Health News

2014: A Year in Review

by Columbia Surgery on December 26, 2014

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Using 3D printing technology to repair a baby’s heart, discovering new ways to preserve livers for transplantation, helping chemotherapy drugs find their way to treat pancreatic cancer, and performing surgery with robots through pinhole incisions are just some of the breakthroughs that stood out during 2014 at Columbia University Department of Surgery. Some of these innovations are already saving and improving lives, while others under investigation have demonstrated significant success in advancing our understanding of the science behind the medicine. All will have far-reaching impact for years to come

Read more about this year’s highlights:

Three-Dimensional Printed Heart Helps to Save Baby’s Life

Even the most ardent advocates for 3-D printing may have may have been stunned in late 2014 when Dr. Emile Bacha, Chief of the Congenital and Pediatric Heart Surgery, used the technology to save the life of a two-week old baby.

The baby was born with complex heart defects including many holes and malformations. Dr. Bacha’s surgical team printed a 3-D model of the heart based on a CT scan, which they were able to study before operating. This process enabled them to plan exactly how they would approach the procedure, including the order of steps and where they would put patches and sutures.

According to Dr. Bacha, “the baby went from having a limited life expectancy to normal life expectancy. And instead of needing three or four surgeries to repair the multiple defects, we were able to correct all the defects in a single surgery.”

See CNBC’s coverage of the story:

Tackling Pancreatic Cancer: New Strategy to Help Chemotherapy Drugs Reach their Target

Pancreatic cancers are notoriously resistant to chemotherapy drugs because their dense tissue blocks penetration of systemic drugs. Thanks to the persistence of determined researchers and significant funding from the National Institutes of Health, that barrier may soon be overcome. A study led by Dr. Kazuki Sugahara, who joined Columbia University College of Physicians and Surgeons as a research scientist and surgical resident in 2014, aims to create a new type of chemotherapy delivery system that will be far more effective than what has been available to date.

Building on his earlier discovery that found that small pieces of proteins called peptides are able to penetrate deeply into pancreatic cancers and other fibrotic tissue, Dr. Sugahara and his colleagues are now working to test the safety of using the peptides as carriers for cancer drugs.

According to Dr. Sugahara, a delivery system that gets through the tissue barrier and directly infiltrates the tumor cells could have tremendous therapeutic impact.  The work in the Sugahara laboratory is part of the Department of Surgery’s broad mission to tackle pancreatic cancer from every angle, which includes initiatives in early detection, prevention and genetic testing, and the full range of medical and surgical options.

Learn more about our efforts to fight pancreatic cancer at PancreasMD.org.

First Robotic Whipple Procedure for Pancreatic Cancer

Use of the surgical robot gained a significant foothold during 2014 when Drs. Yanghee Woo, Director of the Global Center of Excellence in Gastric Cancer Care and John Chabot, Chief of the Division of GI/Endocrine Surgery and Executive Director of the Pancreas Center, performed the first robotic Whipple procedures at the NewYork-Presbyterian/Columbia University Medical Center.

The Whipple procedure, a common surgical procedure to remove pancreatic tumors, was first developed in 1935 by Dr. Allen Whipple, a professor of surgery at Columbia University.  It involves removal of the head of the pancreas, the first part of small intestine (duodenum), the gallbladder, the end of the common bile duct, and sometimes a portion of the stomach.

The robotic surgical approach was initially used it to treat benign conditions and less advanced cancers before reaching patients with pancreatic cancer. While this process revealed it to be less useful in some operations, it has great benefit for a number of colorectal, liver, and gastric operations where it reduced surgical trauma, shorter hospital stays, and shorter recovery times. Because of the surgical robot’s freedom of movement, precision, and magnified 3-D imaging capability, Dr. Woo is confident that she is able to do complex gastric operations better with the robot than without, and that robots will become an integral part of the OR in the coming decades.

Read the full story on our previous blog post.

Preventing and Reversing Lymphedema after Breast Surgery

The treatment of lymphedema, a disfiguring, painful swelling of the arms and hands that can occur after removal of the lymph nodes during breast cancer surgery, saw much innovation with the Clinical Breast Cancer Program in 2014.

The Department of Surgery is the first in the U.S. to perform LYMPHA, a procedure at the time of lymph node removal that could potentially prevent the development of lymphedema. This surgical procedure creates a bypass to restore lymphatic flow by connecting lymph vessels to a branch of the axillary vein, significantly reducing the risk of developing the condition.

