Dr. Amer Karam attended medical school at the American University in Beirut. He completed his internship and residency at the Johns Hopkins Hospital in Baltimore, Maryland, a fellowship in gynecologic oncology at the University of California Los Angeles and a fellowship in breast surgery at the Memorial Sloan-Kettering Cancer Center. Dr. Karam has a vested interest in minimally invasive and robotic surgery with a practice centered on this approach for the treatment of patients with gynecologic malignancy and complicated pelvic surgery. He is currently an associate clinical professor at the Stanford Hospital and Clinics and Director of Robotic Surgery and Outreach in the Division of Gynecologic Oncology

Clinical Focus

  • Cancer > Gynecologic Cancer
  • Gynecologic Oncology

Academic Appointments

Administrative Appointments

  • Unit Medical Director, Stanford University Hospital (2018 - Present)
  • Co-Director, Stanford Robotic Surgery Committee (2016 - Present)
  • Medical Director, Stanford Cancer Center South Bay (2015 - Present)
  • Director of Robotic Surgery, Stanford Gynecologic Oncology (2013 - Present)
  • Director of Outreach, Stanford Gynecologic Oncolgy (2013 - Present)

Professional Education

  • Residency:Johns Hopkins University School of Medicine (2004) MD
  • Medical Education:American University of Beirut Office of the Registrar (2000) Lebanon
  • Fellowship:UCLA General Surgery Residency (2007) CA
  • Fellowship:Memorial Sloan-Kettering Cancer Center (2008) NY
  • Board Certification: Gynecologic Oncology, American Board of Obstetrics and Gynecology (2012)
  • Board Certification: Hospice and Palliative Medicine, American Board of Obstetrics and Gynecology (2010)
  • Board Certification: Obstetrics and Gynecology, American Board of Obstetrics and Gynecology (2009)

Research & Scholarship

Clinical Trials

  • Clinical Trial of Lurbinectedin (PM01183) in Platinum Resistant Ovarian Cancer Patients Not Recruiting

    Multicenter, open-label, randomized, controlled phase III clinical trial to evaluate the activity and safety of PM01183 versus PLD or topotecan as control arm in patients with platinum-resistant ovarian cancer. PM01183 will be explored as single agent in the experimental arm (Arm A) versus PLD or topotecan in the control arm (Arm B).

    Stanford is currently not accepting patients for this trial. For more information, please contact Aarti Kale, 650-723-0622.

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  • Health and Recovery Program in Increasing Physical Activity Level in Stage IA-IIIA Endometrial Cancer Survivors Not Recruiting

    This randomized phase II trial studies how well a health and recovery program works in increasing physical activity level in stage IA-IIIA endometrial cancer survivors. Health and recovery program which includes exercise counseling, Fitbit tracker, and phone or email/text communication may increase the level of physical activity in endometrial cancer survivors and promote and maintain behavior change at a lower cost.

    Stanford is currently not accepting patients for this trial. For more information, please contact Melissa Usoz, 650-723-8843.

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  • Olaparib Maintenance Monotherapy in Patients With BRCA Mutated Ovarian Cancer Following First Line Platinum Based Chemotherapy. Not Recruiting

    Olaparib Monotherapy in Patients with BRCA Mutated Ovarian Cancer following First Line Platinum Based Chemotherapy.

    Stanford is currently not accepting patients for this trial. For more information, please contact Suzanne Friedrich, 650-725-0426.

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  • Safety and Efficacy of CRS-207 With Epacadostat in Platinum Resistant Ovarian, Fallopian or Peritoneal Cancer Not Recruiting

    This 2-part, Phase 1/2 study will test investigational cancer drugs known as CRS-207, epacadostat (IDO), and pembrolizumab (pembro). The purpose of this study is to find out how safe it is to give the investigational drugs to women with platinum-resistant ovarian, fallopian tube, or peritoneal cancer and if it helps patients with these types of cancer live longer or can help shrink or slow the growth of cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • Study of DPX-Survivac Therapy in Patients With Recurrent Ovarian Cancer Not Recruiting

    T cell activating therapy DPX-Survivac, low dose oral cyclophosphamide, and IDO1 inhibitor epacadostat will be tested together for the first time in patients with recurrent ovarian, fallopian tube, or peritoneal cancer to determine the safety and potential immune-modulating activity of the combination of these agents.

