John Kunstman
Research & Publications
Biography
News
Research Summary
I maintain an active research program at Yale examining the development of such pancreatic cystic neoplasms as well as the genetics of associated pancreatic cancers. I also conduct clinical research seeking to improve the outcomes of patients undergoing pancreatic surgery.
Extensive Research Description
As a surgeon, it is my goal to improve the survivorship of patients affected by pancreatic neoplasms, which requires timely detection and management of these diverse tumors. Thus, as a scientist, my research efforts are focused on early detection and better characterization of precursor lesions within the pancreas, enabling better access to potentially curative treatment. Clinical management of such lesions is controversial and objective data to guide decision-making is notably lacking. Currently, we are performing a two-part project in examining intraductal papillary mucinous neoplasms, the precursor lesion for 15-20% of invasive pancreas cancers. We are seeking markers at the single-cell level to understand the mechanism by which some of these lesions progress to cancer while others remain benign and are also attempting to define the genetic characteristics of patients that exhibit a cyst-forming phenotype, as they are a uniquely at-risk population for developing pancreas cancer.
Our clinical research is focused on optimizing outcomes in patients undergoing pancreatic surgery. In particular, pancreaticoduodenectomy, or the Whipple procedure, which is the most common technique utilized to resect the head of the pancreas and associated structures for cancer, has been plagued by an operative mortality rate in excess of 20%. This has greatly improved over the past two decades to under 3% at high-volume academic centers. This has allowed a renewed focus in decreasing procedure-related complications such as delayed gastric emptying and pancreatic fistula formation. We have been at the forefront of this trend and have conducted numerous studies both at Yale and as part of a multi-institutional group aimed at optimizing surgery-related outcomes. In particular, we authored the first large study on forgoing nasogastric decompression after pancreaticoduodenectomy and have contributed multiple manuscripts detailing optimal management of surgical drains and fistula mitigation using both institutional and international datasets.
Coauthors
Research Interests
Pancreatic Cyst; Carcinoma, Pancreatic Ductal; Pancreatic Intraductal Neoplasms
Selected Publications
- Impact of COVID-19 on the gastrointestinal surgical oncology patient populationBakkila B, Bakkila B, Marks V, Marks V, Kerekes D, Kunstman J, Kunstman J, Salem R, Salem R, Billingsley K, Ahuja N, Ahuja N, Laurans M, Laurans M, Olino K, Olino K, Khan S. Impact of COVID-19 on the gastrointestinal surgical oncology patient population Heliyon 2023, 9: e18459. DOI: 10.1016/j.heliyon.2023.e18459.
- Surgical treatment of stage IV gastroenteropancreatic neuroendocrine carcinoma: Experience and outcomes in the United StatesKerekes D, Frey A, Bakkila B, Kunstman J, Khan S. Surgical treatment of stage IV gastroenteropancreatic neuroendocrine carcinoma: Experience and outcomes in the United States Journal Of Surgical Oncology 2023 PMID: 37435780, DOI: 10.1002/jso.27392.
- Utility of promoter hypermethylation in malignant risk stratification of intraductal papillary mucinous neoplasmsChhoda A, Sharma A, Sailo B, Tang H, Ruzgar N, Tan W, Ying L, Khatri R, Narayanan A, Mane S, De Kumar B, Wood L, Iacobuzio-Donahue C, Wolfgang C, Kunstman J, Salem R, Farrell J, Ahuja N. Utility of promoter hypermethylation in malignant risk stratification of intraductal papillary mucinous neoplasms Clinical Epigenetics 2023, 15: 28. PMID: 36803844, PMCID: PMC9942382, DOI: 10.1186/s13148-023-01429-5.
- Mo1131: HIGHLY SPECIFIC PROMOTER METHYLATION MARKERS FOR MALIGANT STRATIFICATION OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMSChhoda A, Sharma A, Tang H, Tan W, Sailo B, Peters N, Ying L, Ruzgar N, Kunstman J, Salem R, Farrell J, Ahuja N. Mo1131: HIGHLY SPECIFIC PROMOTER METHYLATION MARKERS FOR MALIGANT STRATIFICATION OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS Gastroenterology 2022, 162: s-708. DOI: 10.1016/s0016-5085(22)61664-0.
