Join host Alisyn Camerota as she sits down with Dr. Niraj Gusani, a board-certified surgical oncologist at Baptist MD Anderson Cancer Center in Jacksonville, Florida, to discuss the role of surgery in pancreatic cancer treatment. In this episode, we learn how doctors determine if a patient is a candidate for curative surgery, the impact of tumor location on surgical approach, and dive deep into the two main procedures: the Whipple procedure for tumors in the head of the pancreas and distal pancreatectomy for tumors in the tail. Dr. Gusani also explains why many patients receive chemotherapy before surgery and what patients can expect during recovery.Learn More: Let's Win Pancreatic CancerPanCANPanCAN's Patient ServicesThe Anatomy of a Whipple Procedure Understanding Distal Pancreatectomy Transcript:Julie Fleshman: Hi, I'm Julie Fleshman, President and CEO of PanCAN. On today's podcast, we are taking a closer look at surgery for patients who have been diagnosed with pancreatic cancer.Alisyn Camerota: Hi, everyone. I'm Alisyn Camerota. Welcome to episode seven of PancChat. Today's episode focuses on surgery for pancreatic cancer, including the Whipple procedure. We want to thank our sponsor, Revolution Medicines, and I want to introduce our guest.Dr. Niraj Gusani is a board-certified general surgeon and surgical oncologist with more than twenty years of experience in cancer surgery. He currently serves as the Chief of Surgical Oncology at Baptist MD Anderson Cancer Center in Jacksonville, Florida. So welcome, Dr. Gusani.Great to see you.Dr. Niraj Gusani: Oh, thank you, Alisyn. Great to be here.Alisyn Camerota: Okay, so as I understand it, there are a couple of different types of surgery. The first one is used to treat symptoms. In other words, inserting a stent, say, to open a blocked bile duct. And then there is the kind of surgery that tries to actually cure the patient of pancreatic cancer by removing the tumor, and that's the one that we want to be talking about today. So let's start there.Can you explain where surgery fits into pancreatic cancer treatment?Dr. Niraj Gusani: Yeah, thank you. You know, as you said, there are a lot of options at every stage for every patient to help them with symptoms, blockages, etcetera. And so palliative surgery is an important part of cancer surgery for pancreas cancer and for many other cancers. But today, let's focus a little bit more on what we call curative intent surgery. And that would be basically you have a tumor that's localized to the pancreas or the area of the pancreas, and we're trying to remove it completely, to help in the treatment of the patient with an attempt for cure.Now, it's really important to remember, surgery only works in combination with other treatments. Pancreatic cancer is not a disease surgery alone can cure. We need all patients to get a combination of treatments, usually chemotherapy and surgery in different orders, depending on the patient, and sometimes radiation as well, sometimes immunotherapy, vaccines, a lot of the newer things that we're doing for pancreatic cancer treatment.Alisyn Camerota: In my just very limited experience, my impression is that very few patients are eligible for surgery because it has to be caught at such an early stage. Is that accurate? And do you have any, can you give us any idea of what percentage of patients?Dr. Niraj Gusani: Yeah, so as you're suggesting, unfortunately, most pancreatic cancers are caught at a very late stage and we're working on early diagnosis and screening and so on. But the reality is that a lot of people are not going to be candidates for curative surgery, but a large percentage are, and we're increasing that pool by shrinking the tumors with chemotherapy, with immunotherapy, other treatments first, so we can get to surgery. I would say early on upfront, the percentage of patients who have a resectable tumor is quite small, ten or fifteen percent, but we can get that number higher with modern treatments.Alisyn Camerota: Good, I do want to talk about that, how we get there. So first off, how do you decide if a candidate is a good one for surgery?Dr. Niraj Gusani: Yeah, so it's a bunch of different things that we have to look at. So the very first thing, we start just because it's cancer, we start to know, we want to know all about the tumor. So we want to know anatomically where it lies, is it involved with the pancreas, is it involving other organs, is it involving blood vessels? God forbid, could it have spread to other organs? So we do staging, looking for signs of tumor elsewhere. So we want to know all the details about the tumor itself. Next, we want to know about the tumor biology. So is it something that is very aggressive, has been growing fast, has high tumor markers in the blood suggesting shed potentially into the blood. Those things help us determine how aggressive that tumor is, and under the microscope, we look at the pathology as well. And then finally, we look ...
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