In addition, following the success of a similar study among English-speaking patients, a new study by the Clinical Breast Cancer Program aims to reduce the incidence and severity of lymphedema in the Chinese community through implementation of a Chinese language educational intervention. The program emphasizes specific breathing techniques, arm exercises, proper skin care and protection, and behavioral interventions to promote lymph flow, prevent inflammation and infection, and maintain optimal body weight.

Check out ABC 12 KSAT’s coverage of this story.

Hypothermic Liver Perfusion: Closing the Gap between Supply and Demand for Donor Livers

To increase the number of healthy donor livers available for transplant, experts at the Center for Liver Disease and Transplantation and the Molecular Therapies and Organ Preservation Laboratory of the Department of Surgery have been working to find ways to better preserve and protect donated livers, rendering them eligible for transplantation. Dr. James Guarrera, Surgical Director of Adult Liver Transplantation, and his team became the first anywhere to successfully use hypothermic machine perfusion (HMP) in the liver.

Whereas traditional cold perfusion involves preserving the donor organ at cold temperature, hypothermic machine perfusion (HMP) entails infusing the donor organ with oxygen and nutrients to simulate aliveness and reduce injury to the organ. The continuous flow of nutrients not only preserves the organ, which has shown better outcomes, shorter hospital stays, and fewer long-term complications, but it can also improve the function of an imperfect liver.

These were considered “orphan” livers that were initially deemed too compromised for transplant and likely would have been among the 600 donor livers discarded each year, but with these advances,  “we should be able to expand the liver donor pool, making transplant available to many more patients,” says Dr. Guarrera.

Learn more about HMP here.

TAVR offers Lifesaving Option for Patients Unable to withstand Open-heart Surgery

The Columbia Heart Valve Center at the Department of Surgery marked a milestone in cardiac care upon completing its 1,000th transcatheter aortic valve replacement (TAVR) in March, 2014.

TAVR is a catheter-based procedure for patients with aortic stenosis who need a new heart valve but are too sick to undergo open-heart surgery.  During TAVR, a replacement valve is inserted through the groin and advanced to the heart using a specially designed delivery catheter. With this technique, the aortic valve can be replaced without incisions and without stopping the heart.

“Before we had TAVR, many of our patients had no clinical options to treat their aortic stenosis, a potentially fatal condition,” says Dr. Susheel Kodali, Director of the Columbia Heart Valve Center. “As of today, we have been able to treat more than 1,200 patients with exceptional outcomes, thanks to this lifesaving procedure.”  With this milestone, he Columbia Heart Valve Center remains the highest volume center in the US and plays an integral role in the development of the technique.

See CBS’s coverage of the story:

Unprecedented Studies in Human Immunology

Because of the near-impossibility in obtaining human immune cells from healthy lymphoid tissues, research has generally been done on peripheral blood and mouse models, leaving 98% of the immune function (the lymphatic system) almost entirely unstudied and very poorly understood. A new multicenter study led by Columbia Center for Translational Immunology (CCTI) is now exploring this frontier with unprecedented access to human lymph tissues (the spleen and lymph nodes, lungs and intestines, and skin and liver) from deceased organ donors, provided through the first-ever collaboration with the New York Organ Donor Network.

The first part of the 4-part study, directed by Dr. Donna Farber of CCTI has already led to new discoveries about T cells that have the potential to yield paradigm changes in the effectiveness of vaccines and immunotherapies.  Other segments of the study investigate how to effectively target B cells in vaccines and immunotherapies and to develop new tissue repair strategies. A fourth segment, which includes collaboration with Dr. Megan Sykes, Director of CCTI, and Dr. Tomoaki Kato, Surgical Director of Liver and Intestinal Transplantation at the Department of Surgery, may yield new methods of achieving immune tolerance after organ transplantation.

According to Dr. Farber, “We now have the technological tools for high-throughput analysis and for probing molecules and proteins. With these tissue samples, we can go far beyond what we were ever able to do in studying human physiology.”

Reducing the Toll of Liver Disease: Education Matters

Treatment of liver disease is only the first step; the next most important task may be educating the public about it. In a host of speaking engagement, television appearances, and publications, Dr. Robert Brown, Jr., Medical Director of the Transplantation Initiative at the Department of Surgery, has contributed powerfully to public awareness of trends in hepatitis C and fatty liver disease during 2014.

