Natalie Kirilcuk, MD, FACS

All Publications

Rectal Cancer, Version 6.2020 Featured Updates to the NCCN Guidelines JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Al-Hawary, M. M., Arain, M. A., Chen, Y., Ciombor, K. K., Cohen, S., Cooper, H. S., Deming, D., Garrido-Laguna, I., Grem, J. L., Gunn, A., Hoffe, S., Hubbard, J., Hunt, S., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Meyerhardt, J., Miller, E. D., Mulcahy, M. F., Nurkin, S., Overman, M. J., Parikh, A., Patel, H., Pedersen, K., Saltz, L., Schneider, C., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Johnson-Chilla, A., Gurski, L. A. 2020; 18 (7): 807–15
Abstract

The NCCN Guidelines for Rectal Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with rectal cancer. These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines. These updates include clarifying the definition of rectum and differentiating the rectum from the sigmoid colon; the total neoadjuvant therapy approach for localized rectal cancer; and biomarker-targeted therapy for metastatic colorectal cancer, with a focus on new treatment options for patients with BRAF V600E- or HER2 amplification-positive disease.

View details for DOI 10.6004/jnccn.2020.0032

View details for Web of Science ID 000577820100003

View details for PubMedID 32634771
IMMUNE PROFILING TO PREDICT RECOVERY OUTCOMES AFTER SURGERY Tsai, E. S., Rumer, K., Wong, K., Warrington, B., Shelton, E., Ganio, E., Verdonk, F., Ando, K., Tingle, M., Folk-Tolbert, M., Shankar, K., Shelton, A., Morris, A., Kirilcuk, N., Gurland, B., Kebebew, E., Kin, C., Angst, M. S., Aghaeepour, N., Gaudilliere, B. LIPPINCOTT WILLIAMS & WILKINS. 2020: 66–67
View details for Web of Science ID 000587668800152
Pelvic/Perineal Reconstruction: Time to Consider the Anterolateral Thigh Flap as a First-line Option? Plastic and reconstructive surgery. Global open Perrault, D., Kin, C., Wan, D. C., Kirilcuk, N., Shelton, A., Momeni, A. 2020; 8 (4): e2733
Abstract

Abdominoperineal resection (APR) and pelvic exenteration continue to be common procedures for the treatment of colorectal malignancy. The workhorse flap for reconstruction in these instances has been the vertical rectus abdominis myocutaneous flap. The associated donor site morbidity, however, cannot be ignored. Here, we provide a review of the literature and present the senior author's (A.M.) experience using the pedicled anterolateral thigh (ALT) flap for reconstruction of soft tissue defects following APR and pelvic exenteration.Patients who underwent pelvic/perineal reconstruction with pedicled ALT flaps between 2017 and 2019 were included in the study. Parameters of interest included age, gender, body mass index, comorbidities, history of radiation, extent of ablative surgery, and postoperative complication rate.A total of 23 patients (16 men and 7 women) with a median age and body mass index of 66 years (inter-quartile range [IQR]: 49-71 years) and 24.9 kg/m2 (IQR: 24.2-26.7 kg/m2) were included in the study, respectively. Thirteen (56.5%) patients presented with rectal cancer, 5 (21.7%) with anal squamous cell carcinoma (SCC), 4 (17.4%) with Crohn's disease, and 1 (4.3%) with Paget's disease. Nineteen patients (82.6%) received neoadjuvant radiation. Nine (39.1%) patients experienced 11 complications (2 major and 9 minor). The most common complication was partial perineal wound dehiscence (N = 6 [26.1%]). Stable soft tissue coverage was achieved in all but one patient.The ALT flap allows for stable soft tissue coverage following APR and pelvic exenteration without being associated with abdominal donor site morbidity. Consideration to its use as a first-line reconstructive option should be given in pelvic/perineal reconstruction.

View details for DOI 10.1097/GOX.0000000000002733

View details for PubMedID 32440406

View details for PubMedCentralID PMC7209827
Oncologic and Perioperative Outcomes of Laparoscopic, Open, and Robotic Approaches for Rectal Cancer Resection: A Multicenter, Propensity Score-Weighted Cohort Study. Diseases of the colon and rectum Kethman, W. C., Harris, A. H., Morris, A. M., Shelton, A., Kirilcuk, N., Kin, C. 2019
Abstract