    Stanford is currently not accepting patients for this trial. For more information, please contact Cancer Clinical Trials Office (CCTO), 650-498-7061.

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  • Trametinib in Treating Patients With Recurrent or Progressive Low-Grade Ovarian Cancer or Peritoneal Cavity Cancer Not Recruiting

    This randomized phase II/III trial studies how well trametinib works and compares it to standard treatment with either letrozole, tamoxifen, paclitaxel, pegylated liposomal doxorubicin, or topotecan in treating patients with low-grade ovarian cancer or peritoneal cavity cancer that has come back (recurrent), become worse (progressive), or spread to other parts of the body. Trametinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It is not yet known whether trametinib is more effective than standard therapy in treating patients with ovarian or peritoneal cavity cancer.

    Stanford is currently not accepting patients for this trial. For more information, please contact Madelyn Gutierrez Gomez, 650-723-0298 .

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All Publications

  • Endometriosis Malignant Transformation Review: Rhabdomyosarcoma Arising From an Endometrioma. JSLS : Journal of the Society of Laparoendoscopic Surgeons Nezhat, C., Vu, M., Vang, N., Ganjoo, K., Karam, A., Folkins, A., Nezhat, A., Nezhat, F. ; 23 (4)


    Endometriosis is a widely known benign disease, but 0.5%-1% of cases are associated with malignancy. It has been linked with ovarian neoplasms, particularly endometrioid and clear cell adenocarcinoma histology. Rhabdomyosarcomas are rarely associated with endometriosis.A 35-year-old patient underwent surgical management of endometriomas to optimize infertility treatment. She later developed abdominal pain with rapid recurrence of ovarian masses. This prompted additional surgery with biopsies diagnosing ovarian rhabdomyosarcoma. Retroactive review of pathologic specimens from her prior surgery demonstrated the neoplasm originated from her prior endometrioma. Focal areas suggested possible underlying ovarian adenosarcoma with stromal overgrowth.The incidence of rhabdomyosarcoma arising from endometriosis is exceedingly rare. The accuracy of diagnosing endometriosis and ruling out neoplasm requires coordinated efforts of a multidisciplinary team, involving radiologists, pathologists, oncologists, and gynecologic surgeons.

    View details for DOI 10.4293/JSLS.2019.00038

    View details for PubMedID 31624455

    View details for PubMedCentralID PMC6791399

  • Coexistence of BRAF V600E and TERT Promoter Mutations in Low-grade Serous Carcinoma of Ovary Recurring as Carcinosarcoma in a Lymph Node: Report of a Case INTERNATIONAL JOURNAL OF GYNECOLOGICAL PATHOLOGY Tavallaee, M., Steiner, D. F., Zehnder, J. L., Folkins, A. K., Karam, A. K. 2019; 38 (4): 386–92
  • Transesophageal Echocardiographic Observation of Caval Thrombus Followed by Intraoperative Placement of Inferior Vena Cava Filter for Presumed Pulmonary Embolism During Cesarean Hysterectomy for Placenta Percreta: A Case Report A & A PRACTICE Nanji, J. A., Ansari, J. R., Yurashevich, M., Ismawan, J. M., Lyell, D. J., Karam, A. K., Hovsepian, D. M., Riley, E. T. 2019; 12 (2): 37–40
  • Sentinel lymph node biopsies in endometrial cancer - practice patterns among Gynecologic Oncologists in the United States. Journal of minimally invasive gynecology Renz, M., Diver, E., English, D., Kidd, E., Dorigo, O., Karam, A. 2019