October 2014 marked the arrival of a single tablet regimen (Sofosbuvir/Ledipasvir) for Hepatitis C that cures 95% of patients in 8 weeks, with extremely low side effects. This regimen marks a radical departure from painful injections of interferon and oral medications, which cure less than half of patients while causing side effects so serious that many patients refuse therapy. Dr. Brown asserts that the new, highly effective regimen “should herald a long-awaited milestone in medicine: the beginning of the end of hepatitis C, the most common and deadly chronic liver disease plaguing millions of Americans.” Unfortunately, the high cost of the therapy currently presents a deterrent to insurers, physicians, and patients. Dr. Brown presents critical insight on what appears to be a conflict between curing millions of patients and managing health care costs – and calls on the medical community to consider long-term costs, quality of care, and ethics in their equation.

Dr. Brown also addressed another common liver disease, non-alcoholic fatty liver disease (also called NASH), which affects approximately 80 million Americans. Speaking on the New England Cable Network in the fall of 2014, he informs listeners about the silent but growing epidemic and its relationship to obesity and diabetes.

Read the Dr. Brown’s article in Pacific-Standard Magazine.

See the NECN coverage on fatty liver disease:

Perfecting the Mechanical Heart: 25 Years of Innovation

Initiation of a study of the HeartMate III Left Ventricular Assist System (also called a left ventricular assist device, or LVAD) in 2014 marks 25 years of pioneering work in the field of ventricular support and heart failure management for the Department of Surgery.

Implantable LVADs take over the pumping action of the left ventricle in patients whose hearts are too weak to sustain themselves. Candidates for the HeartMate III trial include patients with advanced heart failure who need a device either as a bridge to heart transplantation, or who are ineligible for transplant and who will use the device indefinitely (called ‘destination therapy’).

The Mechanical Circulatory Support Program at the Department of Surgery is the only New York area surgical group to participate in the HeartMate III study. Having been one of the first surgical centers to pioneer heart transplantation (beginning in 1971), The Department of Surgery has played an integral role in the development of many groundbreaking devices and procedures, including the FDA approval of the HeartMate® II LVAS, the predecessor to the HeartMate III.

Learn more about the history of the artificial heart in the TIME Magazine feature.

Find out more about the current Heartmate III trial here.

Preventing Diabetes after Surgery for Pancreatitis

Beginning in 2014, the Pancreas Center at the Department of Surgery became the first New York surgical center to offer autologous pancreatic islet cell transplantation providing many patients an option to prevent diabetes after undergoing pancreatic surgery.

Every year, roughly 87,000 people in the United States receive surgical treatment for pancreatitis, a debilitating condition that causes intense abdominal pain and, potentially, diabetes. Pancreatitis can be so painful that in some cases, patients must have the entire pancreas removed. While surgery to remove the pancreas (pancreatectomy) relieves pain in 90% of cases, patients are left without the ability to produce insulin, causing a difficult-to-treat form of Type 1 diabetes known as “brittle diabetes.”

In auto islet transplantation, the patient’s islet cells, which produce hormones that regulate the endocrine system, are extracted from the pancreas after it is removed. The cells are then processed and re-infused into the patient’s liver, where they may eventually produce insulin to regulate blood sugar.

According to Dr. Beth Schrope, who spearheaded the auto islet transplant protocol at the Department of Surgery, about one third of patients require no insulin therapy after autologous islet transplantation, another third require some insulin therapy after the procedure, and the procedure is still unsuccessful in preventing diabetes in the remaining third. For two thirds of patients, the reduction of prevention of diabetes represents a tremendous advantage

Learn more in our previous blog posting and Healthpoints newsletter.

We’re looking for to 2015 as a year of continued scientific progress, clinical innovation, and care for our patients!  Keep informed by following us on Facebook and Twitter!

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Pancreatic Cancer: Family History and Genetics

by Columbia Surgery on November 10, 2014

Fay Kastrinos, MD

Dr. Fay Kastrinos, Director of the Muzzi Mirza Pancreatic Cancer Prevention and Genetics Program, recently asked readers to send her questions about the role of genetics and family history in pancreatic cancer.

 

What are the main causes of developing pancreatic cancer? What is the average person’s risk of developing pancreatic cancer in his or her life?