BACKGROUND: Minimally invasive approaches have been shown to reduce surgical site complications without compromising oncologic outcomes.OBJECTIVE: The primary aim of this study is to evaluate the rates of successful oncologic resection and postoperative outcomes among laparoscopic, open, and robotic approaches to rectal cancer resection.DESIGN: This is a multicenter, quasiexperimental cohort study using propensity score weighting.SETTINGS: Interventions were performed in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program.PATIENTS: Adult patients who underwent rectal cancer resection in 2016 were included.MAIN OUTCOME MEASURES: The primary outcome was a composite variable indicating successful oncologic resection, defined as negative distal and radial margins with at least 12 lymph nodes evaluated.RESULTS: Among 1028 rectal cancer resections, 206 (20%) were approached laparoscopically, 192 (18.7%) were approached robotically, and 630 (61.3%) were open. After propensity score weighting, there were no significant sociodemographic or preoperative clinical differences among subcohorts. Compared to the laparoscopic approach, open and robotic approaches were associated with a decreased likelihood of successful oncologic resection (ORadj = 0.64; 95% CI, 0.43-0.94 and ORadj = 0.60; 95% CI, 0.37-0.97), and the open approach was associated with an increased likelihood of surgical site complications (ORadj = 2.53; 95% CI, 1.61-3.959). Compared to the laparoscopic approach, the open approach was associated with longer length of stay (6.8 vs 8.6 days, p = 0.002).LIMITATIONS: This was an observational cohort study using a preexisting clinical data set. Despite adjusted propensity score methodology, unmeasured confounding may contribute to our findings.CONCLUSIONS: Resections that were approached laparoscopically were more likely to achieve oncologic success. Minimally invasive approaches did not lengthen operative times and provided benefits of reduced surgical site complications and decreased postoperative length of stay. Further studies are needed to clarify clinical outcomes and factors that influence the choice of approach. See Video Abstract at http://links.lww.com/DCR/B70.

View details for DOI 10.1097/DCR.0000000000001534

View details for PubMedID 31764247
Small Bowel Adenocarcinoma Version 1.2020 JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Al-Hawary, M. M., Arain, M. A., Chen, Y., Ciombor, K. K., Cohen, S. A., Cooper, H. S., Deming, D. A., Garrido-Laguna, I., Grem, J. L., Hoffe, S. E., Hubbard, J., Hunt, S., Kamel, A., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Meyerhardt, J., Miller, E. D., Mulcahy, M. F., Nurkin, S., Overman, M. J., Parikh, A., Patel, H., Pedersen, K. S., Saltz, L. B., Schneider, C., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Johnson-Chilla, A., Gregory, K. M., Gurski, L. A. 2019; 17 (9): 1109–33
Abstract

Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract that has increased in incidence across recent years. Often diagnosed at an advanced stage, outcomes for SBA are worse on average than for other related malignancies, including colorectal cancer. Due to the rarity of this disease, few studies have been done to direct optimal treatment, although recent data have shown that SBA responds to treatment differently than colorectal cancer, necessitating a separate approach to treatment. The NCCN Guidelines for Small Bowel Adenocarcinoma were created to establish an evidence-based standard of care for patients with SBA. These guidelines provide recommendations on the workup of suspected SBA, primary treatment options, adjuvant treatment, surveillance, and systemic therapy for metastatic disease. Additionally, principles of imaging and endoscopy, pathologic review, surgery, radiation therapy, and survivorship are described.

View details for DOI 10.6004/jnccn.2019.0043

View details for Web of Science ID 000487242700012

View details for PubMedID 31487687
Anal Carcinoma, Version 2.2018 JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Al-Hawary, M. M., Cederquist, L., Chen, Y., Ciombor, K. K., Cohen, S., Cooper, H. S., Deming, D., Engstrom, P. F., Grem, J. L., Grothey, A., Hochster, H. S., Hoffe, S., Hunt, S., Kamel, A., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Meyerhardt, J., Mulcahy, M. F., Murphy, J. D., Nurkin, S., Saltz, L., Sharma, S., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Wuthrick, E., Gregory, K. M., Freedman-Cass, D. A. 2018; 16 (7): 852–71
Abstract

The NCCN Guidelines for Anal Carcinoma provide recommendations for the management of patients with squamous cell carcinoma of the anal canal or perianal region. Primary treatment of anal cancer usually includes chemoradiation, although certain lesions can be treated with margin-negative local excision alone. Disease surveillance is recommended for all patients with anal carcinoma because additional curative-intent treatment is possible. A multidisciplinary approach including physicians from gastroenterology, medical oncology, surgical oncology, radiation oncology, and radiology is essential for optimal patient care.

