Publications by authors named "Greg Sacks"
Background: To improve outcomes for patients with pancreatic ductal adenocarcinoma, a complete resection is crucial. However, evidence regarding the impact of microscopically positive surgical margins (R1) on recurrence is conflicting due to varying definitions and limited populations of patients with borderline-resectable and locally advanced pancreatic cancer. Therefore, we aimed to determine the impact of the resection margin status on recurrence and survival in patients with pancreatic ductal adenocarcinoma stratified by local tumor stage.
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- This study investigates early recurrence in patients with pancreatic ductal adenocarcinoma (PDAC) derived from intraductal papillary mucinous neoplasm (IPMN), aiming to identify predictors to help guide patient management.
- The research found that early recurrence is defined as occurring within 10.5 months post-surgery, affecting 38% of patients who experienced recurrence, with CA19-9 levels and N2 disease being significant predictors.
- Adjuvant chemotherapy showed a survival advantage only for high-risk patients, highlighting the importance of risk stratification for better treatment outcomes.
Background: The National Comprehensive Cancer Network guidelines consider pancreatic cancer with celiac axis (CA), proper hepatic artery (PHA), and superior mesenteric artery (SMA) involvement unresectable. Thus, technical reports and video illustrations of these operations are rare. We report the stepwise management of multivascular reconstruction for Mayo Clinic class IIIb CA resections at New York University Langone Health, a dedicated center of excellence in pancreatic surgery.
View Article and Find Full Text PDFBackground: The existence of sociodemographic disparities in pancreatic cancer has been well-studied but how these disparities have changed over time is unclear. The purpose of this study was to longitudinally assess patient management in the context of sociodemographic factors to identify persisting disparities in pancreatic cancer care.
Methods: Using the National Cancer Database, patients diagnosed with pancreatic ductal adenocarcinoma from 2010 to 2017 were identified.
Objectives: To evaluate patient preferences for decision-making role in the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and to identify individual characteristics associated with those preferences.
Background: Management of IPMNs is rooted in uncertainty with current guidelines failing to incorporate patients' preferences and values.
Methods: A representative sample of participants aged 40-70 were recruited to evaluate a clinical vignette where they were given the option to undergo surveillance or surgical resection of their IPMN.
Purpose: Dynamics of carbohydrate antigen 19-9 (CA19-9) often inform treatment decisions during and after neoadjuvant chemotherapy (NAT) of patients with pancreatic ductal adenocarcinoma (PDAC). However, considerable dispute persists regarding the clinical relevance of specific CA19-9 thresholds and dynamics. Therefore, we aimed to define optimal thresholds for CA19-9 values and create a biochemically driven composite score to predict survival in CA19-9-producing patients with PDAC after NAT.
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- The study aimed to establish a cancer risk threshold (CRT) for patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) to determine when surgery is preferable to surveillance.
- A decision model was used to assess the quality-adjusted life years (QALYs) for hypothetical patients with varying factors like age, comorbidities, and lesion location.
- Results indicated that surgery was slightly favored over surveillance in a typical case, with the CRT differing based on patient specifics, suggesting a need for personalized treatment guidelines.
Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic premalignant lesions frequently detected incidentally. Choosing between surgery and surveillance for IPMNs is rooted in uncertainty. We characterized patient preferences in IPMN management, and examined associations with patients' uncertainty profiles (risk perception, risk attitude, and uncertainty tolerance).
View Article and Find Full Text PDFObjective: To assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section.
Summary Background Data: The ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable.
Background: Little is known about the prognostic significance of pancreatic duct (PD) dilation following pancreatoduodenectomy for intraductal papillary mucinous neoplasms (IPMN). Although PD dilation is typically the hallmark radiographic feature of IPMN, other causes of PD dilation exist, including anastomotic stricture, pancreatitis, senescence, and postsurgical passive dilation. Therefore, PD dilation after pancreatoduodenectomy for IPMN represents a diagnostic and management dilemma.
View Article and Find Full Text PDFBackground And Aim: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) management is generally extrapolated from pancreatic intraepithelial neoplasia (PanIN)-derived PDAC guidelines. However, these are biologically divergent, and heterogeneity further exists between tubular and colloid subtypes.
Methods: Consecutive upfront surgery patients with PanIN-derived and IPMN-derived PDAC were retrospectively identified from international centers (2000-2019).
Article Synopsis
- Researchers studied a classification system called T1 sub-staging for IPMN-derived pancreatic ductal adenocarcinoma (PDAC), aiming to better understand its characteristics compared to other types of PDAC.
