Washington University HPB-GI surgeons have established a legacy of pioneering treatment for disorders of the liver, pancreas and biliary tract. This section is a high-volume national referral center for open and laparoscopic surgical procedures to treat patients with benign and malignant disorders of the liver, biliary tree, pancreas, stomach, small intestine and retroperitoneum. Faculty are at the forefront of research on new and improved therapies for HPB-GI disorders with active research laboratories, pre-clinical studies and clinical trials. This section also offers a one-year HPB-GI surgery fellowship to train the next generation of leaders in HPB-GI surgery.
Section of Hepatobiliary-Pancreatic and GI Surgery | 2022 Annual Report
An ongoing clinical trial lead by Washington University HPB-GI investigators is studying the use of personalized vaccines to treat pancreas cancer. This trial seeks to evaluate the safety of an optimized neoantigen synthetic long peptide (SLP) vaccine in patients following chemotherapy but prior to surgery. In its first phase, the trial will involve an estimated 30 participants with newly diagnosed cases of pancreatic cancer. The vaccines will be provided on a patient-specific basis after chemotherapy but before undergoing surgery.
The population of sick and elderly patients in the United States is rapidly growing. Studies show patients over the age of 65 account for a third of the surgical patient population, and this number is expected to rise. A majority of Americans over 65 have at least one chronic comorbidity, and many of them have multiple of these conditions. A recent study found the Surgical Prehabilitation and Readiness (SPAR) program at Washington University School of Medicine in St. Louis has led to a reduction in postoperative length of stay and improved outcomes for such elderly patients.
Natasha Leigh, MD, joins the HPB-GI faculty as an assistant professor of surgery. Leigh earned her bachelor of medicine and surgery at the University of Birmingham School of Medicine in England, then completed general surgery residency at Mount Sinai St. Luke’s Roosevelt Hospital. Before joining the faculty, Leigh completed HPB fellowship training at Washington University. Leigh has served as a clinical research fellow, has been widely published throughout her career and has extensive experience in minimally invasive and robotic HPB surgery. In a specialty known for complex, demanding procedures, Leigh is a skilled surgeon committed to her patients. She also serves as a role model whose mentorship will help develop a new generation of HPB surgeons.
A novel combination of drugs–including a molecule first designed and synthesized at Washington University–could revolutionize the treatment of pancreatic cancer and other cancers. Research from the laboratory of Section Chief of HPB-GI Surgery William Hawkins, MD, the Neidorff Family and Robert C. Packman Professor, suggests the molecule ACxT and the drug Trametinib can cause metabolic collapse of cancer cells, even in low doses. General surgery resident Kenneth Newcomer, MD, received the Basic and Translational Research Award for his presentation of these critical findings at this year’s Samuel A. Wells Jr. Research Day Competition. Newcomer and Hawkins aim to introduce a clinical trial for this treatment regimen.
In 2006, the section established a one-year clinical fellowship for graduates of accredited general surgery training programs. The fellowship has since attracted fellows from around the world, demonstrating the level of expertise and international reputation of Washington University HPB surgery. Current fellow Brittany Greene, MD, MSc, came to Washington University from University of Toronto, where she completed general surgery residency training. Past trainees have come from England, Mexico, New Zealand, Ireland and other countries. “Our section publishes widely and presents research at national and international meetings; as such, we continue to attract some of the best fellows from around the world in an environment where fellows can thrive,” says section chief William Hawkins, MD.
Personalizing Pancreas Cancer Care
An ongoing clinical trial lead by Washington University HPB-GI investigators is studying the use of personalized vaccines to treat pancreas cancer. This trial seeks to evaluate the safety of an optimized neoantigen synthetic long peptide (SLP) vaccine in patients following chemotherapy but prior to surgery.