    To evaluate practice patterns among gynecologic oncologists with regards to sentinel lymph node injection and biopsy in endometrial cancer.Observational study with no control group.Active members of the Society of Gynecologic Oncology.After IRB approval, we performed an online survey amongst active members of the Society of Gynecologic Oncology. Members were contacted via email and their answers anonymously captured. Study data were collected using REDCap.318 of 1216 listed members completed the online survey, The majority of respondents (82.7%) perform sentinel lymph node sampling for endometrial cancer staging. Most technical aspects of sentinel lymph node sampling were consistently applied by the vast majority of respondents, including the choice of indocyanine green (ICG) as lymphatic tracer (97.3%) and its injection into the cervix (100%). Other technical aspects of sentinel lymph node sampling, such as the depth of injection, varied amongst respondents. While 50.9% of the respondents perform an intraoperative assessment of the uterus by frozen section, only 17.9% assess sentinel lymph nodes by frozen section and/or touch prep. Some of the respondents' approaches are based on limited data, including (i) the use of sentinel lymph node injection and biopsy for high-risk histologies (performed by 69 - 75% of the respondents dependent upon the histology), (ii) omitting side-specific completion lymphadenectomy in the absence of sentinel node mapping (in up to 57.8%) or (iii) when lymph node metastases are present (in 39.9%).In summary, despite the growing use of sentinel lymph node injection and biopsy in endometrial cancer, practice patterns vary considerably among providers sampled by this survey. Some of the decisions are based on limited evidence and, in some instances, deviate from current published guidelines.

    View details for PubMedID 30980995

  • Advanced communication: A critical component of high quality gynecologic cancer care: A Society of Gynecologic Oncology evidence based review and guide. Gynecologic oncology Littell, R. D., Kumar, A., Einstein, M. H., Karam, A., Bevis, K. 2019


    Effective communication between gynecologic oncology providers and patients is vital to patient-centered care. Skilled communication improves the patient's knowledge retention, builds trust in providers, enhances shared decision-making, and alleviates anxiety of both patients and caregivers. Effective communication is also associated with reduced provider burnout due to improved comfort from possessing the skills to handle emotionally charged situations. Therefore, training in serious illness communication skills is critically important to gynecologic oncology practice and benefits patients, providers, and the healthcare system. Like surgical skills, communication skills can be learned and improved upon, particularly by making use of communication skills courses and other resources. While the purpose of each conversation will vary based on the medical setting, most communication roadmaps incorporate four basic components: 1) Assess patient knowledge and understanding, 2) inform patient in accordance with her communication preferences, 3) recognize and respond to emotion 4) elicit patient values, and create a plan that aligns with those values. Improved patient outcomes associated with addressing patient emotions underscore a critical need to recognize and address emotional cues during difficult conversations. We present strategies for delivering serious news, and for discussing prognosis and goals of care. In each strategy, we highlight skills for recognizing and responding to patient and family emotional cues.

    View details for DOI 10.1016/j.ygyno.2019.07.026

    View details for PubMedID 31422857

  • Acute Optic Neuritis Diagnosed by Bedside Ultrasound in an Emergency Department. The Journal of emergency medicine Saigh, M. P., Plauché, H. M., Butts, C., Karam, A. K., Suau, S. J., Moreno-Walton, L. 2019


    Transorbital ultrasound was used to diagnose acute optic neuritis (AON) at bedside in an emergency department (ED).A 59-year-old female patient presented to an ED after 7 days of progressive unilateral visual loss while she was receiving outpatient treatment for relapsing-remitting multiple sclerosis. Transorbital ultrasound revealed a disparity between the optic nerve sheath diameters of the affected and nonaffected eyes and striking optic nerve edema in the affected eye. These findings led to a diagnosis of AON and early definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given an absence of reliable diagnostic criteria for AON, comorbidity with multiple sclerosis, and limitations inherent to magnetic resonance imaging, transorbital sonography may facilitate diagnosis of this condition in emergent presentations.

