CUTTING EDGE SURGICAL OPTIONS
FOR CANCER AT UPMC-PASSAVANT

For more than a decade, cancer patients in Pittsburgh’s northern suburbs have had convenient local access to the most advanced medical and radiation treatments for their disease at UPMC Cancer Center at UPMC Passavant and UPMC Cancer Center, Wexford. Patients whose disease required surgery, however, would have to travel into the city for surgical treatment. But with a new multidisciplinary partnership with UPMC Cancer Centers, cutting-edge oncology surgical services are now available at UPMC Passavant.

Through this partnership of medical, radiation, and surgical oncologists, patients have access to state-of-the-art surgical procedures, including specialized techniques that previously were not available outside major university medical centers,” says Libby Shumaker, director of UPMC Cancer Center at UPMC Passavant and the Comprehensive Breast Center at UPMC Passavant Cranberry.

“Surgical oncology is a key component of the comprehensive cancer services available at UPMC Cancer Center at UPMC Passavant, along with the most advanced radiation therapies available with technologies such as IMRT (intensity-modulated radiation therapy) and IGRT (image-guided radiation therapy), and the latest cancer drug clinical trials,” she adds.

INNOVATIVE TECHNIQUES KEY TO PATIENT CARE

At UPMC Cancer Center at UPMC Passavant, innovative techniques and state-of-the-art technology are providing patients with a variety of new treatment options. These advances, along with the expertise of the center’s surgical oncologists, enable patients to be treated with the latest strategies for all types of cancers, including breast cancer, lung and esophageal cancers, pancreatic cancer, colorectal cancer, upper gastrointestinal malignancies, and liver tumors.

LUNG AND ESOPHAGEAL CANCERS

As one of the first institutions in the country to perform minimally invasive lobectomies for lung cancer patients, UPMC Passavant is on the forefront of new treatments for patients with this disease. “They say it’s not bragging if it’s true, and it’s true that we are making incredible advances in cancer treatment at UPMC Passavant,” says Rodney Landreneau, MD, professor of surgery and director of the Comprehensive Lung Center. “Not only were we one of the first hospital teams in the nation to perform this minimally invasive surgery, but we still have one of the largest experiences in the country.”

VATS, or video-assisted thoracic surgery lobectomies, are performed roughly 150 times a year at UPMC Passavant. Using this technique, surgeons are able to remove large segments of the lung through keyhole-sized incisions, avoiding the need for a thoracotomy, or a large surgical incision in the chest. This procedure enables patients to have less pain, a quicker recovery, and a shorter hospital stay.

“We were also the first thoracic surgery and radiation oncologist team in the world to perform intraoperative brachytherapy, which is used to preserve lung function and reduce the likelihood of local recurrence in patients with early-stage lung cancer who could not tolerate lobectomy,” says Dr. Landreneau. “This procedure, which was designed by myself and radiation oncologist Alex Chen, MD, places a radiation implant over the edge of a resected tumor, killing any cells that are trying to repercolate through the body.” Intraoperative brachytherapy is used when surgeons cannot remove the entire lobe of a lung.

For lung cancer patients who cannot undergo surgery of any type because
they have more severe medical conditions or are physiologically impaired, radio-frequency ablation, or RFA, can be performed as an alternative to surgery to coagulate tumors still within the body. During this procedure, a needle is placed into the tumor percutaneously with CT guidance. The needle is connected to a generator, which heats the tumor and causes death of the cancer cells. This is a very new and promising, nonsurgical treatment for primary and metatastic lung cancer. According to Ghulam Abbas, MD, assistant professor of thoracic surgery, this innovative procedure, which is performed regionally at UPMC Passavant and UPMC Shadyside, is available at very few hospitals throughout the country.

