Peter Allen

Positions:

Professor of Surgery

Surgical Oncology
School of Medicine

Chief, Division of Surgical Oncology

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1989

Harvard University

M.D. 1993

Dartmouth Medical School

Surgical Intern, Surgery

Walter Reed Army Medical Center

Surgical Resident, Surgery

Walter Reed Army Medical Center

Research Fellow

Memorial Sloan Kettering Cancer Center

Surgical Oncology Fellow, Surgery

Memorial Sloan Kettering Cancer Center

Grants:

Biomarker validation for intraductal papillary mucinous neoplasms of the pancreas

Administered By
Surgical Oncology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Preventing an Incurable Disease: The Prevention of Progression to Pancreatic Cancer Trial (The 3P-C Trial)

Administered By
Surgical Oncology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Detection and Prognosis of Early-stage Pancreatic Cancer by Interdependent Plasma Markers

Administered By
Surgical Oncology
Awarded By
Van Andel Research Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Lending a hand for laparoscopic distal pancreatectomy: the optimal approach?

© 2019 International Hepato-Pancreato-Biliary Association Inc. Background: Both minimally invasive surgery (MIS) and open approaches for distal pancreatectomy are acceptable. MIS options include total laparoscopic/robotic (TLR) and hand-assist laparoscopy (HAL). When considering safety profile and specimen quality, the optimal approach is unknown. Methods: Patients who underwent distal pancreatectomy from 2010-2018 at two major academic institutions were included. Converted procedures were categorized into final approach. Ninety-day perioperative/pathologic outcomes of MIS and open were compared. Subset analyses between TLR vs HAL and HAL vs open were performed. Intent-to-treat analysis was performed. Results: Among 1006 patients, resection was performed by MIS in 35% (n = 352), open in 65% (n = 654). MIS had similar patient comorbidity profile as open but had increased operative time (183 vs 162 min; p < 0.01), lower estimated-blood-loss (EBL; 131 vs 341 mL; p < 0.01), fewer intraoperative blood transfusions (1.4 vs 5%; p < 0.01), shorter LOS (5.2 vs 7.2 days; p < 0.01). Tumor size was smaller (3.2 vs 4.4 cm; p < 0.01) with lower lymph node (LN) yield (14 vs 16; p < 0.01). When comparing HAL (n = 109) to TLR (n = 243), despite increased prior abdominal operations (60 vs 43%; p = 0.008), HAL had shorter operative time (167 vs 191 min; p < 0.01), similar length-of-stay (LOS; 5.4 vs 5.1 days; p = 0.27), and readmission rate (15 vs 13%; p = 0.47). When comparing HAL to open, the advantages of TLR approach persisted including lower EBL (171 vs 342 mL; p < 0.01), and shorter LOS (5.4 vs 7.2 days; p < 0.01). Although HAL had smaller tumors, it had a similar LN yield (16 vs 16; p = 0.80), and higher R0-rate (97 vs 83%; p < 0.01). Conclusion: Hand-assist laparoscopy is safe and feasible for distal pancreatectomy as operative time, complication profile, lymph node yield, and R0-rates are similar to open procedures, while maintaining the associated the advantages of a total laparoscopic/robotic approach with reduced blood loss and shorter length-of-stay.
Authors
Gamboa, AC; Aveson, VG; Zaidi, MY; Lee, RM; Jarnagin, WR; Allen, PJ; Drebin, JA; Peter Kingham, T; DeMatteo, RP; Sarmiento, JM; Russell, MC; Cardona, K; Kooby, DA; D'Angelica, MI; Maithel, SK
MLA Citation
Gamboa, A. C., et al. “Lending a hand for laparoscopic distal pancreatectomy: the optimal approach?.” Hpb, Jan. 2019. Scopus, doi:10.1016/j.hpb.2019.09.007.
URI
https://scholars.duke.edu/individual/pub1415155
Source
scopus
Published In
Hpb : the Official Journal of the International Hepato Pancreato Biliary Association
Published Date
DOI
10.1016/j.hpb.2019.09.007