    View details for DOI 10.1016/j.jemermed.2019.04.032

    View details for PubMedID 31229301

  • Racial disparities in outcomes for high-grade uterine cancer: A California cancer registry study CANCER MEDICINE Baskovic, M., Lichtensztajn, D. Y., Trung Nguyen, Karam, A., English, D. P. 2018; 7 (9): 4485–95

    View details for DOI 10.1002/cam4.1742

    View details for Web of Science ID 000444945200030

  • Racial disparities in outcomes for high-grade uterine cancer: A California cancer registry study. Cancer medicine Baskovic, M., Lichtensztajn, D. Y., Nguyen, T., Karam, A., English, D. P. 2018


    BACKGROUND: Endometrial cancer (EC) is the most common gynecologic malignancy. We examined factors affecting overall prognosis and survival among different racial groups diagnosed with high-grade EC.METHODS: We utilized the California Cancer Registry database (CCR) to identify women with high-grade II EC from 1998 to 2009. Using the Kaplan-Meier method, we described disease-specific survival. Survival by stage, race, and time to treatment category was compared using the log-rank test. The associations of race with disease-specific survival were modeled using Cox proportional hazards regression. Covariates were selected a priori.RESULTS: A total of 10647 patients met study eligibility criteria. The majority of patients in this cohort of high-grade EC were non-Hispanic (NH) white (64.1%), followed by Hispanic (15.7%), Asian (10.4%), and NH black (9.8%). NH black women had higher incidence of certain aggressive histologic subtypes in comparison with NH whites, including serous carcinomas and carcinosarcoma. Non-Hispanic black patients had a worse 5-year disease-specific survival (DSS) when compared to other racial groups. The five-year DSS for NH black women was 54% (51%-57%), compared to NH white women 66% (65%-67%), Hispanic 67% (64%-69%), and Asians 69% (67%-72%) (P<0.0001). This clear survival disadvantage of NH black women persisted when controlling for other factors.CONCLUSIONS: Non-Hispanic black women have a higher incidence of more aggressive histologic subtypes even among a cohort of women high-grade EC and have a disproportionately worse disease-specific survival after controlling for factors such as age, histologic subtype, stage, time to treatment, and type of treatment.

    View details for PubMedID 30123978

  • Transesophageal Echocardiographic Observation of Caval Thrombus Followed by Intraoperative Placement of Inferior Vena Cava Filter for Presumed Pulmonary Embolism During Cesarean Hysterectomy for Placenta Percreta: A Case Report. A&A practice Nanji, J. A., Ansari, J. R., Yurashevich, M., Ismawan, J. M., Lyell, D. J., Karam, A. K., Hovsepian, D. M., Riley, E. T. 2018


    During a cesarean hysterectomy for placenta percreta, transesophageal echocardiography was used to monitor volume status and guide resuscitation. After delivery of the neonate but before massive surgical hemorrhage, a thrombus appeared in the inferior vena cava. Roughly 3 hours later, the patient had hemodynamic changes consistent with an intraoperative pulmonary embolism. Boluses of epinephrine stabilized the patient. An inferior vena cava filter was placed via an in situ internal jugular central venous cannula to prevent further embolic events. We believe transesophageal echocardiography is a useful monitor during surgery for placenta percreta.

    View details for PubMedID 30020106

  • Case of Metastatic Extramammary Paget Disease of the Vulva Treated Successfully With Trastuzumab Emtansine JCO PRECISION ONCOLOGY Hsieh, G. L., English, D. P., Tu, P., Folkins, A. K., Karam, A. K. 2018; 2
  • Coexistence of BRAF V600E and TERT Promoter Mutations in Low-grade Serous Carcinoma of Ovary Recurring as Carcinosarcoma in a Lymph Node: Report of a Case. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists Tavallaee, M., Steiner, D. F., Zehnder, J. L., Folkins, A. K., Karam, A. K. 2018


    Low-grade serous carcinomas only rarely coexist with or progress to high-grade tumors. We present a case of low-grade serous carcinoma with transformation to carcinosarcoma on recurrence in the lymph node. Identical BRAF V600E and telomerase reverse transcriptase promoter mutations were identified in both the original and recurrent tumor. Given that telomerase reverse transcriptase promotor mutations are thought to play a role in progression of other tumor types, the function of telomerase reverse transcriptase mutations in BRAF mutated low-grade serous carcinoma deserves investigation.