View details for DOI 10.6004/jnccn.2018.0060

View details for Web of Science ID 000438786300009

View details for PubMedID 30006428
Rectal Cancer, Version 2.2018 Clinical Practice Guidelines in Oncology JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Al-Hawary, M. M., Cederquist, L., Chen, Y., Ciombor, K. K., Cohen, S., Cooper, H. S., Deming, D., Engstrom, P. F., Grem, J. L., Grothey, A., Hochster, H. S., Hoffe, S., Hunt, S., Kamel, A., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Meyerhardt, J., Mulcahy, M. F., Murphy, J. D., Nurkin, S., Saltz, L., Sharma, S., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Wuthrick, E., Gregory, K. M., Gurski, L., Freedman-Cass, D. A. 2018; 16 (7): 874–901
Abstract

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Rectal Cancer address diagnosis, staging, surgical management, perioperative treatment, management of recurrent and metastatic disease, disease surveillance, and survivorship in patients with rectal cancer. This portion of the guidelines focuses on the management of localized disease, which involves careful patient selection for curative-intent treatment options that sequence multimodality therapy usually comprised of chemotherapy, radiation, and surgical resection.

View details for DOI 10.6004/jnccn.2018.0061

View details for Web of Science ID 000438786300010

View details for PubMedID 30006429
NCCN Guidelines (R) Insights Colon Cancer, Version 2.2018 Featured Updates to the NCCN Guidelines JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Al-Hawary, M. M., Cederquist, L., Chen, Y., Ciombor, K. K., Cohen, S., Cooper, H. S., Deming, D., Engstrom, P. F., Garrido-Laguna, I., Grem, J. L., Grothey, A., Hochster, H. S., Hoffe, S., Hunt, S., Kamel, A., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Meyerhardt, J., Miller, E. D., Mulcahy, M. F., Murphy, J. D., Nurkin, S., Saltz, L., Sharma, S., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Wuthrick, E., Gregory, K. M., Freedman-Cass, D. A. 2018; 16 (4): 359–69
Abstract

The NCCN Guidelines for Colon Cancer provide recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, management of recurrent and metastatic disease, and survivorship. These NCCN Guidelines Insights summarize the NCCN Colon Cancer Panel discussions for the 2018 update of the guidelines regarding risk stratification and adjuvant treatment for patients with stage III colon cancer, and treatment of BRAF V600E mutation-positive metastatic colorectal cancer with regimens containing vemurafenib.

View details for DOI 10.6004/jnccn.2018.0021

View details for Web of Science ID 000429534300005

View details for PubMedID 29632055
Colon Cancer, Version 1.2017 Clinical Practice Guidelines in Oncology JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK Benson, A. B., Venook, A. P., Cederquist, L., Chan, E., Chen, Y., Cooper, H. S., Deming, D., Engstrom, P. F., Enzinger, P. C., Fichera, A., Grem, J. L., Grothey, A., Hochster, H. S., Hoffe, S., Hunt, S., Kamel, A., Kirilcuk, N., Krishnamurthi, S., Messersmith, W. A., Mulcahy, M. F., Murphy, J. D., Nurkin, S., Saltz, L., Sharma, S., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Wu, C. S., Gregory, K. M., Freedman-Cass, D. 2017; 15 (3): 370-398
Abstract

This portion of the NCCN Guidelines for Colon Cancer focuses on the use of systemic therapy in metastatic disease. Considerations for treatment selection among 32 different monotherapies and combination regimens in up to 7 lines of therapy have included treatment history, extent of disease, goals of treatment, the efficacy and toxicity profiles of the regimens, KRAS/NRAS mutational status, and patient comorbidities and preferences. Location of the primary tumor, the BRAF mutation status, and tumor microsatellite stability should also be considered in treatment decisions.

View details for Web of Science ID 000395889300010

View details for PubMedID 28275037
Rectal Cancer, Version 2.2015. Journal of the National Comprehensive Cancer Network Benson, A. B., Venook, A. P., Bekaii-Saab, T., Chan, E., Chen, Y., Cooper, H. S., Engstrom, P. F., Enzinger, P. C., Fenton, M. J., Fuchs, C. S., Grem, J. L., Grothey, A., Hochster, H. S., Hunt, S., Kamel, A., Kirilcuk, N., Leong, L. A., Lin, E., Messersmith, W. A., Mulcahy, M. F., Murphy, J. D., Nurkin, S., Rohren, E., Ryan, D. P., Saltz, L., Sharma, S., Shibata, D., Skibber, J. M., Sofocleous, C. T., Stoffel, E. M., Stotsky-Himelfarb, E., Willett, C. G., Gregory, K. M., Freedman-Cass, D. 2015; 13 (6): 719-728
Abstract

The NCCN Guidelines for Rectal Cancer begin with the clinical presentation of the patient to the primary care physician or gastroenterologist and address diagnosis, pathologic staging, surgical management, perioperative treatment, posttreatment surveillance, management of recurrent and metastatic disease, and survivorship. The NCCN Rectal Cancer Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize major discussion points from the 2015 NCCN Rectal Cancer Panel meeting. Major discussion topics this year were perioperative therapy options and surveillance for patients with stage I through III disease.