In its first phase, the trial will involve an estimated 30 participants with newly diagnosed cases of pancreatic cancer. The vaccines will be provided on a patient-specific basis after chemotherapy but before undergoing surgery. Any adverse events will be recorded over the course of the trial to measure the safety of the SLP vaccines, and the immunogenicity of the vaccines will be measured by recording the number of neoantigen-specific T-cells present over a period of 2 years and 78 days.
Prior studies, including the cancer vaccine work of Vice-Chair for Research William Gillanders, MD, have investigated the possibility of vaccines that utilize the patient’s unique genetic makeup and the genetics of the tumor to craft a personalized treatment targeting cancer cells. This trial will also complement the R01 grant-funded research of Washington University Assistant Professor of Surgery Dirk Spitzer, PhD, which seeks to develop of a drug that causes tumor-selective cell death.
This study, part of the Specialized Programs of Research Excellence (SPORE) in pancreatic cancer at Siteman Cancer Center, is projected to be completed in the fall of 2027.
“We are studying these vaccines in a new space,” says Chief of Hepatobiliary-Pancreatic and Gastrointestinal Surgery William Hawkins, MD, who is director of the Pancreas SPORE. “We are using vaccines before surgery, giving the immune system a chance to see the tumor and a chance to try out its newfound T cells against the existing tumor. Then, when we remove the tumor during surgery, we can do a deeper scientific look into what makes an effective immune response against tumors.”
The trial, funded by a grant through NCI and industry partnership with biomedical research company Leidos, expands upon promising results from past trials. Gillanders, the William K. Bixby Professor of surgery, serves as principal investigator for the trial, partnered with sub-investigators including Hawkins, the Neidorff Family and Robert C. Packman Professor of Surgery. Felicia Zhang, MD, a general surgery resident, will contribute to the basic science behind the trial during her two years of research in the Hawkins laboratory. Collectively, the investigators seek to create new, personalized therapies for pancreatic cancer.
Optimizing Outcomes Before Surgery
The population of sick and elderly patients in the United States is rapidly growing. Studies show patients over the age of 65 account for a third of the surgical patient population, and this number is expected to rise. A majority of Americans over 65 have at least one chronic comorbidity, and many of them have multiple of these conditions. When an elderly patient requires major surgery, these comorbidities pose a significant barrier to quality outcomes.
A recent study found the Surgical Prehabilitation and Readiness (SPAR) program at Washington University School of Medicine in St. Louis has led to a reduction in postoperative length of stay and improved outcomes for such elderly patients. Rather than focusing on recovery and rehabilitation after a procedure, “prehabilitation” targets the preoperative period to offer patients functional capacity and optimize them for surgery.
Led by Washington University HPB-GI surgeon Dominic Sanford, MD, MPHS, the recent SPAR study focused on patients over 70 who were scheduled for inpatient surgery. For two weeks, the patients underwent holistic prehabilitation including physical activity, lung strengthening, healthy diet and mental health practices. Sanford and team found that preoperative interventions can improve patient outcomes, especially in complex HPB and oncologic surgery procedures. SPAR was rolled out to specialties across the department over the past year, and physicians have already seen improvements for participating patients.
“With increased age comes decreased functional status, and this translates into increased postoperative morbidity and mortality,” says Heidi Cos, MD, a general surgery resident involved in the SPAR study. Preoperative physical assessment, fitness, physical activity, nutritional status, anxiety and depression have been identified as predicting factors for surgical outcomes that are potentially modifiable.”
The study compared postoperative results of SPAR patients to data from the American College of Surgeons National Surgical Quality Improvement Program database. When implemented among a group of 100 patients with high frailty risks, participation in and compliance with the SPAR program led to a decreased median of hospital stays and a decrease in discharges to further rehabilitation facilities postoperatively. These results open doors for further study and implementation of the SPAR program to ease the process of surgery and recovery for high-risk patients across the department.
“The SPAR program has unlimited potential. We think it will improve almost every measurable outcome we can consider,” says Ryan Fields, MD, the Kim and Tim Eberlein Distinguished Professor, who has implemented SPAR in the Section of Surgical Oncology.