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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2012 Issue | Archived Issues

Physician honors

- George Berci, MD, FACS

- Philip K. Frykman, MD, PhD, FACS, FAAP

- Hyung L. Kim, MD


Congenital heart disease expert joins Cedars-Sinai Heart Institute

Evan Zahn, MD, an expert in treating children born with life-threatening structural heart problems, has joined the Cedars-Sinai Heart Institute to advance the study of congenital heart disease and develop more minimally invasive treatments.


Upcoming CME conferences


Grand rounds

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Advancements in the treatment of pancreatic cancer

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By Andrew Klein, MD, MBA, FACS

Pancreatic adenocarcinoma is the fourth leading cause of cancer death in the U.S. and presents as advanced disease in greater than 80 percent of cases. Numerous advancements have led to significant improvement in survival of patients at all stages of disease.

Led by Nicholas Nissen, MD, director of Hepatobiliary and Pancreatic Surgery at Cedars-Sinai, surgeons at medical center have contributed directly to improving the surgical management of pancreatic cancer. First, the utilization of vascular reconstructive techniques common to liver transplantation such as portal vein grafting have allowed for resection of locally advanced tumors previously felt to be unresectable. Second, patients with disease that is initially felt to be unresectable can often be treated with neoadjuvant chemoradiation to allow successful surgery at a later date.

These protocols take advantage of more active chemotherapeutic regimens, such as the use of the nanoparticle Abraxane©, as well as improvements in the delivery of highly focused radiation therapy (Stereotactic Body Radiation Therapy, or SBRT).In addition, surgeons at Cedars-Sinai have developed an intraoperative surgical microscopy system to assist in the complex components of these procedures. Combining these advancements with improvements in anesthesia, ICU and ancillary care, the success rate for pancreatic surgery at Cedars-Sinai is now more than 98 percent.

The adjuvant treatment of pancreatic cancer in the past was limited both in number and efficacy of chemotherapeutic agents. New agents and creative chemotherapeutic regimens have resulted in improved survival of pancreatic cancer patients, and these regimens can be further tailored to the individual patient by direct analysis of individual tumor characteristics. An additional novel adjuvant approach, spear-headed by Cedars-Sinai surgeons, utilizes vaccines to boost the body’s innate immune response to pancreatic cancer antigens.

Unfortunately, most patients undergoing surgical resection of pancreatic adenocarcinoma will see recurrence, and as such, new treatments are desperately needed. Many of the therapies previously reserved for other tumors such as metastatic colorectal cancer are now being applied to pancreatic cancer, including resection or ablation of metastases, SBRT treatment of local recurrence, or hepatic arterial therapy for liver metastases.

But perhaps the greatest overall advancement in the treatment of pancreatic cancer has in fact been the development of the true multidisciplinary team approach to patient care, exemplified in part by the establishment of a weekly Pancreatic Cancer Conference which provides a forum for physicians to discuss complex patient issues.

For further details regarding advancements in the treatment of pancreatic cancer at Cedars-Sinai, please contact nicholas.nissen@cshs.org.

Klein, pictured above with a patient, is director of Cedars-Sinai’s Comprehensive Transplant Center, the Esther and Mark Schulman Chair of Surgery and Transplant Medicine, and professor and vice chair, Department of Surgery.