- Tu1185: DOES CURRENT EVIDENCE SUPPORT CYST GROWTH RATE AS A WORRISOME FEATURE? A SYSTEMATIC REVIEW AND META-ANALYSISSingh S, Chhoda A, Vodusek Z, Khatri R, Gunderson C, McCarty T, Sharma P, Grimshaw A, Kunstman J, Sharma A, Ahuja N, Gonda T, Farrell J. Tu1185: DOES CURRENT EVIDENCE SUPPORT CYST GROWTH RATE AS A WORRISOME FEATURE? A SYSTEMATIC REVIEW AND META-ANALYSIS Gastroenterology 2022, 162: s-907. DOI: 10.1016/s0016-5085(22)62148-6.
- Abstract PO-155: Racial heterogeneity in the molecular landscape of pancreatic adenocarcinoma: A call for actionLarson H, Chhoda A, Hengartner A, Hasan N, Ruzgar N, Yalamanchi S, Kunstman J, Farrell J, Sharma A, Ahuja N. Abstract PO-155: Racial heterogeneity in the molecular landscape of pancreatic adenocarcinoma: A call for action Cancer Epidemiology Biomarkers & Prevention 2022, 31: po-155-po-155. DOI: 10.1158/1538-7755.disp21-po-155.
- Sa298 IS IT SAFE TO STOP SURVEILLANCE OF PANCREATIC CYSTS AFTER 5 YEARS OF STABILITY?: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CURRENT EVIDENCE.Chhoda A, Singh S, Sheth A, Sharma P, Sharma A, Kunstman J, Grimshaw A, Ahuja N, Farrell J. Sa298 IS IT SAFE TO STOP SURVEILLANCE OF PANCREATIC CYSTS AFTER 5 YEARS OF STABILITY?: A SYSTEMATIC REVIEW AND META-ANALYSIS OF CURRENT EVIDENCE. Gastroenterology 2021, 160: s-475. DOI: 10.1016/s0016-5085(21)01841-2.
- Sa302 IS MULTIFOCALITY IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS A RISK FACTOR FOR PANCREATIC MALIGNANCY?: A SYSTEMATIC REVIEW AND META-ANALYSISChhoda A, Singh S, Grimshaw A, Sheth A, Sharma A, Kunstman J, Ahuja N, Farrell J. Sa302 IS MULTIFOCALITY IN INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS A RISK FACTOR FOR PANCREATIC MALIGNANCY?: A SYSTEMATIC REVIEW AND META-ANALYSIS Gastroenterology 2021, 160: s-477. DOI: 10.1016/s0016-5085(21)01845-x.
- Cystic Tumors Other than IPMNKunstman J, Farrell J. Cystic Tumors Other than IPMN 2021, 608-623. DOI: 10.1002/9781119570097.ch74.
- Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under SurveillanceChhoda A, Yousaf MN, Madhani K, Aslanian H, Jamidar PA, Suarez AL, Salem R, Muniraj T, Kunstman J, Farrell JJ. Comorbidities Drive the Majority of Overall Mortality in Low-Risk Mucinous Pancreatic Cysts Under Surveillance Clinical Gastroenterology And Hepatology 2020, 20: 631-640.e1. PMID: 33309984, DOI: 10.1016/j.cgh.2020.12.008.
- S0106 Imaging Resource Utilization in the Surveillance of Presumed Branched Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN)Yousaf M, Zhang Z, Chhoda A, Madhani K, Chaudhary F, Suarez A, Muniraj T, Kunstman J, Jamidar P, Aslanian H, Salem R, Farrell J. S0106 Imaging Resource Utilization in the Surveillance of Presumed Branched Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN) The American Journal Of Gastroenterology 2020, 115: s51-s51. DOI: 10.14309/01.ajg.0000702472.90174.1c.
- S0116 Balancing Risks of Pancreatic Malignancy-Related and Non-Pancreatic-Related Mortality in Surveillance of Low-Risk Presumed Mucinous Pancreatic CystsChhoda A, Madhani K, Yousuf M, Aslanian H, Jamidar P, Kunstman J, Salem R, Suarez A, Farrell J. S0116 Balancing Risks of Pancreatic Malignancy-Related and Non-Pancreatic-Related Mortality in Surveillance of Low-Risk Presumed Mucinous Pancreatic Cysts The American Journal Of Gastroenterology 2020, 115: s56-s57. DOI: 10.14309/01.ajg.0000702512.87644.ef.
