Two surgeons at the Ochsner Cancer Institute in New Orleans recently performed procedures that marked firsts for Louisiana.
Dr. W. Charles Conway, a surgical oncologist at Ochsner Medical Center, performed the first totally robotic pancreaticoduodenectomy, or Whipple procedure. The complex operation is most commonly done for pancreatic cancer, and if performed conventionally, requires a large abdominal incision.
Dr. Rodney J. Landreneau, director of the Cancer Institute and vice chairman of the Department of Surgery for Cancer Services, recently performed a surgical debulking procedure with hyperthermic chemotherapy to treat malignant mesothelioma of the chest. Landreneau had performed the procedure many times during his 25 years at University of Pittsburgh Medical Center, but the surgery was the first intervention of its kind in Louisiana.
Both procedures improve the quality of patients’ lives and may increase their survival time.
“Overall survival with pancreatic cancer is poor. The chance of being alive five years after the diagnosis is 6 percent for everyone with this disease, but much better at 25 percent to 30 percent for those who can have their tumor removed surgically, which is about 20 percent of all patients with pancreatic cancer,” Conway said.
Since the internal operation does not change, the cancer outcomes with robotically assisted surgery are equivalent to traditional open surgery, he said.
But because the chance of a cure is relatively low, quality of life has to be considered during treatment planning, Conway said. The most common surgical procedure is removal of the pancreatic head. The Whipple procedure is an extremely complex operation that can have a significant effect on quality of life.
Robotically assisted surgery allows a minimally invasive surgery, with small incisions, reducing the wound size, patients’ pain, and recovery time while improving the quality of life, he said.
Ochsner Medical Center was one of the early adopters of the da Vinci Surgical System and describes itself as the Gulf South’s leader in robotic surgery. In 2007, Ochsner was designated a training center for the da Vinci system.
The da Vinci system is the only robotic product available for general surgery. The devices are used in everything from prostate and gall bladder surgery to cardiovascular and gynecological procedures.
The only such system for general surgery, da Vinci robots are used for a growing array of procedures, including prostate, gallbladder, cardiovascular and gynecological surgery. Around 1.5 million surgeries have been performed with the system.
Although there have been recent reports criticizing robotically assisted surgery, Ochsner has not had any of those issues, according to the health system.
“The device should be considered a surgical instrument just like any other and can be used appropriately by experienced surgeons with great patient benefit,” Conway said.
Conway said in his area of practice, upper GI and hepatobiliary surgical oncology, physicians perform the majority of surgeries for cancer of the esophagus, stomach and left side of the pancreas with the surgical robot.
“More recently, we have started using the da Vinci system for liver resections, and the Whipple procedure. This approach allows the same cancer operation, maximizing the chance for cure, with smaller incisions,” he said.
Landreneau’s innovative approach may lead to improved removal of visible tumors and cancer-related survival, according to Ochsner. Malignant mesothelioma is a serious, difficult to treat cancer related to asbestos exposure and commonly involves the lining cells of the lung.
The procedure Landreneau is pioneering here – surgical debulking with hyperthermic chemotherapy – involves removal of all visible tumors from the chest cavity, commonly saving the patient’s lung, and then instilling “hot” chemotherapy throughout the chest cavity to treat microscopic tumor cells that may remain.
“This therapy provides hope for the many patients of our region with this potentially devastating disease,” said Landreneau, a world-recognized expert in thoracic surgical oncology.
Landreneau said about 60 percent of mesothelioma patients whose disease is limited to one side can be treated in this manner.
“The preliminary information suggests that local control of the disease is improved and intermediate term survival and quality of life appears to be improved by 20 percent to 30 percent,” Landreneau said.
Hyperthermic chemo perfusion is commonly used for metastatic appendiceal carcinoma, abdominal mesothelioma and selected cases of metastatic colorectal cancer, Landreneau said.
He began using the procedure to treat mesothelioma while at the University of Pittsburgh Cancer Institute. Landreneau was UPCI’s lead Thoracic Surgical Oncologist, focusing on lung cancer and mesothelioma.
“The University of Pittsburgh was an international pioneer in the hyperthermic chemo perfusion approach following pneumonectomy or pleurectomy for mesothelioma,” he said.