Publishing date	2022-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.02.058
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Article: Pre-treatment inflamed tumor immune microenvironment is associated with FOLFIRINOX response in pancreatic cancer.

Gao, Zachary / Kang, Sung Wook / Erstad, Derek / Azar, Joseph / Van Buren, George / Fisher, William / Sun, Zequn / Rubinstein, Mark P / Lee, Hyun-Sung / Camp, E Ramsay

Frontiers in oncology

2023 Volume 13, Page(s) 1274783

Abstract: Introduction: Pancreatic adenocarcinoma (PDAC) is an aggressive tumor with limited response to both chemotherapy and immunotherapy. Pre-treatment tumor features within the tumor immune microenvironment (TiME) may influence treatment response. We ... ...

Abstract	Introduction: Pancreatic adenocarcinoma (PDAC) is an aggressive tumor with limited response to both chemotherapy and immunotherapy. Pre-treatment tumor features within the tumor immune microenvironment (TiME) may influence treatment response. We hypothesized that the pre-treatment TiME composition differs between metastatic and primary lesions and would be associated with response to modified FOLFIRINOX (mFFX) or gemcitabine-based (Gem-based) therapy. Methods: Using RNAseq data from a cohort of treatment-naïve, advanced PDAC patients in the COMPASS trial, differential gene expression analysis of key immunomodulatory genes in were analyzed based on multiple parameters including tumor site, response to mFFX, and response to Gem-based treatment. The relative proportions of immune cell infiltration were defined using CIBERSORTx and Dirichlet regression. Results: 145 samples were included in the analysis; 83 received mFFX, 62 received Gem-based therapy. Metastatic liver samples had both increased macrophage (1.2 times more, p < 0.05) and increased eosinophil infiltration (1.4 times more, p < 0.05) compared to primary lesion samples. Further analysis of the specific macrophage phenotypes revealed an increased M2 macrophage fraction in the liver samples. The pre-treatment CD8 T-cell, dendritic cell, and neutrophil infiltration of metastatic samples were associated with therapy response to mFFX (p < 0.05), while mast cell infiltration was associated with response to Gem-based therapy (p < 0.05). Multiple immunoinhibitory genes such as ADORA2A, CSF1R, KDR/VEGFR2, LAG3, PDCD1LG2, and TGFB1 and immunostimulatory genes including C10orf54, CXCL12, and TNFSF14/LIGHT were significantly associated with worse survival in patients who received mFFX (p = 0.01). There were no immunomodulatory genes associated with survival in the Gem-based cohort. Discussion: Our evidence implies that essential differences in the PDAC TiME exist between primary and metastatic tumors and an inflamed pretreatment TiME is associated with mFFX response. Defining components of the PDAC TiME that influence therapy response will provide opportunities for targeted therapeutic strategies that may need to be accounted for in designing personalized therapy to improve outcomes.
Language	English
Publishing date	2023-11-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.1274783
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Article: MUC1 Expressions and Its Prognostic Values in US Gastric Cancer Patients.

Kim, Young-Il / Pecha, Robert Luke / Keihanian, Tara / Mercado, Michael / Pena-Munoz, S Valeria / Lang, Kailash / Van Buren, George / Dhingra, Sadhna / Othman, Mohamed O

Cancers

2023 Volume 15, Issue 4

Abstract: This study aims to evaluate the prognostic value of MUC expression in US GC patients. A total of 70 tumor specimens were collected from GC patients who underwent surgery or endoscopic resection between 2013 and 2019 at a tertiary referral center in the ... ...

