Douglas S. Tyler, MD

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Services

• Bone and Soft Tissue Cancer
• Gastroenterology
• Gastrointestinal Cancer
• Skin Cancer

Department / Division:
Surgery / General Surgery

Address:
DUMC 3118
Durham, NC 27710

Appointment Telephone:
(919) 684-6858 or (919) 684-2137

Office Telephone:
(919) 684-6858

Fax Telephone:
(919) 681-8701 or (919) 684-6044

• M.D., Dartmouth Medical School, New Hampshire, 1985

• Surgery, Duke University Medical Center, North Carolina, 1985-1992

• Surgical Oncology, M.D. Anderson Cancer Center, Texas, 1992-1994

Clinical Interests:
Surgical oncology, surgical treatment of colon and rectal cancer, specializing in sphincter preserving operations for rectal cancer, surgical treatment of pancreatic cancer and gastric cancer, carcinoid tumors, melanoma, including intraoperative lymphatic mapping and sentinel lymph node biopsy, hyperthermic isolated limb perfusion for melanoma and sarcoma, sarcomas or retroperitoneum, abdominal wall, and extremities

Research Interests:
 My research activities can be broken down into two categories: basic science and clinical.  
 My basic science research involves improving regional therapies for melanomas and sarcomas.  We have developed animal models that mimic the human clinical situation of advanced extremity melanoma and sarcoma. Our approaches involve testing new/novel drugs that are themselves cytotoxic or inhibit various chemotherapy resistance pathways that decrease the effacacy of the chemotehrapeutic agent. We collaborate closely with Dr Henry Friedman on these projects.  In addition,  we are also exploring how hyperthermia can be utilized to optimize the therapeutic index of drugs and how tissue directed gene therapy with GMCSF in conjunction with regional chemotherapy can attempt to allow a regional chemotherapy treatment that causes local cytotoxicity to generate a systemic immune response.  We colloborate closely with Dr Mark Dewhirst and Dr Scott Pruitt on these studies.  This work is currently funded through a VA Merit Review grant and a grant from the American College of Surgeons Oncology Group.  Although this is the main thrust of our laboratory currently we are also involved in developing novel vaccine strategies for patients with pancreatic cancer and better ways to detect subclinical metastatic disease.
My clinical research focuses on innovative ways to approach malignant tumors such as GI tumors, melanoma, and sarcomas. We have a multidisciplinary GI tumor clinic and melanoma clinic on Mondays.   The goal of these clinics is to manage patients with complex GI tumors or melanoma in innovative ways.  We currently have several active clinical protocols  and offer a broad range of cutting edge treatments including neoadjuvant chemotherapy, intraoperative radiation therapy, and regional therapies for melanoma. We have large databases on melanoma, pancreatic cancer, rectal cancer, and carcinoid tumors.  Most of our clinical research focuses on outcomes after neoadjuvant therapies of the pancreatic and rectal cancer.  In addition, we run a clinical research program in regional therapies looking at the pharmacokinetics and drug resistance involved in the regional treatment of patients with advanced extremity melanoma.

Representative Publications:
Ritter EF, Lee CG, Tyler DS, Ferraro F, Whiddon C, and Scully S. Advances in prevention of radiation damage to visceral and solid organs in patients requiring radiation to the trunk. Journal of Surgical Oncology. 64:109-114, 1997. (1997)

Keogan M, Tyler DS, Clark L, Branch S, McDermott VG, Coleman E, Diagnosis of pancreatic cancer; role of FDG-PET imaging. Amnerican Journal of Roentgenology. 171:1565-1570,1998. (1998)

Clark L, Ritter EF, Glazebrook K, and Tyler DS. Recurrent ductal carcinoma in-situ after total mastectomy. Journal of Surgical Oncology. 71:182-185, 1999. (1999)

Dong XD, Tyler DS, Johnson J, DeMatos P, and Seigler HF. Analysis of prognosis and progression of disease following local recurrence from melanoma. Cancer. 88:1063-1071, 2000. (2000)

Purcell GP, Odunze MJ, and Tyler DS. Utilities for temporary health states in pancreatic cancer. Surgical Forum. 52:462-464, 2001. (2001)

