Scholars@Duke
Garth S Herbert

Garth S Herbert

Assistant Professor of Surgery
Surgical Oncology
garth.herbert@duke.edu
3410 Executive Drive, Suite 203, Raleigh, NC 27609

Selected Publications

Market Factors, Not Quality, Influence Reimbursement for Pancreaticoduodenectomy in an Era of Price Transparency.

Journal Article Ann Surg Oncol · November 2024 BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) price transparency rule tries to facilitate cost-conscious decision-making. For surgical services, such as pancreaticoduodenectomy (PD), factors mediating transparency and real-world reimburs ... Full text Link to item Cite

Simple versus radical cholecystectomy and survival for pathologic stage T1B gallbladder cancer.

Journal Article HPB (Oxford) · April 2024 BACKGROUND: Radical cholecystectomy is recommended for T1B and greater gallbladder cancer, however, there are conflicting reports on the utility of extended resection for T1B disease. Herein, we characterize outcomes following simple and radical cholecyste ... Full text Link to item Cite

Development of a prospective biliary dashboard to compare performance and surgical cost.

Journal Article Surg Endosc · November 2023 BACKGROUND: Transparency around surgeon level data may align healthcare delivery with quality care for patients. Biliary surgery includes numerous procedures performed by both general surgeons and subspecialists alike. Cholecystectomy is a common surgical ... Full text Link to item Cite

Comparing Survival After Resection, Ablation, and Radiation in Small Intrahepatic Cholangiocarcinoma.

Journal Article Ann Surg Oncol · October 2023 BACKGROUND: Hepatectomy is the cornerstone of curative-intent treatment for intrahepatic cholangiocarcinoma (ICC). However, in patients unable to be resected, data comparing efficacy of alternatives including thermal ablation and radiation therapy (RT) rem ... Full text Open Access Link to item Cite

Trends in Receipt of Adjuvant Chemotherapy and its Impact on Survival in Resected Biliary Tract Cancers.

Journal Article Ann Surg Oncol · August 2023 BACKGROUND: Resection remains the cornerstone of curative-intent treatment for biliary tract cancers (BTCs). However, recent randomized data also support a role for adjuvant chemotherapy (AC). This study aimed to characterize trends in the use of AC and su ... Full text Link to item Cite

Surgical resection is associated with improved long-term survival of patients with resectable pancreatic head cancer compared to multiagent chemotherapy.

Journal Article HPB (Oxford) · July 2022 BACKGROUND: Standard of care for resectable pancreatic cancer is a combination of surgical resection (SR) and multiagent chemotherapy (MCT). We aim to determine whether SR or MCT is associated with superior survival for patients receiving only single-modal ... Full text Link to item Cite

Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors.

Journal Article Cancers (Basel) · February 1, 2021 The scope of our study was to compare the predictive ability of American Joint Committee on Cancer (AJCC) 7th and 8th edition in gallbladder carcinoma (GBC) patients, investigate the effect of AJCC 8th nodal status on the survival, and identify risk factor ... Full text Link to item Cite

Abstract 6536: Safety and efficacy of autologous tumor lysate particle loaded dendritic cell (TLPLDC) vaccination in combination with systemic therapies in patients with metastatic melanoma

Conference Cancer Research · August 15, 2020 AbstractBackground: The treatment of melanoma has changed drastically with the advent of immunotherapy, particularly checkpoint inhibition (CPI). Unfortunately, only 50-60% of tumors respond to current immun ... Full text Cite

Final analysis of a phase I/IIa trial of the folate-binding protein-derived E39 peptide vaccine to prevent recurrence in ovarian and endometrial cancer patients.

Journal Article Cancer Med · August 2019 BACKGROUND: E39, an HLA-A2-restricted, immunogenic peptide derived from the folate-binding protein (FBP), is overexpressed in multiple malignancies. We conducted a phase I/IIa trial of the E39 + GM-CSF vaccine with booster inoculations of either E39 or E39 ... Full text Link to item Cite

Initial safety analysis of a randomized phase II trial of nelipepimut-S + GM-CSF and trastuzumab compared to trastuzumab alone to prevent recurrence in breast cancer patients with HER2 low-expressing tumors.

