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 College, Geisel School of Medicine

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
Role
Principal Investigator
Start Date
End Date

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

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:

Detailed Analysis of Margin Positivity and the Site of Local Recurrence After Pancreaticoduodenectomy.

BACKGROUND: The association between a positive surgical margin and local recurrence after resection of pancreatic adenocarcinoma (PDAC) has been reported. Assessment of the location of the a positive margin and the specific site of local recurrence has not been well described. METHODS: A prospectively maintained database was queried for patients who underwent R0/R1 pancreaticoduodenectomy for PDAC between 2000 and 2015. The pancreatic, posterior, gastric/duodenal, anterior peritoneal, and bile duct margins were routinely assessed. Postoperative imaging was reviewed for the site of first recurrence, and local recurrence was defined as recurrence located in the remnant pancreas, surgical bed, or retroperitoneal site outside the surgical bed. RESULTS: During the study period, 891 patients underwent pancreaticoduodenectomy, and 390 patients had an initial local recurrence with or without distant metastases. The 5-year cumulative incidence of local recurrence by site included the remnant pancreas (4%; 95% confidence interval [CI], 3-5%), the surgical bed (35%; 95% CI, 32-39%), and other regional retroperitoneal site (4%; 95% CI, 3-6%). In the univariate analysis, positive posterior margin (hazard ratio [HR], 1.50; 95% CI, 1.17-1.91; p = 0.001) and positive lymph nodes (HR, 1.36; 95% CI, 1.06-1.75; p = 0.017) were associated with surgical bed recurrence, and in the multivariate analysis, positive posterior margin remained significant (HR, 1.40; 95% CI, 1.09-1.81; p = 0.009). An isolated local recurrence was found in 197 patients, and a positive posterior margin was associated with surgical bed recurrence in this subgroup (HR, 1.51; 95% CI, 1.08-2.10; p = 0.016). CONCLUSION: In this study, the primary association between site of margin positivity and site of local recurrence was between the posterior margin and surgical bed recurrence. Given this association and the limited ability to modify this margin intraoperatively, preoperative assessment should be emphasized.
Authors
McIntyre, CA; Zambirinis, CP; Pulvirenti, A; Chou, JF; Gonen, M; Balachandran, VP; Kingham, TP; D'Angelica, MI; Brennan, MF; Drebin, JA; Jarnagin, WR; Allen, PJ
MLA Citation
McIntyre, Caitlin A., et al. “Detailed Analysis of Margin Positivity and the Site of Local Recurrence After Pancreaticoduodenectomy.Ann Surg Oncol, vol. 28, no. 1, Jan. 2021, pp. 539–49. Pubmed, doi:10.1245/s10434-020-08600-9.
URI
https://scholars.duke.edu/individual/pub1447018
PMID
32451945
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
539
End Page
549
DOI
10.1245/s10434-020-08600-9

Invasive central venous monitoring during hepatic resection: unnecessary for most patients.

BACKGROUND: Low central venous pressure (LCVP) anesthesia reduces blood loss during hepatic resection and historically has required a central venous catheter (CVC) for intra-operative monitoring. The aim of this study was to assess the effect of an evolution of practice to CVP monitoring without CVC on the perioperative outcomes after liver resection. METHODS: A retrospective study of partial hepatectomy patients from 2007 to 2016 who were over 18 years of age was performed. RESULTS: Of 3903 patients having partial hepatectomy, 2445 (62%) met inclusion criteria, and 404 (16%) had a CVC. Overall morbidity (33% non-CVC vs 38% CVC P = 0.076), major morbidity (16% vs 20% P = 0.067), and infective complications (superficial wound infection) 3% vs 4% P = 0.429; deep wound infection (5% vs 6% P = 0.720) did not differ between the two groups. In multivariate analysis, superficial wound infection, deep wound infection, and major complications were not associated with the presence of a CVC. All-cause mortality at 90 days was associated with CVC presence (OR 3.45, CI 1.74-6.85, P = 0.001) and age (OR 1.05, CI 1.02-1.08, P < 0.001). CONCLUSION: Since the adoption of non-invasive CVP monitoring, there has been no increase in adverse peri-operative outcomes.
Authors
O'Connor, DC; Seier, K; Gonen, M; McCormick, PJ; Correa-Gallego, C; Parker, B; Weiser, E; Balachandran, VP; Dematteo, RP; D'Angelica, M; Kingham, PT; Allen, PJ; Drebin, JA; Jarnagin, WR; Fischer, ME
MLA Citation
O’Connor, David C., et al. “Invasive central venous monitoring during hepatic resection: unnecessary for most patients.Hpb (Oxford), vol. 22, no. 12, Dec. 2020, pp. 1732–37. Pubmed, doi:10.1016/j.hpb.2020.03.020.
URI
https://scholars.duke.edu/individual/pub1440769
PMID
32336555
Source
pubmed
Published In
Hpb (Oxford)
Volume
22
Published Date
Start Page
1732
End Page
1737
DOI
10.1016/j.hpb.2020.03.020

The diagnosis and management of cystic lesions of the pancreas.

