“Surgical oncologists in the Program for Liver, Pancreas, and Foregut Tumors at Penn State Hershey Cancer Institute, Penn State Hershey Medical Center, are using a robotic-assisted approach to complex gastrointestinal surgeries. The team performed an average of four to five such cases per month during 2013- 2014. “Distal pancreatectomy with splenectomy is the most common procedure in which we use a robotic technique. Compared to laparoscopy, we’re finding that more tumors and cysts are amenable to a robotic approach, with less conversion to an open procedure compared to a laparoscopic approach,” says Niraj Gusani, M.D., director of the Program for Liver, Pancreas, and Foregut Tumors.
Gusani has partnered with Joyce Wong, M.D., director of the Robotic Surgical Oncology Program, to implement a two-attending model for all robotics procedures. Amanda Cooper, M.D., the third member of the team, will also perform robotics procedures. Gusani notes, “Visualization is much better with the robotic platform [see Figure] versus open surgery. This is really key with very complex anatomy. Resections may be more thorough.” Wong further adds, “The robot mimics your hand movements with more precision; there is less internal manipulation. It’s a shift from ‘feeling’ to ‘seeing’.” To date, the team has performed more than thirty complex oncologic cases robotically.
Intraoperative view from the robotics platform during resection of a gastric mass and suture repair of gastrostomy.
Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Usually detected at only the most advanced stages and with median survival time of only three to six months, it leaves little time for treatment or cure. This abysmal clinical outlook has fueled a great deal of research into the nature of pancreatic cancer, as well as key patient factors that place some people at increased risk of the disease.
According to Gail Matters, Ph.D., associate professor of biochemistry and molecular biology at Penn State Hershey Medical Center, Penn State College of Medicine, “The link between patient factors like obesity, chronic pancreatitis, and a family history of pancreatic cancer have provided clues about underlying cellular and molecular pathologies. We know that certain normally-occurring peptides, like cholecystokinin (CCK), are found in elevated concentrations in mice that have been fed a high-fat diet. These peptides have a growth-factor-like effect on pancreatic tumor cells.” Continue reading
Cancer of the pancreas remains one of the greatest clinical challenges in oncology. With no reliable screening tests and a poor prognosis following identification, the need for novel approaches toward this disease remains largely unmet.
In recent years, however, pre-malignant pancreatic cystic lesions have been increasingly discovered in patients undergoing cross-sectional imaging for unrelated reasons. While over half of pancreatic cystic lesions have little to no malignant potential, mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) can carry a high potential for progression into pancreatic cancer.
Discovering a pancreatic cyst poses a new set of difficulties. According to Matthew T. Moyer, M.D. M.S., associate professor of medicine, Penn State Hershey Medical Center, “Either serial radiographic surveillance or surgical resection is generally recommended for these cysts, both of which have significant limitations. Surveillance is inconvenient and expensive with no therapeutic aspect, while surgical resection is associated with a significant risk of morbidity (20 to 40 percent) and mortality (1 to 2 percent).” Continue reading