Journal Article Clin Immunol · April 2019 The development of HER2-targeted therapy has decreased recurrence rates and improved survival, transforming the natural history of HER2-positive breast cancer. However only a minority of breast cancer patients benefit as these agents are not used in patien ... Full text Link to item Cite

Initial phase I/IIa trial results of an autologous tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine in patients with solid tumors.

Journal Article Vaccine · May 31, 2018 INTRODUCTION: Tumor vaccines use various strategies to generate immune responses, commonly targeting generic tumor-associated antigens. The tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine is produced from DC loaded with autologous tumor anti ... Full text Link to item Cite

Cancer Vaccines for Solid Tumors

Chapter · April 13, 2018 Since the late 19th century, when William Coley first injected cancer patients with "Coley's Toxin," we have been searching for a method of inoculation that will effectively harness the power of the immune system to destroy cancer cells. In the realm of so ... Full text Cite

Tumor lysate particle loaded dendritic cell vaccine: preclinical testing of a novel personalized cancer vaccine.

Journal Article Immunotherapy · April 2018 AIM: We developed a novel approach to efficiently deliver autologous tumor antigens to the cytoplasm of dendritic cells (DC) using yeast cell wall particles (YCWP). MATERIALS AND METHODS: Loading of YCWP, leakage of protein from loaded YCWP and cytoplasmic ... Full text Link to item Cite

Transected thin melanoma: Implications for sentinel lymph node staging.

Journal Article J Surg Oncol · March 2018 BACKGROUND AND OBJECTIVES: Indications for sentinel lymph node (SLN) biopsy in patients with thin melanoma (≤1 mm thick) are controversial. We asked whether deep margin (DM) positivity at initial biopsy of thin melanoma is associated with SLN positivity. M ... Full text Link to item Cite

Cancer vaccines in colon and rectal cancer over the last decade: lessons learned and future directions.

Journal Article Expert Rev Clin Immunol · March 2017 Great advances have been made in screening for and treatment of colorectal cancer (CRC), but recurrence rates remain high and additional therapies are needed. There is great excitement around the field of immunotherapy and many attempts have been made to b ... Full text Link to item Cite

Interim analysis of a phase I/IIa trial assessing E39+GM-CSF, a folate binding protein vaccine, to prevent recurrence in ovarian and endometrial cancer patients.

Journal Article Oncotarget · February 28, 2017 BACKGROUND: Folate binding protein(FBP) is an immunogenic protein over-expressed in endometrial(EC) and ovarian cancer(OC). We are conducting a phase I/IIa trial of E39 (GALE 301)+GM-CSF, an HLA-A2-restricted, FBP-derived peptide vaccine to prevent recurre ... Full text Link to item Cite

Routine pre-treatment MRI for breast cancer in a single-payer medical center: Effects on surgical choices, timing and outcomes

Journal Article Journal of Cancer · January 1, 2017 Introduction: Pre-operative MRI is being used with increasing frequency to evaluate breast cancer patients, but the debate surrounding risks and benefits of this use continues. At our institution, we instituted a standardized protocol for pre-operative MRI ... Full text Cite

Evaluation of attenuated tumor antigens and the implications for peptide-based cancer vaccine development

Journal Article Journal of Cancer · January 1, 2017 INTRODUCTION: Peptide vaccines offer anti-tumor efficacy with very low toxicity. However, repeat stimulation with an immunogenic peptide leads to activation induced cell death (AICD), decreasing efficacy. We engineered variants of an immunogenic peptide (E ... Full text Cite

Gaining ground on a cure through synergy: combining checkpoint inhibitors with cancer vaccines.

Journal Article Expert Rev Clin Immunol · December 2016 The approval of multiple checkpoint inhibitors (CPIs) for the treatment of advanced malignancies has sparked an explosion of research in the field of cancer immunotherapy. Despite the success of these medications, a large number of patients with advanced m ... Full text Link to item Cite

A phase I/IIa clinical trial in stage IV melanoma of an autologous tumor-dendritic cell fusion (dendritoma) vaccine with low dose interleukin-2.

Journal Article Cancer Immunol Immunother · April 2016 BACKGROUND: Stage IV melanoma has high mortality, largely unaffected by traditional therapies. Immunotherapy including cytokine therapies and checkpoint inhibitors improves outcomes, but has significant toxicities. In this phase I/IIa trial, we investigate ... Full text Link to item Cite

Early trends in serum phosphate and creatinine levels are associated with mortality following major hepatectomy.