Cystic lesions of the pancreas are radiographic findings that have a very broad histologic differential. This differential spans the spectrum from benign to cancerous, and includes non-neoplastic pseudocysts, benign neoplastic cysts, pre-malignant cysts, and cystic lesions with invasive carcinoma. This chapter will highlight the challenges with diagnosis and management of patients who present with cystic neoplasms of the pancreas.
Authors
Allen, PJ
MLA Citation
Allen, Peter J. “The diagnosis and management of cystic lesions of the pancreas.Chin Clin Oncol, vol. 6, no. 6, Dec. 2017, p. 60. Pubmed, doi:10.21037/cco.2017.12.05.
URI
https://scholars.duke.edu/individual/pub1436118
PMID
29307200
Source
pubmed
Published In
Chin Clin Oncol
Volume
6
Published Date
Start Page
60
DOI
10.21037/cco.2017.12.05

Anatomy of the pancreas and biliary tree

Authors
Zambirinis, CP; Allen, PJ
MLA Citation
Zambirinis, C. P., and P. J. Allen. “Anatomy of the pancreas and biliary tree.” Surgical Diseases of the Pancreas and Biliary Tree, 2018, pp. 1–26. Scopus, doi:10.1007/978-981-10-8755-4_1.
URI
https://scholars.duke.edu/individual/pub1432488
Source
scopus
Published Date
Start Page
1
End Page
26
DOI
10.1007/978-981-10-8755-4_1

Is Hepatectomy Justified for BRAF Mutant Colorectal Liver Metastases?: A Multi-institutional Analysis of 1497 Patients.

OBJECTIVE: To analyze clinical outcomes and prognostic variables of patients undergoing hepatic resection for BRAF mutant (BRAF-mut) colorectal liver metastases (CRLM). BACKGROUND: Outcomes following hepatectomy for BRAF-mut CRLM have not been well studied. METHODS: All patients who underwent hepatectomy for CRLM with complete resection and known BRAF status during 2001 to 2016 at 3 high-volume centers were analyzed. RESULTS: Of 4124 patients who underwent hepatectomy for CRLM, 1497 had complete resection and known BRAF status. Thirty-five (2%) patients were BRAF-mut, with 71% of V600E mutation. Compared with BRAF wild-type (BRAF-wt), BRAF-mut patients were older, more commonly presented with higher ASA scores, synchronous, multiple and smaller CRLM, underwent more major hepatectomies, but had less extrahepatic disease. Median overall survival (OS) was 81 months for BRAF-wt and 40 months for BRAF-mut patients (P < 0.001). Median recurrence-free survival (RFS) was 22 and 10 months for BRAF-wt and BRAF-mut patients (P < 0.001). For BRAF-mut, factors associated with worse OS were node-positive primary tumor, carcinoembryonic antigen (CEA) >200 μg/L, and clinical risk score (CRS) ≥4. Factors associated with worse RFS were node-positive primary tumor, ≥4 CRLM, and positive hepatic margin. V600E mutations were not associated with worse OS or RFS. A case-control matching analysis on prognostic clinicopathologic factors confirmed shorter OS (P < 0.001) and RFS (P < 0.001) in BRAF-mut. CONCLUSIONS: Patients with resectable BRAF-mut CRLM are rare among patients selected for surgery and more commonly present with multiple synchronous tumors. BRAF mutation is associated with worse prognosis; however, long-term survival is possible and associated with node-negative primary tumors, CEA ≤ 200 μg/L and CRS < 4.
Authors
Gagnière, J; Dupré, A; Gholami, SS; Pezet, D; Boerner, T; Gönen, M; Kingham, TP; Allen, PJ; Balachandran, VP; De Matteo, RP; Drebin, JA; Yaeger, R; Kemeny, NE; Jarnagin, WR; D'Angelica, MI
MLA Citation
Gagnière, Johan, et al. “Is Hepatectomy Justified for BRAF Mutant Colorectal Liver Metastases?: A Multi-institutional Analysis of 1497 Patients.Ann Surg, vol. 271, no. 1, Jan. 2020, pp. 147–54. Pubmed, doi:10.1097/SLA.0000000000002968.
URI
https://scholars.duke.edu/individual/pub1427003
PMID
29995686
Source
pubmed
Published In
Ann Surg
Volume
271
Published Date
Start Page
147
End Page
154
DOI
10.1097/SLA.0000000000002968