During November’s Medical Student Grand Rounds at DHMC, Geisel students shared their research involving a patient with a chronic Stanford Type B aortic dissection, metastatic pattern and inflammation-related biomarkers as potential predictors of long-term survival in metastatic PDAC, and global GI care in Rwanda.
Here are summaries of their presentations:
Derek Colaizzo MED’26, MBA: Chronic Stanford type B Aortic Dissection Septostomy in a patient with a previous Elephant Trunk Procedure Graft to False Lumen
“A patient with a rare and technically demanding cardiovascular case with a chronic Stanford Type B aortic dissection, had previously undergone an “elephant trunk” graft and later received a thoracic endovascular aortic repair (TEVAR) that was inadvertently deployed into the false lumen—the abnormal channel created when blood tears between layers of the aortic wall. This misplacement left the true and false lumens separated, driving unstable blood flow and raising the risk of organ injury, stroke, and rupture. To correct this, surgeons performed an electrified septostomy, using specialized instruments to create controlled openings between the two channels and restore a unified pathway for blood. The extraordinary anesthetic challenges of the operation required the need for precise blood-pressure control, advanced monitoring to distinguish pressures in each lumen, and continuous coordination with the surgical team as circulatory dynamics shifted rapidly during the septostomy. Emphasis was placed on protecting the spinal cord, kidneys, and brain—organs highly vulnerable during descending aortic repairs. This underscored not only the complexity of managing chronic dissections altered by prior grafts but also the critical role anesthesiologists play in maintaining stability and preventing catastrophic complications during these high-risk, highly specialized procedures.”
Dain Shirmer MED’27: Predictors of two-year survival in patients receiving chemotherapy for metastatic pancreatic ductal adenocarcinoma (mPDAC): A single-center retrospective cohort study
“Pancreatic ductal adenocarcinoma (PDAC) is a very deadly cancer, with most patients presenting with locally advanced or metastatic disease and a median overall survival of only 9–12 months. Curative therapy requires surgical resection, but fewer than 20% are eligible, leaving systemic chemotherapy—most commonly modified FOLFIRINOX or gemcitabine/nab-paclitaxel—as the mainstay of treatment. Our single-center retrospective study evaluated predictors of ≥2-year survival in metastatic PDAC. Baseline characteristics, laboratory trajectories over six months, and Kaplan-Meier survival outcomes were compared between survivors <730 days and ≥730 days. Several findings diverged from conventional teaching: survival outcomes for mFOLFIRINOX and gemcitabine/nab-paclitaxel were similar—consistent with emerging trials such as PASS-01. A notable prognostic signal was the neutrophil-to-lymphocyte ratio (NLR), which was significantly lower in long-term survivors at baseline and remained distinct over time, driven primarily by neutrophil count differences. Lung-only metastases also correlated with improved survival, aligning with limited but growing literature suggesting this subgroup may have more favorable tumor biology. Unresolved questions include whether liver dysfunction or systemic inflammation mediates survival differences and the ambiguous role of prior pancreatectomy in the likelihood of ≥2-year survival. Overall, our study highlights metastatic pattern and inflammation-related biomarkers, particularly NLR, as potential predictors of long-term survival in metastatic PDAC.”
This project will be published in the spring and was inspired through my experience as a first-year medical student in the "Translational Oncology Program for Scholars (TOPS)," a paid summer research program for Geisel students sponsored by the Dartmouth Cancer Center.
Kamila Zakowicz MED’28: Global GI Care: Lessons Learned in Follow-up of Rwandan Endoscopy Week
“Since 2017, Dartmouth has collaborated with hospitals in Rwanda to conduct an annual Rwanda Society for Endoscopy (RSE) Week. This initiative, which has brought together physicians, residents, and medical students from across the world, consists of didactic training and endoscopic procedures performed at various hospitals throughout Rwanda. Patients are referred for endoscopic procedures for various presentations and symptomatology. Depending on the outcome and pathology, patients may be asked to follow up with various surgical or medicine teams. The goal of this project was to determine follow up status of the 884 endoscopy week patients seen in March 2025 and develop a QI plan for following up with these patients in the future.”