Conference HPB (Oxford) · December 2015 BACKGROUND: Mortality after major hepatectomy remains high and is frequently related to post-hepatectomy liver failure (PHLF). Other than pre-existing liver disease and a small future liver remnant, few patient factors or early postoperative indicators ide ... Full text Link to item Cite

The triangular intermuscular space as a site of lymph node metastasis in melanoma of the back.

Journal Article Ann Plast Surg · January 2010 The Triangular Intermuscular Space is defined by borders of the teres major, teres minor, and long head of the triceps. Through this space pass the descending circumflex scapular artery, vena comitants, and lymphatics. We report 3 patients with truncal mel ... Full text Link to item Cite

Prophylactic mesh to prevent incisional hernia: a note of caution.

Journal Article Am J Surg · May 2009 BACKGROUND: Ventral hernia is a common complication of open Roux-en-Y gastric bypass (RYGB). The aim of this study was to determine whether prophylactic mesh placement during RYGB would reduce the incidence of postoperative hernias. METHODS: Obese patients ... Full text Link to item Cite

Demographics, treatment, and early outcomes in penetrating vascular combat trauma.

Journal Article Arch Surg · August 2008 OBJECTIVES: To describe arterial and venous injuries and their management and short-term outcomes in a wartime hospital. DESIGN: Retrospective review of patients with vascular injuries. Mechanism, location, method of repair, and outcomes were analyzed with ... Full text Link to item Cite

Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.

Journal Article J Trauma · February 2008 BACKGROUND: Up to 9% of casualties killed in action during the Vietnam War died from exsanguination from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extr ... Full text Link to item Cite

Acute and chronic mesenteric ischemia.

Journal Article Surg Clin North Am · October 2007 This article briefly reviews the various etiologies, presentation, and diagnosis of different types of mesenteric ischemia. Operative management techniques and the applicability of percutaneous endovascular intervention are discussed. Finally, the authors ... Full text Link to item Cite

Breast papillomas in the era of percutaneous needle biopsy.

Journal Article Ann Surg Oncol · October 2007 BACKGROUND: The significance of breast papillomas detected on core needle biopsy (CNB) remains unclear. While those associated with malignancy or atypia are excised, no clear solution exists for benign papillomas. We sought to determine the indication for ... Full text Link to item Cite

Atypical ductal hyperplasia: improved accuracy with the 11-gauge vacuum-assisted versus the 14-gauge core biopsy needle.

Journal Article Ann Surg Oncol · September 2007 BACKGROUND: Percutaneous stereotactic core needle biopsy (CNB) has become the primary diagnostic modality for evaluating nonpalpable, mammographically detected breast lesions. Atypical ductal hyperplasia (ADH) uncovered by CNB confers a significant risk of ... Full text Link to item Cite

Mid-aortic syndrome and renovascular hypertension in a 14-year-old Iraqi girl: pitfalls in diagnosis and surgical management.

Journal Article Ann Vasc Surg · September 2007 Mid-aortic syndrome remains an uncommon cause of hypertension in the pediatric population. Reported management options include percutaneous intervention, medical management, renal autotransplantation, and bypass of diseased portions of the aorta with prost ... Full text Link to item Cite

The impact of nodal isolated tumor cells on survival of breast cancer patients.

Journal Article Am J Surg · May 2007 BACKGROUND: Isolated tumor cells (ITCs), often detectable only with immunohistochemical techniques, have an unknown significance in the prognosis of breast cancer. The American Joint Committee on Cancer guidelines classify such patients as N0 (immunohistoc ... Full text Link to item Cite

Prognostic significance of reactivation of telomerase in breast core biopsy specimens.

Journal Article Am J Surg · May 2007 BACKGROUND: Telomerase is not expressed in most somatic tissues, but activity has been shown in breast carcinoma and up to 90% of solid tumors. We sought to determine whether activation of telomerase, as shown by immunohistochemical staining for human telo ... Full text Link to item Cite

Intestinal fatty acid binding protein (I-FABP) for the detection of strangulated mechanical small bowel obstruction.

Journal Article Curr Surg · 2006 OBJECTIVE: Intestinal fatty acid binding protein (I-FABP), a protein released by necrotic enterocytes, is a useful marker for the detection of ischemia from mechanical small bowel obstruction. DESIGN: Validation cohort. SETTING: Academic medical center. PA ... Full text Link to item Cite