    View details for PubMedID 29620581

  • Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: first-line interventions ANNALS OF ONCOLOGY Karam, A., Ledermann, J. A., Kim, J., Sehouli, J., Lu, K., Gourley, C., Katsumata, N., Burger, R. A., Nam, B., Bacon, M., Ng, C., Pfisterer, J., Bekkers, R. L., Casado Herraez, A., Redondo, A., Fujiwara, H., Gleeson, N., Rosengarten, O., SCAMBIA, G., Zhu, J., Okamoto, A., Stuart, G., Ochiai, K. 2017; 28 (4): 711-717


    The consensus statements regarding first-line therapies in women with ovarian cancer, reached at the Fifth Ovarian Cancer Consensus Conference held in Tokyo, Japan, in November 2015 are reported. Three topics were reviewed and the following statements are recommended: (i) Surgery: the subgroups that should be considered in first-line ovarian cancer clinical trials should be (a) patients undergoing primary debulking surgery and (b) patients receiving neo-adjuvant chemotherapy. The amount of residual disease following surgery should further stratify patients into those with absent gross residual disease and others. (ii) Control arms for chemotherapy: for advanced stage ovarian cancer the standard is intravenous 3-weekly carboplatin and paclitaxel. Acceptable alternatives, which should be stratified variables in trials when more than one regimen is offered, include weekly paclitaxel plus 3-weekly carboplatin, the addition of bevacizumab to 3-weekly carboplatin and paclitaxel, and intraperitoneal therapy. (iii) Trial Endpoints: overall survival is the preferred primary endpoint for first-line clinical trials with or without a maintenance component. Progression-free survival (PFS) is an alternative primary endpoint, but if PFS is chosen overall survival must be measured as a secondary endpoint and PFS must be supported by additional endpoints, including predefined patient reported outcomes and time to first or second subsequent therapy. For neoadjuvant therapy, additional 'window of opportunity' endpoints should be included.

    View details for DOI 10.1093/annonc/mdx011

    View details for Web of Science ID 000397622100010

    View details for PubMedID 28327917

  • Breast Cancer Posttreatment Surveillance: Diagnosis and Management of Recurrent Disease. Clinical obstetrics and gynecology Karam, A. K. 2016; 59 (4): 772-778


    There has been a steady decline in breast cancer mortality that has led to a significant increase in the number of patients surviving breast cancer. We will review in this manuscript the evidence and guidelines for posttreatment surveillance of patients with breast cancer as well as the management options for patients who are diagnosed with local-regional and distant recurrences.

    View details for PubMedID 27681690

  • Risk-Reducing Surgery in Hereditary Breast and Ovarian Cancer NEW ENGLAND JOURNAL OF MEDICINE Karam, A. 2016; 374 (24): 2403

    View details for PubMedID 27305205

  • Pilot prospective evaluation of F-18-FPPRGD(2) PET/CT in patients with cervical and ovarian cancer EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING Minamimoto, R., Karam, A., Jamali, M., Barkhodari, A., Gambhir, S. S., Dorigo, O., Iagaru, A. 2016; 43 (6): 1047-1055