Tyler DS, Lyerly HK, Weinhold KJ. Anti-HIV-1 ADCC. AIDS Res Hum Retroviruses. 1989 Dec;5(6):557-63. (1989) Abstract

Kalady MF, Onaitis MW, Padilla KM, Emani S, Tyler DS, Pruitt SK. Enhanced dendritic cell antigen presentation in RNA-based immunotherapy. J Surg Res. 2002 Jun 1;105(1):17-24. (2002) Abstract

Owen SA, Sanders LL, Edwards LJ, Seigler HF, Tyler DS, Grichnik JM. Identification of higher risk thin melanomas should be based on Breslow depth not Clark level IV. Cancer. 2001 Mar 1;91(5):983-91. (2001) Abstract

Weinhold KJ, Tyler DS, Lyerly HK. Measurement of direct and indirect forms of anti-HIV-1 ADCC: implications for other retroviral disease. Dev Biol Stand. 1990;72:343-8. (1990) Abstract

White RR, Tyler DS. Management of node-positive melanoma in the era of sentinel node biopsy. Surg Oncol. 2000 Nov;9(3):119-25. (2000) Abstract

Tyler DS, Shaunak S, Bartlett JA, Iglehart JD. HIV-1-associated thrombocytopenia. The role of splenectomy. Ann Surg. 1990 Feb;211(2):211-7. (1990) Abstract

Tyler DS, Shaha AR, Udelsman RA, Sherman SI, Thompson NW, Moley JF, Evans DB. Thyroid cancer: 1999 update. Ann Surg Oncol. 2000 Jun;7(5):376-98. (2000) Abstract

Tyler DS, Winchester DJ, Caraway NP, Hickey RC, Evans DB. Indeterminate fine-needle aspiration biopsy of the thyroid: identification of subgroups at high risk for invasive carcinoma. Surgery. 1994 Dec;116(6):1054-60. (1994) Abstract

Tyler DS, Onaitis M, Kherani A, Hata A, Nicholson E, Keogan M, Fisher S, Coleman E, Seigler HF. Positron emission tomography scanning in malignant melanoma. Cancer. 2000 Sep 1;89(5):1019-25. (2000) Abstract

DeMatos P, Tyler DS, Seigler HF. Malignant melanoma of the mucous membranes: a review of 119 cases. Ann Surg Oncol. 1998 Dec;5(8):733-42. (1998) Abstract

Kirshbom PM, Kherani AR, Onaitis MW, Feldman JM, Tyler DS. Carcinoids of unknown origin: comparative analysis with foregut, midgut, and hindgut carcinoids. Surgery. 1998 Dec;124(6):1063-70. (1998) Abstract

Onaitis M, Kalady MF, Pruitt S, Tyler DS. Dendritic cell gene therapy. Surg Oncol Clin N Am. 2002 Jul;11(3):645-60. (2002) Abstract

Kalady MF, White DC, Fields RC, Coleman RE, Schuler FR, Seigler HF, Tyler DS. Validation of delayed sentinel lymph node mapping for melanoma. Cancer J. 2001 Nov-Dec;7(6):503-8. (2001) Abstract

Kalady MF, Clary BM, Tyler DS, Pappas TN. Pancreas-preserving duodenectomy in the management of duodenal familial adenomatous polyposis. J Gastrointest Surg. 2002 Jan-Feb;6(1):82-7. (2002) Abstract

DeMatos P, Tyler D, Seigler HF. Mucosal melanoma of the female genitalia: a clinicopathologic study of forty-three cases at Duke University Medical Center. Surgery. 1998 Jul;124(1):38-48. (1998) Abstract

Clark L, Ritter EF, Glazebrook K, and Tyler DS. Recurrent ductal carcinoma in-situ after total mastectomy. 1997. (Submitted, Surgery). (1997)

Onaitis M, Ludwig K, Perez-Tamayo A, Gotfried M, Russell L, Shadduck P, Pappas TN, Seigler HF, and Tyler DS. The kraske procedure: an under utilized approach for mid-rectal lesions. 1997. (Submitted, Annals of Surgery). 9. DeMatos P, Tyler DS, and Seigler HF. Malignant melanoma of the mucous membranes: A review of 119 cases. 1997. (Submitted, Annals of Surgery). (1997)