- The study involved 747 surgery patients and found that increased T-stages correlated with worse overall survival, more advanced disease features, and higher recurrence rates.
- The findings support the validity of T1 sub-staging, indicating that higher sub-stages relate to poorer outcomes and suggesting its importance in clinical assessments.
Article Synopsis
- - The study investigates the effects of different surgical procedures (pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy) on outcomes for patients with pancreatic neck tumors, finding similar rates of successful tumor removal (R0-resection) across these methods.
- - Among 846 patients analyzed, results showed significant differences in lymph node involvement and the number of lymph nodes examined, with total pancreatectomy associated with worse survival rates compared to pancreatoduodenectomy.
- - The findings suggest that while distal pancreatectomy may lead to inadequate lymph node removal, this did not adversely affect patient survival, indicating that total pancreatectomy does not provide additional survival benefits over partial resections.
Background Objectives: The aim of this study was to determine the role of site-specific metastatic patterns over time and assess factors associated with extended survival in metastatic PDAC. Half of all patients with pancreatic ductal adenocarcinoma (PDAC) present with metastatic disease. The site of metastasis plays a crucial role in clinical decision making due to its prognostic value.
View Article and Find Full Text PDFObjective: We aimed to better understand patients' treatment preferences and quantify the level of cancer risk at which treatment preferences change (risk threshold) to inform better counseling of patients with intraductal papillary mucinous neoplasms (IPMNs).
Summary Background Data: The complexity of IPMN management provides an opportunity to align treatment with individual preference.
Methods: We surveyed a sample of healthy volunteers simulating a common scenario: undergoing an imaging study that incidentally identifies an IPMN.
Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death. Approximately 20-30% of patients will develop hepatic metastasis in the form of synchronous or metachronous disease. The treatment of colorectal liver metastasis (CRLM) has evolved into a multidisciplinary approach, with chemotherapy and a variety of locoregional treatments, such as ablation and portal vein embolization, playing a crucial role.
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- * A study of 342 PDAC patients showed that 57.3% experienced recurrence, often within 11.3 months, with different survival rates depending on the recurrence site, notably lung involvement correlating with longer survival.
- * Findings suggest that while most patients face poor survival post-recurrence, some with local-only recurrence may survive longer, especially those with favorable tumor characteristics, indicating they might benefit from possible curative re-resections.
Objectives: We aimed to determine whether surgeon variation in management of intraductal papillary mucinous neoplasm (IPMN) is driven by differences in risk perception and quantify surgeons' risk threshold for changing their recommendations.
Background: Surgeons vary widely in management of IPMN.
Methods: We conducted a survey of members of the Americas HepatoPancreatoBiliary Association, presented participants with 2 detailed clinical vignettes and asked them to choose between surgical resection and surveillance.
Introduction: There is no consensus regarding the role of primary tumor resection for patients with metastatic pancreatic neuroendocrine tumors (panNET). We assessed surgical treatment patterns and evaluated the survival impact of primary tumor resection in patients with metastatic panNET.
Methods: Patients with synchronous metastatic nonfunctional panNET in the National Cancer Database (2004-2016) were categorized based on whether they underwent primary tumor resection.
Objective: We aimed to determine whether surgeon variation in management of intraductal papillary mucinous neoplasms (IPMN) is driven by differences in risk perception and quantify surgeons' risk threshold for changing their recommendations.
Background: Surgeons vary widely in management of IPMN.
Methods: We conducted a survey of members of the Americas HepatoPancreatoBiliary Association, presented participants with 2 detailed clinical vignettes and asked them to choose between surgical resection and surveillance.
Background: Time to treatment (TTT) varies widely for patients with gastric cancer. We aimed to evaluate relationships between time to treatment, overall survival (OS), and other surgical outcomes in patients with stage I-III gastric cancer.
Methods: We identified patients with clinical stage I-III gastric cancer who underwent curative-intent gastrectomy within the National Cancer Database (2006-2015) and grouped them by treatment sequence: neoadjuvant chemotherapy or surgery upfront.
Objective: To evaluate long-term oncologic outcomes of patients with stage IV pancreatic ductal adenocarcinoma and to identify survival benchmarks for comparison when considering resection in these patients.
Background: Highly selected cohorts of patients with liver-oligometastatic pancreas cancer have reported prolonged survival after resection. The long-term impact of surgery in this setting remains undefined because of a lack of appropriate control groups.