    We report the effect of antiangiogenic therapy on the biodistribution of (18)F-FPPRGD2 (a surrogate biomarker of integrin αvβ3 expression), and the potential of (18)F-FPPRGD2 to predict the prognosis in patients with cervical cancer and ovarian cancer in this clinical scenario.Data from six women, age range 30 - 59 years (mean ± SD 44.0 ± 12.5 years), who had undergone a (18)F-FPPRGD2 PET/CT scan and bevacizumab-containing therapy were prospectively collected and analyzed. We compared baseline (18)F-FPPRGD2 and (18)F-FDG uptake in the lesions and tumor-to-background (T/B) ratios. The maximum and mean (18)F-FPPRGD2 standardized uptake values (SUVmax and SUVmean) were recorded for 13 normal organs, as well as in all the identified malignant lesions on the pretreatment scan and the 1-week post-treatment scan. We also measured changes in (18)F-FPPRGD2 uptake from before to 1 week after treatment, and compared them to the changes in (18)F-FDG uptake from before to 6 weeks after treatment. Treatment outcomes were correlated with these changes.The uptake in lesions and T/B ratio of (18)F-FPPRGD2 were lower than those of (18)F-FDG (SUVmax 3.7 ± 1.3 vs. 6.0 ± 1.8, P < 0.001; SUVmean 2.6 ± 0.7 vs. 4.2 ± 1.3, P < 0.001; T/B ratio based on SUVmax 2.4 ± 1.0 vs. 2.6 ± 1.0, P < 0.04; T/B ratio based on SUVmean 1.9 ± 0.6 vs. 2.4 ± 1.0, P < 0.003). One patient did not return for the follow-up scan and in another patient no lesions were identified on the pretreatment scan. (18)F-FPPRGD2 uptake in lesions in the remaining four patients had significantly changed 1 week after treatment (SUVmean 3.3 ± 1.0 vs. 2.7 ± 1.0, P < 0.001), while uptake in all normal tissues analyzed was not affected by treatment. One patient with clinical disease progression had a decrease in lesional (18)F-FPPRGD2 SUVmean of 1.6 % and in (18)F-FDG SUVmean of 9.4 %. Two patients with a clinical complete response to treatment had decreases in lesional (18)F-FPPRGD2 SUVmean of 25.2 % and 25.0 % and in (18)F-FDG SUVmean of 6.1 % and 71.8 %. One patient with a clinical partial response had a decrease in lesional (18)F-FPPRGD2 SUVmean of 7.9 % and in (18)F-FDG SUVmean of 76.4 %.This pilot study showed that (18)F-FPPRGD2 and (18)F-FDG provide independent information about the biology of ovarian and cervical cancers. Bevacizumab-containing therapy does not affect (18)F-FPPRGD2 uptake in normal organs, but does result in statistically significant changes in lesions. In addition, (18)F-FPPRGD2 may have potential for early prediction of response to such treatments. These preliminary findings have to be confirmed in larger studies.

    View details for DOI 10.1007/s00259-015-3263-7

    View details for Web of Science ID 000374972900008

    View details for PubMedID 26611425

  • Adenocarcinoma With Breast/Adnexal and Upper Gastrointestinal Differentiation Arising in an Ovarian Mature Cystic Teratoma: A Case Report and Review of the Literature INTERNATIONAL JOURNAL OF GYNECOLOGICAL PATHOLOGY Wheeler, L., Westhoff, G. L., O'Keefe, M. C., Kong, C. S., Karam, A. 2016; 35 (1): 72-77


    Mature cystic teratomas are the most common type of ovarian germ cell tumors. In about 1% of cases, usually among postmenopausal women, a mature cystic teratoma can undergo malignant transformation. Among malignant transformations, squamous cell carcinoma is the most common histology, comprising approximately 80% of cases. In this report, we present the unique case of a 55-yr-old woman with a pelvic mass found to be a mature cystic teratoma with malignant transformation to adenocarcinoma with breast/adnexal, upper gastrointestinal, and neuroendocrine differentiation. The predominant malignant component was the adenocarcinoma exhibiting breast/skin adnexal differentiation, which was found to involve the omentum and a right para-aortic node. We provide an in-depth review of the pathologic findings, as well as a review of the current literature on malignant transformation to adenocarcinoma. This report aims to open a conversation regarding the management of these patients, with a specific focus on the role of molecular analysis and targeted therapies.