Mellard M, Culhane D, and Tyler DS. Breast Examination: Methods to facilitate the early diagnosis of breast cancer. In: Clinics Atlas of Office Procedures: Office Gynecology. Appleby J and Montella KR, eds., W.B. Saunders Co, Philadelphia, 1997 (In press). (1997)

Holzman MD, Reintgen KL, Tyler DS, and Pappas TN. The role of laparoscopy in the management of suspected pancreatic and periampullary malignancies. Journal of Gastrointestinal Surgery. 1:236-244, 1998. (1998)

DeMatos P, Tyler DS, and Seigler HF. Mucosal melanoma of the female genitalia: a clinicopathologic study of 43 cases at Duke University Medical Center. Surgery. 124:38-48, 1998. (1998)

Bartlett JA, Berend C, Petroni G, Ottinger J, Tyler DS, Pettinelli C, and Weinhold KJ. Co-administration of zidovudine and interleukin-2 increases absolute CD4 cells in subjects with Walter Reed stage 2 HIV infection: results of ACTG protocol 042. Journal of Infectious Diseases. 178: 1170-1173, 1998. (1998)

White R., Lee C, Anscher M, Gottfried M, Wolff R, Keogan M, Pappas T, Hurwitz H, and Tyler DS. Preoperative chemoradiation for locally advanced adenocarcinoma of the pancreas. Annals of Surgical Oncology. 6:38-45, 1999. (1999)

Anscher MS, Lee C, Hurwitz H, Tyler DS, Prosnitz L, Jowell P, Rosner G, Samulski T, and Dewhirst MW. A pilot study of preoperative continous infusion 5-fluorouracil, external microwave hyperthermia, and external beam radiotherapy for treatment of locally advanced, unresectable, or recurrent rectal cancer. International Jouurnal of Radiation Oncology, Biology, and Physics. 47:719-724, 2000. (2000)

White R, Hurwitz H, Lee C, Morse M, Paulson E, Gotfried M, Baillie J, Branch M, Jowell P, McGrath K, Clary B, Pappas T, and Tyler DS. Staging of pancreatic cancer before and after neoadjuvant chemoradiation. Journal of Gastrointestinal Surgery. 5:626-633, 2001. (2001)

Tyler DS, Nastala CL, Stanley SD, Matthews TJ, Lyerly HK, Bolognesi DP, Weinhold KJ. GP120 specific cellular cytotoxicity in HIV-1 seropositive individuals. Evidence for circulating CD16+ effector cells armed in vivo with cytophilic antibody. J Immunol. 1989 Feb 15;142(4):1177-82. (1989) Abstract

Kirshbom PM, Kherani AR, Onaitis MW, Hata A, Kehoe TE, Feldman C, Feldman JM, Tyler DS. Foregut carcinoids: a clinical and biochemical analysis. Surgery. 1999 Dec;126(6):1105-10. (1999) Abstract

Towpik E, Kupiec-Weglinski JW, Tyler DS, Araujo JL, Schneider TM, Araneda D, Murphy GM, Tilney NL. Cyclosporine and experimental skin allografts: long-term survival in rats treated with low maintenance doses. Plast Reconstr Surg. 1986 Feb;77(2):268-76. (1986) Abstract

Weinhold KJ, Lyerly HK, Matthews TJ, Tyler DS, Ahearne PM, Stine KC, Langlois AJ, Durack DT, Bolognesi DP. Cellular anti-GP120 cytolytic reactivities in HIV-1 seropositive individuals. Lancet. 1988 Apr 23;1(8591):902-5. (1988) Abstract

Clary BM, Tyler DS, Dematos P, Gottfried M, Pappas TN. Local ampullary resection with careful intraoperative frozen section evaluation for presumed benign ampullary neoplasms. Surgery. 2000 Jun;127(6):628-33. (2000) Abstract

Chari RS, Tyler DS, Anscher MS, Russell L, Clary BM, Hathorn J, Seigler HF. Preoperative radiation and chemotherapy in the treatment of adenocarcinoma of the rectum. Ann Surg. 1995 Jun;221(6):778-86; discussion 786-7. (1995) Abstract