The majority (up to 90%) of patients diagnosed with pancreatic cancer have developed the disease because of “sporadic” causes.  This means the cancers developed from environmental factors (such as toxins from cigarette smoke) that randomly caused abnormalities in pancreas cells and led to uncontrolled growth. Such factors are encountered throughout one’s life and act over a long period of time.  In these “sporadic” cases of pancreatic cancer, there is no identifiable inherited gene involved and in an average person’s life, the risk of developing pancreatic cancer is 1% or less.

 

Does having a family history of pancreatic cancer increase risk? When should a person suspect that pancreatic cancer might run in the family?

Up to 10% of all pancreatic cancers appear to have an inheritable cause where there are multiple relatives in the family with pancreatic cancer or multiple other cancers.

Individuals who have a family history of pancreatic cancer have a considerably increased risk of developing pancreatic cancer.

An increase in an individual’s risk of developing pancreatic cancer is closely tied to the number of family members affected with pancreatic cancer and the relationships among at-risk individuals.  Having multiple first-degree relatives with pancreatic cancer (first-degree relatives include parents, brothers, sisters, and children) increases the risk of non-affected family members developing the disease.

This risk has been estimated to be 4 times greater in individuals with one first-degree relative with pancreatic cancer; 6.4-times greater in individuals with two first-degree relatives with pancreatic cancer pancreatic cancer; and 32-times greater in individuals with three or more first-degree relatives with pancreatic cancer.

 

Is genetic evaluation for pancreatic cancer available? Who is genetic evaluation appropriate for?

In evaluating a patient for a possible inherited cause of pancreatic cancer, it is important to determine whether pancreatic cancer in the family is:

▪ (1) diagnosed in multiple relatives in the same side of the family, or
(2) there are multiple other cancers in the family known to be associated with inherited cancer syndromes for which genetic testing may be appropriate.

In situations where there are multiple first and second degree relatives with pancreatic cancer in the absence of other known, genetic cancer syndromes, the term Familial Pancreatic Cancer may be appropriate.

The specific gene abnormality responsible for causing Familial Pancreatic Cancer has not yet been identified.  Therefore, there is currently no genetic testing for those individuals who have multiple family members diagnosed with pancreatic cancer and no other cancer diagnoses.

However, genetic evaluation and testing may be appropriate in some families with pancreatic cancer and other types of cancers.  There are several genetic conditions where family members develop different types of cancers and are associated with an increased risk of pancreatic cancer.

 

Which genetic conditions have genetic testing?

The following genetic conditions have an elevated risk for certain cancers, including pancreatic cancer, and genetic testing is available:

▪ Hereditary breast and ovarian cancer syndrome: available testing for abnormalities in the BRCA genes.  The condition can effect every generation and is associated with cancers of the prostate and melanoma, in addition to breast and ovaries.

▪  Peutz-Jeghers Syndrome: available testing for abnormalities in the STK11/LKB1 gene.  Patients with this condition often have multiple polyps in the small intestine and colon and can have freckling of the lips or in the mouth.  Family members in every generation can be affected. Patients are at increased risk of also developing cancers of the breast, ovaries, uterus, and testicles.

▪ Hereditary Pancreatitis: available testing for abnormalities in the PRSS1 gene.  Multiple family members have history of pancreatitis (inflammation of the pancreas often requiring hospitalizations) and often manifests at a young age.  It affects every generation and can lead to a high incidence of cancer 30-40 years after the onset of repeated attacks of pancreatitis.

Familial atypical multiple mole melanoma (FAMMM): available testing for abnormalities in the CDKN2A gene.  The condition is characterized by multiple moles, atypical moles, and multiple melanomas.  Every generation can be affected and there is a strong family history of melanoma.

Lynch syndrome (previously referred to as Hereditary Non-Polyposis Colorectal Cancer or HNPCC): available testing for abnormalities in mismatch repair genes MLH1, MSH2, MSH6, PMS2, EPCAM.  The condition is associated with an increased risk of many types of cancer, particularly cancers of the colon and rectum as well as the uterus and ovaries in women.  People with Lynch syndrome can often be affected by cancer at young ages (younger than 60 years) and have multiple cancer diagnoses.  The condition can affect every generation. In addition to pancreatic cancer, other less common cancers include those of the stomach, small intestine, liver, gallbladder ducts, upper urinary tract, and brain.