    View details for DOI 10.1097/PGP.0000000000000218

    View details for Web of Science ID 000366942300012

    View details for PubMedID 26352552

  • Does Omentectomy in Epithelial Ovarian Cancer Affect Survival? An Analysis of the Surveillance, Epidemiology, and End Results Database INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER McNally, L., Teng, N. N., Kapp, D. S., Karam, A. 2015; 25 (4): 607-615


    Although omentectomy is part of the staging and treatment of epithelial ovarian cancer (EOC), its performance in a patient with a grossly normal omentum—acknowledging its role in debulking gross tumor deposits—has never been definitively shown to improve survival.Using Surveillance, Epidemiology, and End Results data from 1998 to 2010, we identified patients with EOC and assessed their age, race, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, lymph node dissection, nodal findings, and performance of omentectomy. We compared disease-specific survival (DSS) based on the presence or absence of omentectomy using log-rank univariate analysis, Cox multivariate analysis, and Kaplan-Meier survival curves.A total of 20,975 patients with invasive EOC underwent surgical treatment. Initial univariate analysis indicated a lower mean DSS with performance of omentectomy. However, multivariate analysis demonstrated no significant association between DSS and performance of omentectomy (hazard ratio, 0.978; P = 0.506). The DSS was improved if lymphadenectomy was performed (hazard ratio, 0.60; P < 0.001). In recent years, there was a trend toward decreased performance of omentectomy.To look specifically at patients without bulky omental disease, a subset analysis was done looking at patients with stage I-IIIA disease who had had lymphadenectomy performed. There were 5454 patients in the group who underwent an omentectomy and 2404 patients in the group who did not. No difference in DSS was seen between the groups based on performance of omentectomy (P = 0.89). However, the analysis was limited by the lack of Surveillance, Epidemiology, and End Results data on the extent of omentectomy, amount of residual disease, and adjuvant chemotherapy.In this analysis, performance of omentectomy in patients with EOC without bulky disease (≤stage IIIA) did not seem to confer improvement in survival. A randomized control trial would be needed to fully address this question.

    View details for DOI 10.1097/IGC.0000000000000412

    View details for Web of Science ID 000354103000011

    View details for PubMedID 25756404

  • Video-based Peer Feedback Through Social Networking for Robotic Surgery Simulation A Multicenter Randomized Controlled Trial ANNALS OF SURGERY Carter, S. C., Chiang, A., Shah, G., Kwan, L., Montgomery, J. S., Karam, A., Tarnay, C., Guru, K. A., Hu, J. C. 2015; 261 (5): 870-875


    To examine the feasibility and outcomes of video-based peer feedback through social networking to facilitate robotic surgical skill acquisition.The acquisition of surgical skills may be challenging for novel techniques and/or those with prolonged learning curves.Randomized controlled trial involving 41 resident physicians performing the Tubes (Da Vinci Intuitive Surgical, Sunnyvale, CA) simulator exercise with versus without peer feedback of video-recorded performance through a social networking Web page. Data collected included simulator exercise score, time to completion, and comfort and satisfaction with robotic surgery simulation.There were no baseline differences between the intervention group (n = 20) and controls (n = 21). The intervention group showed improvement in mean scores from session 1 to sessions 2 and 3 (60.7 vs 75.5, P < 0.001, and 60.7 vs 80.1, P < 0.001, respectively). The intervention group scored significantly higher than controls at sessions 2 and 3 (75.5 vs 59.6, P = 0.009, and 80.1 vs 65.9, P = 0.019, respectively). The mean time (seconds) to complete the task was shorter for the intervention group than for controls during sessions 2 and 3 (217.4 vs 279.0, P = 0.004, and 201.4 vs 261.9, P = 0.006, respectively). At the study conclusion, feedback subjects were more comfortable with robotic surgery than controls (90% vs 62%, P = 0.021) and expressed greater satisfaction with the learning experience (100% vs 67%, P = 0.014). Of the intervention subjects, 85% found that peer feedback was useful and 100% found it effective.Video-based peer feedback through social networking appears to be an effective paradigm for surgical education and accelerates the robotic surgery learning curve during simulation.