View details for PubMedID 26085388
Insulin increases the release of proinflammatory mediators 63rd Annual Meeting of the American-Association-for-the-Surgery-of-Trauma Brundage, S. I., Kirilcuk, N. N., Lam, J. C., Spain, D. A., Zautke, N. A. LIPPINCOTT WILLIAMS & WILKINS. 2008: 367–72
Abstract

Strict glucose control with insulin is associated with decreased mortality in a mixed patient population in the intensive care unit. Controversy exists regarding the relative benefits of glucose control versus a direct advantageous effect of exogenous insulin. As a combined medical/surgical population differs significantly from the critically injured patient primed for secondary insult, our purpose was to determine the influence of insulin on activated macrophages. Our hypothesis was that insulin would directly abrogate the inflammatory cascade.Differentiated human monocytic THP-1 cells were stimulated with endotoxin (lipopolysaccharide [LPS], 100 ng/mL) for 6 hours. Cells were treated +/-10(-7) M insulin for 1 hour and 24 hours. Total RNA was isolated and gene expression for TNF-alpha and IL-6 performed using Q-RT-PCR. Supernatants were assayed for TNF-alpha and IL-6 protein by ELISA.At 1 hour, compared with macrophages treated with LPS alone, macrophages treated with insulin produced significantly more TNF-alpha protein (11.4 +/- 5.9 pg/mL vs. 32.5 +/- 3.1 pg/mL; p < 0.03). At 24 hours compared with macrophages treated with LPS alone, macrophages treated with insulin produced significantly more TNF-alpha protein (83 +/- 2.02 pg/mL vs. 114 +/- 6.54 pg/mL; p < 0.01). However, gene expression of TNF-alpha and IL-6 was not different in LPS stimulated macrophages with and without insulin treatment at both 1 hour and 24 hours.Contrary to our hypothesis, insulin does not have direct anti-inflammatory properties in this experimental model. In fact, insulin increases proinflammatory cytokine protein levels from activated macrophages.

View details for DOI 10.1097/TA.0b013e3181801cc0

View details for Web of Science ID 000258461600026

View details for PubMedID 18695473
Endovascular management of a gunshot wound to the thoracic aorta 35th Annual Meeting of the Western-Trauma-Association Fang, T. D., Peterson, D. A., Kirilcuk, N. N., Dicker, R. A., Spain, D. A., Brundage, S. I. LIPPINCOTT WILLIAMS & WILKINS. 2006: 204–8
View details for Web of Science ID 000235066300046

View details for PubMedID 16456457
Are temporary inferior vena cava filters really temporary? 57th Annual Meeting of the Southwestern-Surgical-Congress Kirilcuk, N. N., Herget, E. J., Dicker, R. A., Spain, D. A., Hellinger, J. C., Brundage, S. I. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2005: 858–63
Abstract

Despite significant risk for venous thromboembolism, severely injured trauma patients often are not candidates for prophylaxis or treatment with anticoagulation. Long-term inferior vena cava (IVC) filters are associated with increased risk of postphlebitic syndrome. Retrievable IVC filters potentially offer a better solution, but only if the filter is removed; our hypothesis is that the most of them are not.This retrospective study queried a level I trauma registry for IVC filter insertion from September 1997 through June 2004.One IVC filter was placed before the availability of retrievable filters in 2001. Since 2001, 27 filters have been placed, indicating a change in practice patterns. Filters were placed for prophylaxis (n = 11) or for therapy in patients with pulmonary embolism or deep vein thrombosis (n = 17). Of 23 temporary filters, only 8 (35%) were removed.Surgeons must critically evaluate indications for IVC filter insertion, develop standard criteria for placement, and implement protocols to ensure timely removal of temporary IVC filters.

View details for DOI 10.1016/j.amjsurg.2005.08.009

View details for Web of Science ID 000233759800007

View details for PubMedID 16307934

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