Multi-institutional Development and External Validation of a Nomogram to Predict Recurrence after Curative Resection of Pancreatic Neuroendocrine Tumors

© 2019 Lippincott Williams and Wilkins. All rights reserved. Objective: To develop a nomogram estimating the probability of recurrence free at 5 years after resection for localized grade 1 (G1)/ grade 2 (G2) pancreatic neuroendocrine tumors (PanNETs). Background: Among patients undergoing resection of PanNETs, approximately 17% experience recurrence. It is not established which patients are at risk, with no consensus on optimal follow-up. Method: A multi-institutional database of patients with G1/G2 PanNETs treated at 2 institutions was used to develop a nomogram estimating the rate of freedom from recurrence at 5 years after curative resection. A second cohort of patients from 3 additional institutions was used to validate the nomogram. Prognostic factors were assessed by univariate analysis using Cox regression model. The nomogram was internally validated using bootstrap resampling method and on the external cohort. Performance was assessed by concordance index (c-index) and a calibration curve. Results: The nomogram was constructed using a cohort of 632 patients. Overall, 68% of PanNETs were G1, the median follow-up was 51 months, and we observed 74 recurrences. Variables included in the nomogram were the number of positive nodes, tumor diameter, Ki-67, and vascular/perineural invasion. The model bias-corrected c-index from the internal validation was 0.85, which was higher than European Neuroendocrine Tumors Society/American Joint Committee on Cancer 8th staging scheme (c-index 0.76, P = <0.001). On the external cohort of 328 patients, the nomogram c-index was 0.84 (95% confidence interval 0.79-0.88). Conclusion: Our externally validated nomogram predicts the probability of recurrence-free survival at 5 years after PanNETs curative resection, with improved accuracy over current staging systems. Estimating individual recurrence risk will guide the development of personalized surveillance programs after surgery.
Authors
Pulvirenti, A; Javed, AA; Landoni, L; Jamieson, NB; Chou, JF; Miotto, M; He, J; Gonen, M; Pea, A; Tang, LH; Nessi, C; Cingarlini, S; D'Angelica, MI; Gill, AJ; Kingham, TP; Scarpa, A; Weiss, MJ; Balachandran, VP; Samra, JS; Cameron, JL; Jarnagin, WR; Salvia, R; Wolfgang, CL; Allen, PJ; Bassi, C
MLA Citation
Pulvirenti, A., et al. “Multi-institutional Development and External Validation of a Nomogram to Predict Recurrence after Curative Resection of Pancreatic Neuroendocrine Tumors.” Annals of Surgery, Jan. 2019. Scopus, doi:10.1097/SLA.0000000000003579.
URI
https://scholars.duke.edu/individual/pub1415156
Source
scopus
Published In
Annals of Surgery
Published Date
DOI
10.1097/SLA.0000000000003579

Histopathological growth patterns and positive margins after resection of colorectal liver metastases.

