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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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New Treatment Options for Hepatitis C in 2014

by Columbia Surgery on February 10, 2014

Most people are aware of the implications of being diagnosed with HIV, but few have any notion how to live with Hepatitis C. Both viruses are spread through some similar means, but for reasons beyond this blog post, HIV is in our usual lexicon, and Hepatitis C (HCV) is not. This is about to change thanks to new research that has and will lead to breakthrough treatments for this disease.

Between four and five million Americans currently have HCV—most were infected in the 1960s through the 1980s. Fifty percent of these HCV infections are caused by intravenous or other drug use (even casual experimentation decades ago), the rest are from blood transfusions, body modifications such as tattoos and piercings, and sexual transmission.

Those with HCV have up to a 37% risk of mortality due to liver failure. Hepatitis C starts insidiously as inflammation and scarring (fibrosis) but then can progress to cirrhosis and liver cancer (hepatocellular carcinoma). Because HCV is asymptomatic, up to 75% of cases aren’t diagnosed until it is too late. Unfortunately our screening procedures don’t work well in targeting populations at risk, because the risks occurred so long ago and may not even be remembered.

But, we are close to a tipping point. Due to the development of new drugs HCV will soon be curable in the vast majority of patients. The decades old therapy of interferon and ribavirin work in some, but require lengthy treatment and have hard-to-tolerate side effects.

To help make more sense of these new drugs, and to better understand the changes that will be coming in the treatment of Hepatitis C, please join Dr. Robert S. Brown, Jr. of the Center of Liver Disease and Transplantation for his webinar New Treatment Options for Hepatitis C in 2014 to be held on February 27th at 1:00 PM/ET.

Topics discussed and questions to be answered include:

  • What is the timeline for DAA treatment therapies? What can HCV patients expect in the next few years?
  • What are the survival rates and treatment costs for HCV?
  • What sub-populations of HCV patients require special attention?
  • What are the results and updates for the latest Hepatitis C clinical trials?
  • What factors should be considered when developing a personal treatment regime for someone affected with HCV?

We are sorry, but this webinar has already occurred. You can listen to an archived copy of this program in the player embedded below this message. Since this a recording, no one is available to answer calls or emails.


The common drugs used to treat HCV and the ways in which they are combined are:

Interferon
  • Interferon does not attack a cancer or virus directly, but boosts the immune systems response to these diseases.
  • There are different types (alpha, beta, lambda & gamma) used to treat different diseases.
  • Many patients cannot tolerate interferon due to side effects and co-morbidities.
Ribavirin
  • Ribavirin affects the reproductive capabilities of the virus through its RNA and DNA.
  • It is a synthetic chemical not found in nature.
  • Ribavirin does not have as many side effects as interferon but is a teratogen, which means it can cause birth defects in a fetus or embryo.
Interferon & Ribavirin
  • Interferon and ribavirin have been used to treat Hepatitis C for almost 20 years.
  • Interferon and ribavirin must be taken for at least 6 months usually up to a year.
  • This drug combination cures less than half of the patients with HCV genotype 1 and 70% of the patients with genotypes 2 & 3.
Boceprevir & Telprevir
  • Developed in May of 2011, boceprevir and telprevir were the first drugs to act directly on the HCV virus (DAA).
  • Boceprevir and teleprevir increased the cure rate for HCV genotype 1 to 70%. (This is the same cure rate for HCV genotypes 2 & 3 using interferon and ribavirin.)
  • A treatment regime with boceprevir or telprevir, with interferon and ribavirin lasts 24-48 weeks.
Sofosbuvir, Interferon & Ribavirin
  • Sofosbuvir was approved as first-in-class nucleotide drug in December 2013.
  • When combined with interferon and ribavirin, sofosbuvir can be used to treat HCV genotype 1 for 12 weeks with a cure rate of 90%.
  • When combined with interferon and ribavirin, sofosbuvir for 12 weeks can also treat some genotype 3 patients. (This is off-label.)
Sofosbuvir & Ribavirin
  • Sofosbuvir & ribavirin for 12-24 weeks cured HCV and allowed the elimination of interferon for the treatment for ~90% of HCV genotype 2 and for many HCV genotype 3 patients.
Sofosbuvir with Simeprevir or NS5A inhibitors
  • The combination of these drug classes together has not been approved for use by the FDA, but will be important since interferon and, likely, ribavirin will no longer be needed.

 

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New Treatments for Hepatitis C

December 18, 2013

TweetHepatitis C (HCV) is an infection that primarily affects the liver. In the majority of persons, HCV infection becomes chronic and if left untreated can cause numerous outcomes, including cirrhosis and liver cancer. HCV-related end-stage liver disease is the leading cause of liver transplantation in the United States. Chronic HCV affects nearly four million Americans, […]

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New Release: Common Liver Diseases and Transplantation, an Algorithmic Approach to Work-Up and Management

February 1, 2013

Tweetby Robert S. Brown, Jr, MD, MPH Frank Cardile Professor of Medicine Chief Center for Liver Disease and Transplantation NewYork-Presbyterian Hospital/Columbia University College of Physicians and Surgeons Common Liver Diseases and Transplantation, an Algorithmic Approach to Work-Up and Management is now available to gastroenterologists, internists, and students of gastroenterology, hepatology, and surgery. Edited by Robert […]

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New Hepatitis C Treatment Therapies at the Center for Liver Disease and Transplantation

November 1, 2012

TweetMore than 3 million Americans suffer from chronic infection with the hepatitis C virus. Often considered a “silent killer, ” an infected individual may go for years without symptoms before liver damage even becomes apparent. As the disease progresses, it can cause long-term damage to the liver and may lead to liver dysfunction or failure. […]

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U.S. News & World Report Recognizes 33 Top Doctors at NYP/Columbia Department of Surgery

September 21, 2012

TweetCongratulations to the thirty three surgeons at the Department of Surgeon for being recognized by U.S. News & World Report in their 2012 list of Top Doctors. Of these top-ranked surgeons, U.S. News further identified seventeen physicians as being in the top one percent in the nation in their specialties. U.S. News & World Report’s […]

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Reflections of a Living Liver Donor

April 30, 2012

TweetIn July 2009, I was a liver donor to my 21 year old daughter, Jen, whose liver failed due to autoimmune hepatitis. I first wrote about the experience in December 2009. Though I accurately captured the emotion and the gratitude I felt at the time, I glossed over many aspects of the journey. Our lives […]

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From the City of Brotherly Love, A Brother’s Liver Saves Sister

April 23, 2012

TweetWhen 46-year-old Sharon Lupo started having stomach pains before Christmas, she brushed it off as a case of too much pre-holiday indulgence. But the pain persisted even after the holidays ended, landing her in the local emergency room. Many tests, scans, and biopsies later, she was shocked to learn the source of her pain: malignant […]

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Challenges in Liver Transplantation: Allocation of Donor Organs

November 16, 2011

TweetThe November 10, 2011 issue of the New England Journal of Medicine features an editorial by Robert S. Brown, Jr., MD, MPH, Director of the Center for Liver Disease and Transplantation, titled Transplantation for Alcoholic Hepatitis — Time to Rethink the 6-Month “Rule.” In this editorial, Dr. Brown addresses the difficult questions surrounding how to […]

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