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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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Recent Questions About the Usefulness of Mammography

by Columbia Surgery on March 7, 2014

mammogramMany patients have inquired about a recent study in the British Medical Journal by Canadian researchers who found that mammography did not reduce death rates from breast cancer and may even have harmed some women by leading to unnecessary surgery, radiation, and chemotherapy. A vast majority of physicians, researchers, and breast radiologists have criticized the study sharply and cited massive evidence to discredit it.

It is important to keep in mind that the study is based on data from mammographic screening performed 30 years ago. At that time, two-view analog film-screening mammography was the standard of care. Unfortunately, the results from the study shed no light on the benefit of screening with current digital mammographic technique.

Differences in sensitivity between mammograms from the 1980s and now

Almost a third (30.6 percent) of the mammographically detected breast cancers in the Canadian study had already spread to lymph nodes and the vast majority were palpable (could be felt) by physical exam. Thus, it is no surprise that there was no survival benefit from mammography performed with the primitive technique of the 1980s. Results from contemporary studies1 show that with modern digital mammography, 18 percent of screening-detected cancers involve the lymph nodes; they are also more likely to be closer to 1 cm at diagnosis, compared with the mean size of 1.91 cm found by mammography in the Canadian study. The improved accuracy of digital mammography vs. analog film is well established for women under age 50 with dense breast tissue.2

Quality-of-Life Advantages to Earlier Detection

The Canadian study fails to acknowledge the many benefits associated with detecting tumors at smaller sizes. When tumors are detected earlier, patients are more likely to avoid mastectomy and to take advantage of breast-conserving options such as lumpectomy. They are also less likely to be prescribed radiation and chemotherapy.

Breast-Cancer Screening of the Future

Scientists at NewYork-Presbyterian/Columbia are involved in research to improve methods for early detection of breast cancer, including a PAP smear-type method to analyze nipple fluid to detect pre-cancerous changes. Another promising approach in development is 3D mammography. According to Sheldon M. Feldman, MD, Chief of the Breast Surgery Division, “Though digital mammography, the current ‘gold standard,’ performs reasonably well, we anticipate significant improvements in diagnostic capabilities in the near future.”

All patients should check with their physician before making any decisions about breast cancer screening or treatment.

Sheldon M. Feldman, MD

        Chief of the Breast Surgery Division

 

      NewYork-Presbyterian/Columbia University Medical Center

Learn more about diagnosis and treatment of breast cancer at breastmd.org

1. Nederend J, Duijm LEM, Louwman MWJ, Groenewoud JH, Donkers-van Rossum AB, Voogd AC. Impact of transition from analog screening mammography to digital screening mammography on screening outcome in the Netherlands: a population-based study. Ann Oncol 2012;23(12):3098–3103
2. Pisano et al; DIMIST Trial: N ENGL J MED 10.1056/NEJMoa052911

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Study Finds Exercise Improves Joint Pain in Women Taking Aromatase Inhibitors for Breast Cancer

February 19, 2014

TweetOne of the main reasons that women have low quality of life while taking hormonal therapy is their side effects, says Dawn Hershman, MD, MS, Associate Professor of Medicine and Epidemiology and leader of the breast cancer program at the Herbert Irving Comprehensive Cancer Center. While taking aromatase inhibitors (such as exemestane), the most common […]

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Innovations in Breast Cancer: Intraoperative Radiation Therapy Update

February 14, 2014

TweetPrevious posts have informed our readers about an innovative breast cancer therapy, intraoperative radiation therapy (IORT), which became available at the Breast Center during the summer of 2013.  New York-Presbyterian/Columbia University Medical Center is one of the first institutions in the New York metropolitan area to offer IORT, which entails a single dose of radiation […]

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Breast Cancer Management 2014: CME

January 16, 2014

TweetOver the past several years there have been many important breakthroughs in the treatment and management of breast cancer. New screening methods, the advent of minimally invasive biopsy techniques, advances in oncoplastic surgical procedures, and new information on the ever-important role of genetic analysis are just a few of the many exciting recent developments in […]

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New Procedure to Prevent Lymphedema Gains Media Attention

January 13, 2014

TweetA new protocol to help patients undergoing breast surgery is gaining widespread media attention as NewYork-Presbyterian/Columbia University Medical Center continues an important clinical trial of the LYMPHA protocol. The LYMPHA protocol combines microsurgery with advanced imaging in order to prevent, detect, and treat lymphedema. Lymphedema, painful swelling of the arm or hand, can be a […]

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Sneak Peak: Breast Cancer and Bridging the Gap

December 4, 2013

TweetOn Saturday December 7th, Columbia University Department of Surgery is hosting its annual breast cancer awareness event, Bridging the Gap: Enhancing Breast Cancer Prevention, Screening and Wellness. We spoke with Preya Ananthakrishnan, MD, one of the key members of the planning committee, for a sneak preview about what we can expect at this year’s event. […]

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Treating Cardiovascular Disease in Breast Cancer Patients

November 21, 2013

TweetResearchers at Columbia University Medical Center have discovered that certain women undergoing radiation therapy for early-stage breast cancer may have an elevated risk of developing cardiovascular disease. David J. Brenner, PhD, DSc, of Columbia University, and his team studied treatment plans of 48 patients with stage 0 through IIA breast cancer in order to assess […]

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A Multicenter “Ablate and Resect” Study of Novilase Interstitial Laser Therapy for the Ablation of Small Breast Cancers

October 2, 2013

TweetColumbia University Medical Center is helping to lead a new clinical trial examining the effectiveness of using laser therapy to treat early-stage breast cancer. This new research involves a non-surgical treatment called, Novilase® Interstitial Laser Therapy (ILT). Novilase Breast Therapy is already cleared by the FDA for the treatment of breast fibroadenomas, which are the […]

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WABC-TV Breast Cancer Special features NYP/Columbia Breast Surgeons

September 28, 2013

TweetTune in October 5th for the WABC-TV Special “BREAST CANCER: ANSWERS, UPDATES & PROGRESS” features NYP/Columbia Breast Surgeons On Saturday, October 5th, WABC-TV will air a special program, “Breast Cancer: Answers, Updates & Progress” at 7:30PM, EDT (also to be re-run Sun. 10/6 at 5:30am).  Hosted by Eyewitness News Anchor Diana Williams, the program focuses […]

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