Minimally invasive thoracic surgery is also available at UPMC Passavant for patients suffering from thymic tumors. “Traditionally, surgeons had to split the sternum in half with a saw-like tool to reach the thymus — it was similar to open-heart surgery,” explains Dr. Abbas. “Now, we make three small incisions, and using video-assisted technology, remove the thymus gland. The patient experiences little pain and can go home the next day.”

Doctors can also use minimally invasive techniques to treat mesothelioma, a cancer caused by exposure to asbestos, and esophageal cancer. “Patients who undergo minimally invasive esophagectomies may have shorter recovery times and lower morbidity and mortality rates compared to the open surgical technique,” says Dr. Abbas. “The average mortality rate with esophagectomy across the country is 10 to 23 percent; the experience of the UPMC Cancer Centers thoracic surgical team has a mortality rate of approximately 1 percent,” says Dr. Landreneau. This surgical team is actively practicing at UPMC Passavant.

The UPMC thoracic surgery team at UPMC Passavant also has one of the largest experiences in the world using laser therapy to oblate obstructing tumors of the lung and esophagus. “We were also the first to introduce photodynamic therapy (PDT) to the region,” says Dr. Landreneau of the procedure that uses a laser to activate a cancer-killing drug that selectively targets cancer cells.

LIVER, UPPER GI, AND COLORECTAL CANCERS

In addition to advanced surgeries to treat lung cancer, innovative treatments are also being used to treat liver, upper GI, and colorectal cancers. “Five to 10 years ago, you wouldn’t see high-end liver operations being performed at a non-university hospital like UPMC Passavant,” says David Geller, MD, Richard L. Simmons Professor of Surgery and director of the UPMC Liver Cancer Center. “Now patients in the North Hills can go to UPMC Passavant for the same high-end surgeries that they used to travel to the city to receive.”

Eight months ago, a branch of the UPMC Liver Cancer Center was opened at UPMC Passavant and, to date, 25 major liver resection operations have been performed and 50 patients have been enrolled in liver tumor clinics. “Four years ago, we began applying laparoscopic techniques for liver surgery within the UPMC system, and we’ve now performed 150 of these — the largest series in the United States,” says Dr. Geller, who adds that one-third of these cases are performed at UPMC Passavant. “Ninety-five percent of these surgeries are bloodless, requiring no blood transfusions or ICU admissions.”

Having this expertise available in the North Hills is especially important to patients who need help quickly. “Two of the first 25 surgeries we performed were for ruptured liver tumors,” says Dr. Geller. “We had one patient come in at 4 a.m. complaining of abdominal pain, and instead of having to fly the patient by helicopter to UPMC Presbyterian for emergency surgery, we were able to perform his liver resection surgery here, and send him home five days later.”

Because of the advanced techniques performed at the UPMC Liver Cancer Center, patients come to UPMC Passavant from outside the northern suburbs as well. “Approximately 10 percent of our patients fly in from out-of-state because they can’t get these types of services where they live,” says Dr. Geller.

Radiofrequency ablation (RFA), which is used at UPMC Passavant to treat lung cancer patients, can also be used to treat patients with liver cancer. “One of the biggest innovations that I’ve seen is the use of advanced, minimally invasive tools like RFA, which allows us to ablate cancers rather than remove them,” says David Bartlett, MD, professor of surgery and chief of the Division of Surgical Oncology. “This area has improved dramatically over the past couple of years.”

Innovations have also been made in the use of chemotherapy perfusion, including the use of intraperitoneal hyperthermic chemotherapy to kill cancer cells in the abdominal cavity. After surgical removal of a tumor, a heated sterile solution containing chemotherapeutic drugs is circulated throughout the abdominal cavity.

“This procedure is used mainly for patients with slow-growing cancers that have not responded well to chemotherapy given intravenously,” explains Steven Ahrendt, MD, associate professor of surgery, of the technique that has been used at UPMC Passavant since March 2006. “It is also used for patients who may have mounting side effects from traditional chemotherapy and whose doctors are reluctant to use chemotherapy over a long period of time.”

