cancer

2014: A Year in Review

by Columbia Surgery on December 26, 2014

2014YearInReview_WebsiteBanner04

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!

>>> MAKE AN APPOINTMENT <<<

{ 0 comments }

6 Grilling Tips to Avoid Carcinogens

by Columbia Surgery on August 22, 2014

177473555Summer 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 cause your meat to form Heterocyclic Amines (HCAs), which studies suggest may cause certain cancers

From Cancer.gov:

“HCAs are formed when amino acids (the building blocks of proteins), sugars, and creatine (a substance found in muscle) react at high temperatures. HCAs are not found in significant amounts in foods other than meat cooked at high temperatures. Whatever the type of meat, however, meats cooked at high temperatures, especially above 300ºF (as in grilling or pan frying), or that are cooked for a long time tend to form more HCAs. HCAs […] become capable of damaging DNA only after they are metabolized by specific enzymes in the body, a process called “bioactivation.” Studies have found that the activity of these enzymes, which can differ among people, may be relevant to cancer risks associated with exposure to these compounds.”

To help combat the formation of HCAs on your meat, dietician Anne Ammons has come up with 6 grilling tips for safer meat cooking:

  1. Avoid flame flare-ups. Flare-ups—when burger the fire shoots up around your meat—greatly increase the chance of HCA formation.
  2. Marinate meat for 30 minutes before grilling several studies (here and here) suggest marinating meat leads to fewer HCAs.
  3. Limit portion sizes. Smaller pieces means shorter cooking time and less chance for HCA formation.
  4. Choose leaner cuts of meats. Leaner cuts cause less flare-ups, which means less chance for HCAs.
  5. Do not overcook* or burn meat. You may prefer your burger resemble a hockey puck, but excessive overcooking can increase the chance for HCAs. (*As always, follow the food safety recommendations for internal cooking temperatures for your meat. The USDA recommends an internal cooking temperature of 160 °F for ground beef. We’d hate to have you avoid HCAs only to get sick with salmonella.)
  6. Switch to fruits and vegetables. Grilled fruits and vegetables are delicious, and they don’t get HCAs!

For smarter grilling, it is never too late to try some delicious, nutritious grilled alternatives:

-        veggie burgers

-        portabella mushroom caps to replace a ground beef burger

-        squash, peppers, or sweet potatoes

-        grilled pineapple is a tasty dessert.

Grilled pineappleGrilled portabello mushrooms

 

Read more:

 Turmeric, Curcumin, and Cancer: What’s the Research?

• Cheers for Chia: the Ancient Superfood

 Following The Dietary Guidelines for Americans May Reduce Your Risk for Pancreatic Cancer

{ 0 comments }

Pancreatic Cancer Awareness (Hope) Day – November 8, 2014

July 5, 2014

TweetThe Pancreas Center will be holding their annual Pancreatic Cancer Awareness Day this year on Saturday, November 8th from 1:00 PM to 3:00 PM at the Vivian and Seymour Milstein Family Heart Center. “Awareness” is the appropriate name for this day. Yet, after attending several of these, a better title would be the annual Pancreatic […]

Read the full article →

Turmeric, Curcumin, and Cancer: What’s the Research?

March 26, 2014

TweetDeborah Gerszberg, RD, CNSC, CDN Clinical Nutritionist The Pancreas Center Turmeric is a root, appearing similar to ginger, with a very mild bitter and spicy flavor, often found ground in the spices section of your grocery store.  As one of the main spices found in curry, you may recognize turmeric by its bright yellow/orange hue. […]

Read the full article →

NewYork-Presbyterian/Columbia University Medical Center Announces Performance of First Robotic Whipple Procedure

March 12, 2014

TweetOn March 4, 2014, the first robotic Whipple procedure was performed by Dr. John Chabot, Executive Director of The Pancreas Center, and Dr. Yanghee Woo at NewYork-Presbyterian/Columbia University Medical Center. This is exemplary of The Pancreas Center’s mission to continually advance the quality of pancreatic care. What is a Whipple Procedure? For those who may […]

Read the full article →

Recent Questions About the Usefulness of Mammography

March 7, 2014

TweetMany 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 […]

Read the full article →

Redefining Gastric Cancer Treatment: An Interdisciplinary Approach

February 25, 2014

TweetThis Blog Talk Radio program has already occurred. Please view the on-demand copy at the bottom of this post. Gastric cancer is a curable disease with effective treatment options.  When discovered in its early stages, gastric cancer can be eliminated with complete resection of the tumor alone.  The treatment of advanced gastric cancer requires a […]

Read the full article →

How Is Gastric Cancer Diagnosed?

February 25, 2014

TweetGastric cancer is hard to detect in early stages because symptoms are uncommon and nonspecific.  When symptoms do occur, they can easily be mistaken for more common ailments such as a stomach virus. Gastric cancer symptoms may include a loss of appetite, indigestion, nausea, stomach discomfort, heartburn, black stool, vomiting, unintentional weight loss, feeling full […]

Read the full article →

Advancement in Gastric Cancer Treatment: Robotic Surgery

February 25, 2014

TweetSpecially trained surgeons in gastric cancer operations and robotic surgery can offer select patients a minimally invasive approach to gastric cancer surgery.  The traditional open operations for gastric cancer are performed through large abdominal incisions; however, for the past thirty years, experts in Korea and Japan and more recently in the U.S. and Europe have […]

Read the full article →

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 […]

Read the full article →