Pancreatic cancer

Laparoscopic Whipple procedure

Dr. Steven Hughes performs a laparoscopic Whipple procedure at UF Health Shands Hospital.

Pancreatic cancer is being treated in a uniquely aggressive manner at UF Health.

The disease, resulting in tumor formation from pancreatic ductal cells, is the fourth-leading cause of cancer death, with less than four percent of diagnosed patients surviving after five years.  It is often called “the silent killer” because patients can have the disease for months or years before diagnosis, said Kevin Behrns, M.D., chairman of the University of Florida Department of Surgery.

Survival from pancreatic cancer is directly tied to the development and advancement of the tumor. Therefore, UF Health physicians use an integrated multidisciplinary approach because patients arrive at different stages of the disease and require specifically tailored treatment programs. Surgeons, radiologists, medical oncologists, radiation oncologists and pathologists unite to determine individualized treatment plans. At UF Health, there is a specific pancreatic cancer tumor conference where new cases are discussed and a comprehensive treatment plan is outlined, incorporating standard and novel therapies. In addition, new patients can see, on a single day, physicians specializing in surgery, chemotherapy or radiation therapy, genetic counselors, dieticians and rehabilitation services. This will frequently allow for a complete evaluation in a single day.  As part of these services, eligible patients are also afforded the opportunity to take part in national and regional trials for chemotherapy and other novel molecular targeted therapies.

The UF Health surgical approach is distinctive from other institutions because it involves aggressive tumor resection, despite often close proximity to the superior mesenteric or portal veins, which are the main veins draining the intestine, Behrns said. UF Health experts found resection of these tumors leads to the same survival of patients who do not have the venous resection, and there is no increased risk of infection with the venous resection. Depending on location and size of the tumor, vascular resection and reconstruction is a highly considered form of treatment because of limited treatment options.

Known as the “Whipple” procedure, this surgery involves removing the head of the pancreas. The first part of the small intestine, a portion of the bile duct and sometimes a portion of the stomach, also are removed as part of the Whipple procedure. Steven J. Hughes, M.D., chief of the division of general surgery at UF, is one of a handful of surgeons in the world pioneering the performance of this complex procedure using minimally invasive (laparoscopic) techniques.  His research has demonstrated that the laparoscopic surgery produces an equivalent resection of pancreatic tumors.  Current research is determining if minimally invasive Whipple leads to fewer complications, less pain and a shorter recovery time. Tumors in the body or tail of the pancreas are also treated laparoscopically at UF Health Shands Hospital, and this approach has been proven to ensure shorter hospitalization and recovery time.

Jose Trevino, M.D., an assistant professor in the department, is investigating how pancreatic cancer resists current chemotherapeutic strategies.  He has discovered that exposure to nicotine, the addictive component of tobacco smoke, may contribute to pancreatic cancer resistance to chemotherapy by potentially increasing expression levels of certain oncoprotients, such as Src a non-receptor tyrosine kinase and inhibitor of differentiation-1 (Id-1), all of which have been demonstrated to contribute to pancreatic cancer tumor progression. This work, as well as other projects he is involved in, may lead to new treatments strategies against pancreatic cancer.  It is the hope of all physicians at the University of Florida involved in the care of patients with pancreatic cancer that novel treatment approaches are rapidly moved from the laboratory to become treatment options for patients with this aggressive disease.

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