    View details for DOI 10.1097/SLA.0000000000000756

    View details for Web of Science ID 000352326900033

    View details for PubMedID 24887970

  • Estimating the Risk of Abnormal Cervical Papanicolaou Test (PAP) in Female Renal Transplant Recipients (RTR) as Compared With Age-Matched Controls Chang, S., Tarin, M., Fung, P., Karam, A., Rao, J. NATURE PUBLISHING GROUP. 2015: 85A
  • Estimating the Risk of Abnormal Cervical Papanicolaou Test (PAP) in Female Renal Transplant Recipients (RTR) as Compared With Age-Matched Controls Chang, S., Tarin, M., Fung, P., Karam, A., Rao, J. NATURE PUBLISHING GROUP. 2015: 85A
  • Increased risk and pattern of secondary malignancies in patients with invasive extramammary Paget disease. British journal of dermatology Karam, A., Dorigo, O. 2014; 170 (3): 661-671


    Extramammary Paget disease (EMPD) is often associated with underlying or distant synchronous malignancies. The prognosis for affected patients is generally favourable; however, the risk of secondary malignancies is unknown.The goal of the study was to analyse the incidence, prognosis and pattern of secondary malignancies for patients with invasive EMPD using data from the Surveillance, Epidemiology and End Results (SEER) Program.We searched the SEER Program database for patients diagnosed with invasive EMPD between 1973 and 2008. Demographic data, outcome and secondary malignancies more than 1 year after the initial diagnosis of invasive EMPD were included in the analysis. We calculated the standardized incidence ratio (SIR) and estimated the excess absolute risk (EAR) per 10 000 person-years (PY).There were 1439 patients who were diagnosed with invasive EMPD. Most patients (80·4%) had localized disease, while 17·1% had locoregional spread and 2·5% presented with distant disease. The SIR for secondary malignancies in patients with invasive EMPD was significantly elevated with an EAR of 97·4 additional malignancies per 10 000 PY. The excess risk was mostly due to a significantly increased incidence of colorectal and anal malignancies. The initial site of disease predicted the site of the secondary malignancies, with patients with colorectal, anal, vulvar and scrotal disease showing an increased risk of colorectal, anal, vulvar and scrotal malignancies, respectively.Our study identified a long-term increased risk of developing secondary malignancies in patients with invasive EMPD that are mainly related to the site of origin of this disease. Patients with invasive EMPD require prolonged follow-up and screening for these malignancies.

    View details for DOI 10.1111/bjd.12635

    View details for PubMedID 24617434

  • HER-2/neu targeting for recurrent vulvar Paget's disease A case report and literature review GYNECOLOGIC ONCOLOGY Karam, A., Berek, J. S., Stenson, A., Rao, J., Dorigo, O. 2008; 111 (3): 568-571


    The treatment of Paget's disease of the vulva particularly for recurrences can be challenging. Overexpression of the HER-2/neu protein has been found in about 30% of vulvar Paget's cases therefore presenting a potential therapeutic target.We report the case of a 52-year-old patient with persistent Paget's disease of the vulva despite eight surgical excisions over a 15-year period. Immunohistochemistry demonstrated overexpression of the HER-2/neu protein in the vulva resection specimen. Treatment with Trastuzumab resulted in a significant regression of her disease and resolution of symptoms.Based on our case report, therapeutic targeting of HER-2/neu for patients with Paget's disease of the vulva using for example Trastuzumab is a potentially effective, alternative approach, and warrants further investigation.

    View details for DOI 10.1016/j.ygyno.2007.12.014

    View details for Web of Science ID 000261758000037

    View details for PubMedID 18252264

  • Her2neu over-expression and PI3kinase/Akt pathway activation in Paget's disease of the vulva. 55th Annual Meeting of the Society-for-Gynecologic-Investigation Stenson, A., Behjatnia, B., Shamonki, J., Rao, J., Karam, A., Berek, J., Dorigo, O. SAGE PUBLICATIONS INC. 2008: 307A–307A