BACKGROUND: Histopathological growth patterns (HGPs) of colorectal liver metastases (CRLM) may be an expression of biological tumour behaviour impacting the risk of positive resection margins. The current study aimed to investigate whether the non-desmoplastic growth pattern (non-dHGP) is associated with a higher risk of positive resection margins after resection of CRLM. METHODS: All patients treated surgically for CRLM between January 2000 and March 2015 at the Erasmus MC Cancer Institute and between January 2000 and December 2012 at the Memorial Sloan Kettering Cancer Center were considered for inclusion. RESULTS: Of all patients (n = 1302) included for analysis, 13% (n = 170) had positive resection margins. Factors independently associated with positive resection margins were the non-dHGP (odds ratio (OR): 1.79, 95% confidence interval (CI): 1.11-2.87, p = 0.016) and a greater number of CRLM (OR: 1.15, 95% CI: 1.08-1.23 p < 0.001). Both positive resection margins (HR: 1.41, 95% CI: 1.13-1.76, p = 0.002) and non-dHGP (HR: 1.57, 95% CI: 1.26-1.95, p < 0.001) were independently associated with worse overall survival. CONCLUSION: Patients with non-dHGP are at higher risk of positive resection margins. Despite this association, both positive resection margins and non-dHGP are independent prognostic indicators of worse overall survival.
Authors
Nierop, PMH; Höppener, DJ; van der Stok, EP; Galjart, B; Buisman, FE; Balachandran, VP; Jarnagin, WR; Kingham, TP; Allen, PJ; Shia, J; Vermeulen, PB; Groot Koerkamp, B; Grünhagen, DJ; Verhoef, C; D'Angelica, MI
MLA Citation
Nierop, Pieter M. H., et al. “Histopathological growth patterns and positive margins after resection of colorectal liver metastases..” Hpb (Oxford), Nov. 2019. Pubmed, doi:10.1016/j.hpb.2019.10.015.
URI
https://scholars.duke.edu/individual/pub1422753
PMID
31735649
Source
pubmed
Published In
Hpb (Oxford)
Published Date
DOI
10.1016/j.hpb.2019.10.015

Assessment of Hepatic Arterial Infusion of Floxuridine in Combination With Systemic Gemcitabine and Oxaliplatin in Patients With Unresectable Intrahepatic Cholangiocarcinoma: A Phase 2 Clinical Trial.

Importance: Unresectable intrahepatic cholangiocarcinoma (IHC) carries a poor prognosis, with a median overall survival (OS) of 11 months. Hepatic arterial infusion (HAI) of high-dose chemotherapy may have potential benefit in these patients. Objective: To evaluate clinical outcomes when HAI chemotherapy is combined with systemic chemotherapy in patients with unresectable IHC. Design, Setting, and Participants: A single-institution, phase 2 clinical trial including 38 patients was conducted with HAI floxuridine plus systemic gemcitabine and oxaliplatin in patients with unresectable IHC at Memorial Sloan Kettering Cancer Center between May 20, 2013, and June 27, 2019. A confirmatory phase 1/2 study using the same therapy was conducted during the same time period at Washington University in St Louis. Patients with histologically confirmed, unresectable IHC were eligible. Resectable metastatic disease to regional lymph nodes and prior systemic therapy were permitted. Patients with distant metastatic disease were excluded. Interventions: Hepatic arterial infusion of floxuridine and systemic administration of gemcitabine and oxaliplatin. Main Outcomes and Measures: The primary outcome was progression-free survival (PFS) of 80% at 6 months. Results: For the phase 2 clinical trial at Memorial Sloan Kettering Cancer Center, 42 patients with unresectable IHC were included and, of these, 38 patients were treated (13 [34%] men; median [range] age at diagnosis, 64 [39-81] years). The median follow-up was 30.5 months. Twenty-two patients (58%) achieved a partial radiographic response, and 32 patients (84%) achieved disease control at 6 months. Four patients had sufficient response to undergo resection, and 1 patient had a complete pathologic response. The median PFS was 11.8 months (1-sided 90% CI, 11.1) with a 6-month PFS rate of 84.1% (90% CI, 74.8%-infinity), thereby meeting the primary end point (6-month PFS rate, 80%). The median OS was 25.0 months (95% CI, 20.6-not reached), and the 1-year OS rate was 89.5% (95% CI, 80.2%-99.8%). Patients with resectable regional lymph nodes (18 [47%]) showed no difference in OS compared with patients with node-negative disease (24-month OS: lymph node negative: 60%; 95% CI, 40%-91% vs lymph node positive: 50%; 95% CI, 30%-83%; P = .66). Four patients (11%) had grade 4 toxic effects requiring removal from the study (1 portal hypertension, 2 gastroduodenal artery aneurysms, 1 infection in the pump pocket). Subgroup analysis showed significant improvement in survival in patients with IDH1/2 mutated tumors (2-year OS, 90%; 95% CI, 73%-99%) vs wild-type (2-year OS, 33%; 95% CI, 18%-63%) (P = .01). In the Washington University in St Louis confirmatory cohort, 9 patients (90%) achieved disease control at 6 months; the most common grade 3 toxic effect was elevated results of liver function tests, and median PFS was 12.8 months (1-sided 90% CI, 6.4). Conclusions and Relevance: Hepatic arterial infusion plus systemic chemotherapy appears to be highly active and tolerable in patients with unresectable IHC; further evaluation is warranted.
Authors
Cercek, A; Boerner, T; Tan, BR; Chou, JF; Gönen, M; Boucher, TM; Hauser, HF; Do, RKG; Lowery, MA; Harding, JJ; Varghese, AM; Reidy-Lagunes, D; Saltz, L; Schultz, N; Kingham, TP; D'Angelica, MI; DeMatteo, RP; Drebin, JA; Allen, PJ; Balachandran, VP; Lim, K-H; Sanchez-Vega, F; Vachharajani, N; Majella Doyle, MB; Fields, RC; Hawkins, WG; Strasberg, SM; Chapman, WC; Diaz, LA; Kemeny, NE; Jarnagin, WR
URI
https://scholars.duke.edu/individual/pub1421449
PMID
31670750
Source
pubmed
Published In
Jama Oncol
Published Date
DOI
10.1001/jamaoncol.2019.3718