- S0101 Clinical and Demographic Predictors of Rapidly Progressive Disease in Patients Undergoing Surgery for Pancreatic Ductal Adenocarcinoma: Risk Profiling From the National Cancer DatabaseIlagan-Ying Y, Ying L, Ferrucci L, Peters N, Blackburn H, Kunstman J, Ahuja N. S0101 Clinical and Demographic Predictors of Rapidly Progressive Disease in Patients Undergoing Surgery for Pancreatic Ductal Adenocarcinoma: Risk Profiling From the National Cancer Database The American Journal Of Gastroenterology 2020, 115: s48-s49. DOI: 10.14309/01.ajg.0000702452.53969.ae.
- Association of Treatment Inequity and Ancestry With Pancreatic Ductal Adenocarcinoma SurvivalHeller DR, Nicolson NG, Ahuja N, Khan S, Kunstman JW. Association of Treatment Inequity and Ancestry With Pancreatic Ductal Adenocarcinoma Survival JAMA Surgery 2020, 155: e195047. PMID: 31800002, PMCID: PMC6902102, DOI: 10.1001/jamasurg.2019.5047.
- Su1459 – Imaging Resource Utilization in Active Pancreatic Cyst SurveillanceYousaf M, Zhang Z, Chhoda A, Madhani K, Suarez A, Muniraj T, Kunstman J, Jamidar P, Aslanian H, Salem R, Farrell J. Su1459 – Imaging Resource Utilization in Active Pancreatic Cyst Surveillance Gastroenterology 2019, 156: s-559. DOI: 10.1016/s0016-5085(19)38287-3.
- Outcomes after pancreatectomy with routine usage of pasireotideKunstman J, Goldman D, Gönen M, Balachandran V, DeMatteo R, D'Angelica M, Jarnagin W, Kingham T, Allen P. Outcomes after pancreatectomy with routine usage of pasireotide Hepato Pancreato Biliary 2018, 20: s30. DOI: 10.1016/j.hpb.2018.02.061.
- Characterization of the mutational landscape of anaplastic thyroid cancer via whole-exome sequencingKunstman JW, Juhlin CC, Goh G, Brown TC, Stenman A, Healy JM, Rubinstein JC, Choi M, Kiss N, Nelson-Williams C, Mane S, Rimm DL, Prasad ML, Höög A, Zedenius J, Larsson C, Korah R, Lifton RP, Carling T. Characterization of the mutational landscape of anaplastic thyroid cancer via whole-exome sequencing Human Molecular Genetics 2015, 24: 2318-2329. PMID: 25576899, PMCID: PMC4380073, DOI: 10.1093/hmg/ddu749.
- Nasogastric Drainage May Be Unnecessary after Pancreaticoduodenectomy: A Comparison of Routine vs Selective DecompressionKunstman JW, Klemen ND, Fonseca AL, Araya DL, Salem RR. Nasogastric Drainage May Be Unnecessary after Pancreaticoduodenectomy: A Comparison of Routine vs Selective Decompression Journal Of The American College Of Surgeons 2013, 217: 481-488. PMID: 23891073, DOI: 10.1016/j.jamcollsurg.2013.04.031.
- Comprehensive Analysis of Variables Affecting Delayed Gastric Emptying Following PancreaticoduodenectomyKunstman JW, Fonseca AL, Ciarleglio MM, Cong X, Hochberg A, Salem RR. Comprehensive Analysis of Variables Affecting Delayed Gastric Emptying Following Pancreaticoduodenectomy Journal Of Gastrointestinal Surgery 2012, 16: 1354-1361. PMID: 22450953, DOI: 10.1007/s11605-012-1873-y.
- Multiple Endocrine NeoplasiasKunstman J, Carling T. Multiple Endocrine Neoplasias 2011 DOI: 10.1002/9780470015902.a0006060.
Clinical Trials
Conditions | Study Title |
---|---|
Pancreas | A Phase III Trial of Perioperative Versus Adjuvant Chemotherapy for Resectable Pancreatic Cancer |
Pancreas; Prevention | The Cancer of the Pancreas Screening-5 (CAPS5) Study |