Holzman MD, Reintgen KL, Tyler DS, Pappas TN. The Role of Laparoscopy in the Management of Suspected Pancreatic and Periampullary Malignancies. J Gastrointest Surg. 1997 May;1(3):236-244. (1997) Abstract

Tyler DS, Evans DB. Reoperative pancreaticoduodenectomy. Ann Surg. 1994 Feb;219(2):211-21. (1994) Abstract

Onaitis MW, Kirshbom PM, Hayward TZ, Quayle FJ, Feldman JM, Seigler HF, Tyler DS. Gastrointestinal carcinoids: characterization by site of origin and hormone production. Ann Surg. 2000 Oct;232(4):549-56. (2000) Abstract

White RR, Hurwitz HI, Morse MA, Lee C, Anscher MS, Paulson EK, Gottfried MR, Baillie J, Branch MS, Jowell PS, McGrath KM, Clary BM, Pappas TN, Tyler DS. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol. 2001 Dec;8(10):758-65. (2001) Abstract

Tyler DS, Francis GM, Frederick M, Tran AH, Ordóñez NG, Smith JL, Eton O, Ross M, Grimm EA. Interleukin-1 production in tumor cells of human melanoma surgical specimens. J Interferon Cytokine Res. 1995 Apr;15(4):331-40. (1995) Abstract

Tyler DS, Stanley SD, Zolla-Pazner S, Gorny MK, Shadduck PP, Langlois AJ, Matthews TJ, Bolognesi DP, Palker TJ, Weinhold KJ. Identification of sites within gp41 that serve as targets for antibody-dependent cellular cytotoxicity by using human monoclonal antibodies. J Immunol. 1990 Nov 15;145(10):3276-82. (1990) Abstract

Onaitis MW, Noone RB, Fields R, Hurwitz H, Morse M, Jowell P, McGrath K, Lee C, Anscher MS, Clary B, Mantyh C, Pappas TN, Ludwig K, Seigler HF, Tyler DS. Complete response to neoadjuvant chemoradiation for rectal cancer does not influence survival. Ann Surg Oncol. 2001 Dec;8(10):801-6. (2001) Abstract

White RR, Stanley WE, Johnson JL, Tyler DS, Seigler HF. Long-term survival in 2,505 patients with melanoma with regional lymph node metastasis. Ann Surg. 2002 Jun;235(6):879-87. (2002) Abstract

Stine KC, Tyler DS, Stanley SD, Bartlett JA, Bolognesi DP, Weinhold KJ. The effect of AZT on in vitro lymphokine-activated killer (LAK) activity in human immunodeficiency virus type-1 (HIV-1) infected individuals. Cell Immunol. 1991 Aug;136(1):165-72. (1991) Abstract

Tyler DS, Stanley SD, Bartlett JA, Bolognesi DP, Weinhold KJ. Lymphokine-activated killer (LAK) cell anti-HIV-1 ADCC reactivity: a potential strategy for reduction of virus-infected cellular reservoirs. J Surg Res. 1998 Oct;79(2):115-20. (1998) Abstract

Tyler DS, Stanley SD, Nastala CA, Austin AA, Bartlett JA, Stine KC, Lyerly HK, Bolognesi DP, Weinhold KJ. Alterations in antibody-dependent cellular cytotoxicity during the course of HIV-1 infection. Humoral and cellular defects. J Immunol. 1990 May 1;144(9):3375-84. (1990) Abstract

Onaitis MW, Noone RB, Hartwig M, Hurwitz H, Morse M, Jowell P, McGrath K, Lee C, Anscher MS, Clary B, Mantyh C, Pappas TN, Ludwig K, Seigler HF, Tyler DS. Neoadjuvant chemoradiation for rectal cancer: analysis of clinical outcomes from a 13-year institutional experience. Ann Surg. 2001 Jun;233(6):778-85. (2001) Abstract

Czito BG, Hong TJ, Cohen DP, Tyler DS, Lee CG, Anscher MS, Ludwig KA, Seigler HF, Mantyh C, Morse MA, Lockhart AC, Petros WP, Honeycutt W, Spector NL, Ertel PJ, Mangum SG, Hurwitz HI. A Phase I trial of preoperative eniluracil plus 5-fluorouracil and radiation for locally advanced or unresectable adenocarcinoma of the rectum and colon. Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):779-85. (2004) Abstract

