John Kunstman

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.

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.