 

What should I consider before receiving genetic evaluation?

Determining whether the relatives of a patient with pancreatic cancer are at increased risk is not simple. Talking to someone with experience in hereditary cancer syndromes such as a genetic counselor, geneticist, gastroenterologist, or oncologist is often helpful.  If a person is considering genetic evaluation and testing, it is important to speak with the appropriate health care provider (genetic counselor or doctor) qualified to interpret and explain the test results before they proceed with testing. It is important for people to understand and carefully weigh the benefits and risks of genetic testing before these tests are done and to be able to interpret the results for other family members.

Variability in insurance coverage for testing may exist and can be addressed during consultation. Often, genetic testing may be most appropriate in those patients affected by cancer and options can be discussed during routine cancer related care.

We offer genetic counseling and screening here as part of the Muzzi Mirza Pancreatic Cancer Prevention and Genetics Program. We assess a person’s individual risk based on a full genetic evaluation including family history of pancreatic cancer and other cancers, genetic screening, and other indicators. From there, our team compiles a personalized surveillance plan. If you would like more details about what our program involves, please visit our Participating in the Program page.

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Diagnosing Pancreatic Cancer Earlier

November 7, 2014

TweetThe following interview was conducted with Dr. John A. Chabot, Chief, Division of GI & Endocrine Surgery, Director, Pancreas Center. There are situations where a pancreatic specialist might be able to diagnose people much earlier than they are currently diagnosed. One thing we know, for example, that is missed frequently is new onset diabetes in […]

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Advances in Treating Pancreatitis: Autologous Islet Cell Transplantation

November 6, 2014

TweetNewYork-Presbyterian/Columbia is the first center in the New York metropolitan area to offer autologous islet cell transplantation. Patients who need a total pancreatectomy for chronic pancreatitis or other benign diseases may be eligible for this procedure to prevent type 1 diabetes. Every year, about 87,000 people in the U.S. receive surgical treatment for pancreatitis. This […]

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Help Take Pain Out of Pancreatitis with your Diet

November 5, 2014

TweetWritten by Deborah Gerszberg, RD, CNSC, CDN
 Clinical Nutritionist, The Pancreas Center “What can I eat?” This is a popular question asked by those suffering from chronic pancreatitis or who have experienced acute pancreatitis and would like to do everything in their power to prevent another attack. First, let’s make sure everyone understands what pancreatitis […]

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8 FOODS TO FEED THE HEALTHY BACTERIA IN YOUR GUT

October 1, 2014

TweetThe supposed benefits of probiotic bacteria in the gut are numerous; from decreasing the incidence of diarrhea,  to replenishing the digestive system’s micro-biome after a heavy treatment of antibiotics to cure an illness. And though there isn’t a definitive consensus amongst medical practitioners that these benefits are scientifically proven, there is agreement on what foods […]

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5 WAYS TO PREPARE YOUR CHILD’S HEART FOR COLLEGE

September 15, 2014

Tweet   September marks the beginning of a new school year and for many students and parents, the start of their college journey.  You’re preparing your child for college by buying them new polka dotted sheets for that extra long dorm bed and textbooks, which you pray they’ll open, but are you preparing your child […]

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6 Grilling Tips to Avoid Carcinogens

August 22, 2014

TweetSummer may be winding down, but there is still plenty of time to gather with friends and family, kick back and relax as your dinner cooks away on the grill. And while this may be good, healthy fun, the way you cook your meat might not be so healthy. Because if cooked incorrectly, grilling can […]

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10 Facts You May Not Have Known About Heart Attacks

July 28, 2014

Tweet(1)  Most heart attacks happen on Monday mornings. In the early morning hours, blood platelets are stickier, a person is partially dehydrated, and stress hormones (such as cortisol) are at their peak. (2)  Women have different heart attack symptoms (nausea, indigestion, and shoulder aches) compared to classic chest pain that men might experience.  25% of […]

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Could your thyroid problem actually be an autoimmune disease?

July 11, 2014

TweetThe American Thyroid Association estimates more than 20 million Americans have some form of thyroid disorder. Of these disorders, Hashimoto’s thyroiditis is one of the most common, believed to be the leading cause of primary hypothyroidism in North America. But it may surprise you to learn that Hashimoto’s thyroiditis, also known as chronic autoimmune thyroiditis, […]

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