Abdel-Wahab Z, Kalady MF, Emani S, Onaitis MW, Abdel-Wahab OI, Cisco R, Wheless L, Cheng TY, Tyler DS, Pruitt SK. Induction of anti-melanoma CTL response using DC transfected with mutated mRNA encoding full-length Melan-A/MART-1 antigen with an A27L amino acid substitution. Cell Immunol. 2003 Aug;224(2):86-97. (2003) Abstract

Kalady MF, Peterson B, Baillie J, Onaitis MW, Abdul-Wahab OI, Howden JK, Jowell PS, Branch MS, Clary BM, Pappas TN, Tyler DS. Pancreatic duct strictures: identifying risk of malignancy. Ann Surg Oncol. 2004 Jun;11(6):581-8. (2004) Abstract

Kalady MF, Clary BM, Clark LA, Gottfried M, Rohren EM, Coleman RE, Pappas TN, Tyler DS. Clinical utility of positron emission tomography in the diagnosis and management of periampullary neoplasms. Ann Surg Oncol. 2002 Oct;9(8):799-806. (2002) Abstract

Kypson AP, Onaitis MW, Feldman JM, Tyler DS. Carcinoid and chylous ascites: an unusual association. J Gastrointest Surg. 2002 Sep-Oct;6(5):781-3. (2002) Abstract

St Louis JD, Leight GS, Tyler DS. Follicular neoplasms: the role for observation, fine needle aspiration biopsy, thyroid suppression, and surgery. Semin Surg Oncol. 1999 Jan-Feb;16(1):5-11. (1999) Abstract

Tyler DS, Lyerly HK, Nastala CL, Shadduck PP, Fitzpatrick KT, Langlois AJ, Moylan JA. Barrier protection against the human immunodeficiency virus. Curr Surg. 1989 Jul-Aug;46(4):301-4. (1989) Abstract

White RR, Paulson EK, Freed KS, Keogan MT, Hurwitz HI, Lee C, Morse MA, Gottfried MR, Baillie J, Branch MS, Jowell PS, McGrath KM, Clary BM, Pappas TN, Tyler DS. Staging of pancreatic cancer before and after neoadjuvant chemoradiation. J Gastrointest Surg. 2001 Nov-Dec;5(6):626-33. (2001) Abstract

Safford SD, Coleman RE, Gockerman JP, Moore J, Feldman JM, Leight GS Jr, Tyler DS, Olson JA Jr. Iodine -131 metaiodobenzylguanidine is an effective treatment for malignant pheochromocytoma and paraganglioma. Surgery. 2003 Dec;134(6):956-62; discussion 962-3. (2003) Abstract

Kalady MF, White RR, Johnson JL, Tyler DS, Seigler HF. Thin melanomas: predictive lethal characteristics from a 30-year clinical experience.  Ann Surg.  2003 Oct;238(4):528-35; discussion 535-7. (2003) Abstract

Kalady MF, Onaitis MW, Emani S, Abdul-Wahab Z, Pruitt SK, Tyler DS. Dendritic cells pulsed with pancreatic cancer total tumor RNA generate specific antipancreatic cancer T cells. J Gastrointest Surg. 2004 Feb;8(2):175-81; discussion 181-2. (2004) Abstract

White RR, Shah AS, Tyler DS. Pancreatic cancer since Halsted: how far have we come and where are we going? Ann Surg. 2003 Dec;238(6 Suppl):S132-44; discussion S145-7. (2003) Abstract

Kalady MF, Onaitis MW, Emani S, Abdel-Wahab Z, Tyler DS, Pruitt SK. Sequential delivery of maturation stimuli increases human dendritic cell IL-12 production and enhances tumor antigen-specific immunogenicity. J Surg Res. 2004 Jan;116(1):24-31. (2004) Abstract

Cisco RM, Abdel-Wahab Z, Dannull J, Nair S, Tyler DS, Gilboa E, Vieweg J, Daaka Y, Pruitt SK. Induction of human dendritic cell maturation using transfection with RNA encoding a dominant positive toll-like receptor 4. J Immunol. 2004 Jun 1;172(11):7162-8. (2004) Abstract

