By Daniel K. Brantley
Comprehensive gastrointestinal cancer care uses today’s advances to create tomorrow’s successes.
A diagnosis of pancreatic cancer has long resulted in individualized care. However, one aspect of the treatment plan is often the same — most plans begin with surgical removal of the pancreas. At times, this one-size-fits-all approach has been followed by early recurrence of the cancer (within a year of surgery), excessive and unnecessary surgical complications, and poor outcomes.
Though immediate surgical intervention was a long-standing standard of care, that standard has been questioned. At Stony Brook Cancer Center and other forward-thinking facilities, previous results are guiding future efforts.
“By studying our failures in the past, we realized we needed to change,” says Georgios V. Georgakis, MD, PhD, surgical oncologist specializing in gastrointestinal robotic-assisted surgery and Assistant Professor in the Department of Surgery, Division of Surgical Oncology at Stony Brook Cancer Center. “With innovative techniques, research and observation, the whole medical community is pushing the envelope for better care, not only to prolong life but to provide a better quality of life.”
360-Degree Pancreatic Cancer Care
Noting Stony Brook Cancer Center’s comprehensive approach to gastrointestinal cancer, the National Pancreas Foundation designated the Cancer Center as a Pancreatic Cancer Center. Such a designation recognizes the Cancer Center’s excellent medical, radiologic and surgical care of patients. Patients achieve positive outcomes, experience shorter hospital stays, and access pain management and nutrition assistance services. All of these serve as a foundation to a successful program.
Appropriate care does not begin in the operating room. For surgical candidates, improved outcomes begin beforehand. At Stony Brook Cancer Center, prehabilitation optimizes patients prior to surgery. Physical therapy, psychological care, nutrition services, palliative care and other services ensure patients are mentally and physically able to withstand surgery.
Among the patient population undergoing surgical intervention for gastrointestinal cancer, Stony Brook’s commitment to patient well-being is demonstrated through the Cancer Center’s reliance upon enhanced recovery after surgery (ERAS) protocols. Today’s medical practitioners are aware of ERAS. Many have witnessed how its implementation leads to shorter hospital stays and faster recovery for patients. These standardized postsurgical care guidelines were pioneered at Stony Brook Cancer Center, and they’ve guided patient care ever since.
A True Multidisciplinary Partnership
One specific area in which this quest has played out is when handling disseminated cancer in the abdominal cavity, also known as peritoneal carcinomatosis. Previously, patients experiencing this disease were relegated to what Dr. Georgakis deems a “horrible death.” A deeper understanding of the disease has led to the development of a novel approach.
With appropriate candidates, the surgical oncologist painstakingly removes all recognized cancer cells. Chemotherapy is subsequently administered directly within the abdomen. Through this approach, the Stony Brook Cancer Center care team slows the progression of disease. As the disease progression slows, the patient enjoys improved quality of life. Life expectancy also improves.
Beneficial as such a therapy is, it comes with the expected limitations.
“In cancer, biology is king,” Dr. Georgakis says. “If we’re dealing with an aggressive tumor, we can’t do much. But when we provide the right treatment to the right patient, we have the best results.”
Providing the right treatment to the right patient depends upon a team approach. At Stony Brook Cancer Center, Dr. Georgakis and other surgical oncologists confer and collaborate with medical oncologists and radiation oncologists. Together with other specialists, they serve as the Cancer Center’s tumor board.
“My job is to perform surgery,” Dr. Georgakis says, “but surgery is not always the best first option. That’s why having a multidisciplinary team is crucial for modern cancer care.”
Based on the specifics of the case, breakthrough chemotherapies, stereotactic radiosurgery, intensity-modulated radiotherapy or robotic-assisted surgical intervention may be indicated. Whatever the need, the team determines the best course of action to lead to optimal patient outcomes. Treatment then begins with one or more of the Cancer Center’s providers.
Based on the therapy’s success or failure, the team modifies the plan as needed. If providers determine that a patient’s cancer is unlikely to respond positively to available therapies, the patient is encouraged to participate in the Cancer Center’s ongoing clinical trials.
Pressing into the Future
While Dr. Georgakis has faith that one day science will uncover a medication that provides a true cure for pancreatic and other gastrointestinal (GI) cancers, he is dedicated to advancing all aspects of cancer care. As a surgeon, for instance, he suspects artificial intelligence may one day be utilized to perform certain surgical procedures. Detractors of such a vision are many. However, the history of gastrointestinal surgical oncology gives Dr. Georgakis reason to expect this advance in the coming years.
“Twenty years ago, no one thought we would perform a robotic Whipple,” he says. “Now, we do most Whipple procedures with robotic assistance. It is imperative that we keep abreast with technology and review new developments critically but with open minds.”
In his own surgical practice, Dr. Georgakis performs approximately 80% of his minimally invasive oncologic procedures robotically. This approach requires additional training and adapting time-honored techniques to new technology. From Dr. Georgakis’s perspective, the effort pays off for patients.
To further the field of gastrointestinal cancer care, Dr. Georgakis actively participates in and leads laboratory and clinical research. Currently, he is studying the effect of different chemotherapy agents and surgical techniques on cancer that disseminates in the abdominal cavity. When patients receive chemotherapy only for these cancers, he explains, life expectancy is approximately six months. By completely excising all detectable cancer prior to injecting chemotherapy into the abdomen, that life expectancy increases four-fold.
Dr. Georgakis hopes to extend life expectancy even more by determining the most effective medication-surgical combination. To date, this arena has not received much attention, and he is hopeful that his laboratory results will be encouraging enough to lead to clinical trials.
“With our combination of surgical innovation, scientific inquiry and patient care, we’re at the forefront of GI oncology care at Stony Brook,” Dr. Georgakis says. “We use every aspect of our experience to advance cancer care and do our jobs better. This is where change happens.”
Visit bit.ly/GICancerTeam to learn more about multidisciplinary GI cancer care available at Stony Brook Cancer Center.