Abstract	This study aims to evaluate the prognostic value of MUC expression in US GC patients. A total of 70 tumor specimens were collected from GC patients who underwent surgery or endoscopic resection between 2013 and 2019 at a tertiary referral center in the US. MUC expression status including MUC1, MUC2, MUC5AC, and MUC6 was evaluated by immunohistochemical staining. The positive rates of MUC1, MUC2, MUC5AC, and MUC6 were 71.4%, 78.6%, 74.3%, and 33.3%, respectively. Patients with positive MUC1 expression had a significantly higher rate of aggressive pathologic features including diffuse-type cancer (42.0% vs. 0%;
Language	English
Publishing date	2023-02-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15040998
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Article ; Online: Pretreatment Health-Related Quality-of-Life Status and Survival in Pancreatobiliary Surgical Patients.

Manisundaram, Naveen / Portuondo, Jorge I / Erstad, Derek / Silberfein, Eric / Hsu, Cary / Barakat, Omar / Wood, Amy / Navarro-Cagigas, Martina / Van Buren, George / Fisher, William E / Camp, E Ramsay

Journal of the American College of Surgeons

2023 Volume 236, Issue 4, Page(s) 861–870

Abstract: Background: Pancreatobiliary (PB) disorders, especially cancer, negatively affect patients' health-related quality of life (HRQoL). However, the influence of baseline, preintervention HRQoL on perioperative and oncologic outcomes has not been well ... ...

Abstract	Background: Pancreatobiliary (PB) disorders, especially cancer, negatively affect patients' health-related quality of life (HRQoL). However, the influence of baseline, preintervention HRQoL on perioperative and oncologic outcomes has not been well defined. We hypothesized that low baseline HRQoL is associated with worse perioperative and long-term survival outcomes for PB surgical patients. Study design: Pretreatment Functional Assessment of Cancer Therapy - Hepatobiliary Survey results and clinical data from PB patients (2008 to 2016) from a single center's prospective database were analyzed. Survey responses were aggregated into composite scores and divided into quintiles. Patients in the highest quintile of HRQoL were compared to patients in the bottom four quintiles combined. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method. Logistic and Cox regressions were used to determine associations between quintiles of HRQoL scores and 30-day complications and long-term survival, respectively. Results: Of 162 patients evaluated, 99 had malignancy, and 63 had benign disease. Median follow-up was 31 months. Baseline HRQoL scores were similar for benign and malignant disease (p = 0.42) and were not associated with the development of any (p = 0.08) or major complications (p = 0.64). Patients with highest quintile HRQoL scores had improved 3-year OS (84.6 vs 61.7%, p = 0.03) compared to patients in the lowest four quintiles of HRQoL. Among cancer patients only, those with the highest quintile scores had improved 3-year OS (81.6 vs 47.4%, p = 0.02). On multivariable analysis, highest quintile HRQoL scores were associated with longer OS and DFS for patients with malignancy. Conclusions: Pretreatment HRQoL was associated with both OS and DFS among PB patients and might have prognostic utility. Future studies are necessary to determine whether patients with poorer HRQoL may benefit from targeted psychosocial interventions.
MeSH term(s)	Humans ; Quality of Life/psychology ; Prognosis ; Disease-Free Survival ; Progression-Free Survival ; Surveys and Questionnaires
Language	English
Publishing date	2023-01-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000549
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Article ; Online: Pancreaticoduodenectomy Without Drains: Interpretation of the Evidence.

Van Buren, George / Fisher, William E

Annals of surgery

2016 Volume 263, Issue 2, Page(s) e20–1

MeSH term(s)	Drainage/methods ; Female ; Humans ; Male ; Pancreaticoduodenectomy ; Postoperative Care/methods ; Postoperative Complications/prevention & control
Language	English
Publishing date	2016-02
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000001242
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Article ; Online: Pancreaticoduodenectomy Without Drains: Interpretation of the Evidence.

Van Buren, George / Fisher, William E

Annals of surgery

2016 Volume 263, Issue 5, Page(s) e74–6

MeSH term(s)	Drainage/methods ; Female ; Humans ; Male ; Pancreaticoduodenectomy ; Postoperative Care/methods ; Postoperative Complications/prevention & control
Language	English
Publishing date	2016-05
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000001152
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