Onaitis MW, Kalady MF, Emani S, Abdel-Wahab Z, Tyler DS, Pruitt SK. CD40 ligand is essential for generation of specific cytotoxic T cell responses in RNA-pulsed dendritic cell immunotherapy. Surgery. 2003 Aug;134(2):300-5. (2003) Abstract

Czito B, Clough R, Tyler D, Hurwitz H, Lee C, Clary B, Morse M, Blobe J, Pappas T. Adjuvant external beam radiotherapy with concurrent chemotherapy following resection of primary gallbladder carcinoma: a 23-year experience. Int J Radiat Oncol Biol Phys. 2003 Oct 1;57(2 Suppl):S385-6. (2003) Abstract

Tyler D. Where are we going with regional therapy for melanoma?  Ann Surg Oncol.  2004 May;11(5):455-7. (2004) Abstract

White R, Lee C, Anscher M, Gottfried M, Wolff R, Keogan M, Pappas T, Hurwitz H, Tyler D. Preoperative chemoradiation for patients with locally advanced adenocarcinoma of the pancreas. Ann Surg Oncol. 1999 Jan-Feb;6(1):38-45. (1999) Abstract

Byrne MF, Mitchell RM, Stiffler H, Jowell PS, Branch MS, Pappas TN, Tyler D, Baillie J. Extensive investigation of patients with mild elevations of serum amylase and/or lipase is 'low yield'. Can J Gastroenterol. 2002 Dec;16(12):849-54. (2002) Abstract

White DC, Schuler FR, Pruitt SK, Culhane DK, Seigler HF, Coleman RE, Tyler D. Timing of sentinel lymph node mapping after lymphoscintigraphy. Surgery. 1999 Aug;126(2):156-61. (1999) Abstract

Morse MA, Lyerly HK, Clay TM, Abdel-Wahab O, Chui SY, Garst J, Gollob J, Grossi PM, Kalady M, Mosca PJ, Onaitis M, Sampson JH, Seigler HF, Toloza EM, Tyler D, Vieweg J, Yang Y. Immunotherapy of surgical malignancies. Curr Probl Surg. 2004 Jan;41(1):15-132. (2004) Abstract

Skinner MA, Tyler D, Branum GD, Cucchiaro G, Branum MA, Meyers WC. Subtotal colectomy for familial polyposis. A clinical series and review of the literature. Arch Surg. 1990 May;125(5):621-4. (1990) Abstract

Onaitis M, White R, Tyler D. Carcinoid tumors of the gastrointestinal tract. A review and the Duke University institutional overview. Minerva Chir. 2003 Feb;58(1):1-8. (2003) Abstract

Tyler D, Effmann E, Shorter N. Pyriform sinus cyst and fistula in the newborn: the value of endoscopic cannulation. J Pediatr Surg. 1992 Dec;27(12):1500-1. (1992) Abstract

Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M, Hurwitz H, Pappas T, Tyler D, McGrath K. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003 Nov;58(5):690-5. (2003) Abstract

Onaitis M, Morse M, Hurwitz H, Cotton P, Tyler D, Clavien P, Clary B. Adjuvant hepatic arterial chemotherapy following metastasectomy in patients with isolated liver metastases. Ann Surg. 2003 Jun;237(6):782-8; discussion 788-9. (2003) Abstract

Morse MA, Nair SK, Boczkowski D, Tyler D, Hurwitz HI, Proia A, Clay TM, Schlom J, Gilboa E, Lyerly HK. The feasibility and safety of immunotherapy with dendritic cells loaded with CEA mRNA following neoadjuvant chemoradiotherapy and resection of pancreatic cancer. Int J Gastrointest Cancer. 2002;32(1):1-6. (2002) Abstract

Cheng TY, Grubbs E, Abdul-Wahab O, Leu SY, Hung CF, Petros W, Aloia T, Fedrau R, Pruitt S, Colvin M, Friedman H, Tyler D. Marked variability of melphalan plasma drug levels during regional hyperthermic isolated limb perfusion. Am J Surg. 2003 Nov;186(5):460-7. (2003) Abstract