“Combined with the surgical removal of all visible cancer within the abdominal cavity, this form of chemotherapy is keeping patients alive longer,” adds Dr. Bartlett. “Studies have shown a doubling of the expected survival rate in patients with advanced colon cancer.” Hyperthermic chemotherapy has also been shown to help in the treatment of ovarian cancer.

Patients with colon cancer also can benefit from the use of minimally invasive laparoscopic colon resection surgeries that have been performed at UPMC Passavant. “Cancer resections using laparoscopic techniques enable patients to have less pain, faster recoveries, and shorter hospital stays,” says Dr. Ahrendt. “These techniques also have been used in patients with suitable tumors in the pancreas.” Dr. Ahrendt also is the leader in surgical resection of pancreatic cancers in the region.

THE FUTURE OF CANCER CARE

The collaboration of medical and radiation oncologists — including Alex Chen, MD; Theodore Crandall, MD; Robert Gluckman, MD; Kiran Mehta, MD; Jennifer Osborn, MD; and Kiran Rajasenan, MD — with UPMC Cancer Centers’ surgical oncologists, offers patients the most comprehensive approach combining innovative drug therapies, state-of-the-art technologies, and the latest surgical options to battle cancer.

“We are at the cutting edge of new technology and clinical trials as it relates to the surgical treatment of cancer,” explains Dr. Bartlett. “Through this multidisciplinary approach, we hope to improve outcomes, even if a cancer is not curable by surgery. Our goal is to improve long-term survival rates for people diagnosed with cancer.”

ONE PATIENT’S STORY

When John Garrott, MD, was first diagnosed with advanced lung cancer, as a physician, he understood that the odds of his recovering from the Stage IV disease were not good. “When I saw that mass on the CAT scan, I had no clue that I would still be here this fall, looking forward to celebrating Thanksgiving and Christmas,” he says.

Because Dr. Garrott’s cancer did not adequately respond to up-front chemo, he became a candidate for an innovative procedure performed at UPMC Passavant that combines surgical debulking of the tumor with heated chemotherapy perfusion.

“I was referred to thoracic surgeon Dr. Landreneau, and surgical oncologist Dr. Bartlett, who thought that I would be a good candidate for the procedure,” says Dr. Garrott. “During the five-hour operation, they removed the right upper lobe and middle lobe of my lung, as well as much of the tumor and lymph nodes as they could, and then treated me with heated chemo profusion.”

Though recovery was difficult, the results speak for themselves. Dr. Garrott is now walking three miles a day and playing nine holes of golf twice a week. “It’s a very valuable procedure, but it isn’t easy,” says Dr. Garrott, whose recovery took approximately two months and included a stay in the ICU. “Recovery was a long, painful, tricky process, but I’m still here a year after being diagnosed with Stage IV lung cancer and that definitely puts me in the minority. I am absolutely enjoying every day.”

THE COMPREHENSIVE BREAST CENTER AT UPMC PASSAVANT CRANBERRY

When a person is diagnosed with breast cancer, there are a lot of decisions that need to be made. One of the most crucial, for both physical and mental well-being, is choosing a team of experts who have the resources — and the expertise — to help patients through this trying time.

At UPMC Passavant Cranberry’s Comprehensive Breast Center, patients have access to state-of-the-art diagnostic equipment, as well as the expertise of a team of clinical experts, including breast and reconstructive surgeons, medical oncologists, radiologists, and pathologists. This team works together to determine the best treatment plan for those dealing with the disease.

“Every person on our staff is dedicated strictly to breast care — it’s all that we do,” says Mary Beth Malay, MD, medical director of the Comprehensive Breast Center. “Our physicians, nurses, and entire imaging staff specialize in this one area.”

In addition to diagnosis and treatment, the center also provides information on the prevention and detection of breast disease, as well as genetic counseling in conjunction with Magee-Womens Hospital for those concerned with hereditary breast cancer.