Prediction of Recurrence Patterns from Hepatic Parenchymal Disease After Resection of Colorectal Liver Metastases.

BACKGROUND: Obesity and metabolic syndrome are associated with inflammatory hepatic parenchymal disease (HPD) and increased risk for recurrence after resection of colorectal liver metastases (CRLM). The independent impact of HPD on recurrence patterns has not been well defined. METHODS: The nonalcoholic fatty liver disease activity score (NAS) was used to quantify HPD including steatosis and fibrosis for all patients with completely resected CRLM between April 2003 and March 2007. Clinicopathologic factors, perioperative history, and outcomes were compared with the NAS. Fisher's exact test was used to examine the association between severe HPD (NAS ≥ 3) with clinical and perioperative characteristics. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS). The cumulative incidences of recurrence [any intrahepatic recurrence (IHR), extrahepatic recurrence only (EHR), and death without recurrence (DWR)] were estimated using competing risks methods. RESULTS: Among the 357 patients included in this study, microsteatosis was noted in 124 (35%) patients, severe HPD in 31 (9%), steatohepatitis in 14 (4%), and sinusoidal injury in 36 (10%). After median follow-up of 127 months (range 4-175 months), 10-year RFS was 22% [95% confidence interval (CI) 17-27%]. Ten-year cumulative incidence for IHR, EHR, and DWR was 37%, 30%, and 12%, respectively. After controlling for confounders, NAS ≥ 3 was independently associated with higher risk of IHR [hazard ratio (HR) 1.76, 95% CI 1.07-2.90, p = 0.027] and lower risk of EHR (HR 0.18, 95% CI 0.04-0.75, p = 0.019) on multivariable analysis. CONCLUSIONS: Severe HPD was associated with increased IHR risk and decreased EHR risk. Future investigation into whether improving HPD from reversible etiologies can reduce the risk for IHR is warranted.
Authors
Narayan, RR; Harris, JW; Chou, JF; Gönen, M; Bao, F; Shia, J; Allen, PJ; Balachandran, VP; Drebin, JA; Jarnagin, WR; Kemeny, NE; Kingham, TP; D'Angelica, MI
MLA Citation
Narayan, Raja R., et al. “Prediction of Recurrence Patterns from Hepatic Parenchymal Disease After Resection of Colorectal Liver Metastases..” Ann Surg Oncol, Oct. 2019. Pubmed, doi:10.1245/s10434-019-07934-3.
URI
https://scholars.duke.edu/individual/pub1417873
PMID
31617122
Source
pubmed
Published In
Annals of Surgical Oncology
Published Date
DOI
10.1245/s10434-019-07934-3