Advances in Surgical Oncology - Fomadistrict2.com by wuzhenguang

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  Advances in Surgical
Oncology and Head & Neck
        Surgery
     Sadir J Alrawi MD FRCS
    Chief of Surgical Oncology
21st Century Oncology Cancer Center
          Introduction
       Cancer care has been
transformed by the availability of
  various specialized personnel
with unparallel skill in cancer care
and management only in recently
        what is named as
      CANCER CENTERS
http://www3.cancer.gov/cancercenters/centerslist.html#L22

 Types of Centers:
    Cancer Centers            22
    Comprehensive             39
 Cancer Centers Total         61
National Cancer Comprehensive Network NCCN
           Sporadic Cancer Centers




                          21st Century Cancer Center
Where to treat cancer
     Listing of Cancer Cooperative Groups
                     /organizations
Cancer and Leukemia Group B (CALGB): www.calgb.org
National Surgical Adjuvant Breast and Bowel Project (NSABP):
http://www.nsabp.pitt.edu/
Southwest Oncology Group (SWOG): www.swog.org
Radiation Therapy Oncology Group (RTOG): www.rtog.org
American College of Surgeons Oncology Group (ACOSOG):
http://www.acosog.org


American Cancer Society: www.cancer.org
Association of Cancer Online Resources: http://www.acor.org
Breast Cancer Research Foundation: www.bcrfcure.org
Canadian Cancer Society: http://www.cancer.ca

Melanoma International Foundation: www.nationalmelanoma.org
     Why to Cancer Centers
     Multidisciplinary Team
Surgical oncology
Medical oncology
Radiation oncology
Gastroenterology / Oncology based
Pathology
Radiology – diagnostic and interventional
Genetic counseling
Social work and clergy
Nutrition specialists /counseling
Rehabilitation specialists
     Comprehensive Patient Care

Psychosocial support
Hereditary and cancer risk assessment program
Social workers
Patient educators and resources
Personal wellness and rehabilitation programs
Spiritual guidance
Palliative care
Home care
Prevention and screening
Support groups
          Questions???
Can this be applicable to community
hospitals?
Do we still need the patient to travel
across the country?
Surgical Oncology vs General Surgery
Education and Quality of Care
Fighting politics
Prospects of Surgical Oncology
             and
      Recent Advances
  Pancreatic
   surgery
Acute and Chronic pancreatitis
Cystic lesions of pancreas ( Pseudocyst,
Serous, Mucinous)
Intraductal Papillary Mucinous Tumor
(IPMT)
Periampullary, Head and Body cancers
Endocrine tumors ( Gastrinoma,
Insulinoma, etc) Neuroendocrine tumors
CT pancreas protocol




                       Arterial phase
                       Portal phase
                       Venous phase
  Endoscopic Ultra Sound

Tumor localization & Size , LN, BX
Relation to PV, SMV/A, Celiac trunk
Resectability
Neoadjuvent RX
Pathologic Evaluation of Pancreatic Biopsy


CT guided percutaneous biopsy
Transabdominal US / EUS guided biopsy
ERCP and spyglass
Laparoscopic biopsy
         Surgical Options
Staging laparoscopy with US
Surgery for chronic pancreatitis
Laparoscopic distal pancreatiectomy
Palliative biliary and gastic bypass surgery
Enucleation of neuroendocrine tumors
Whipple procedure (pyloric preserving)
       Adjuvant Therapy
Neoadjuvant chemoradiation
Adjuvant chemotherapy
Adjuvant chemoradiation
Ablation therapy
Clinical trials
       Palliative Treatment
Pain
– Celiac block: percutaneous or endoscopic
Jaundice
– ERCP and stent
– Percutaneous image guided drainage
– Surgical drainage
Gastric outlet obstruction
– Endoscpic stent placement
– Surgical bypass
Palliative chemoradiation
 Liver & Biliary Surgery

Liver metastases
Cholangiocarcinoma exta and intrahepatic
Gallbladder cancer
Hepatocellular carcinoma
Hepatic adenomas and FNH
Hepatic hemangioma
Choledocal cyst
Biliary stricture
           Diagnostics
Ultrasound
CT scan / biopsy
MRI
PET CT scan
ERCP, spyglass and cytology
Endoscopic US
Tumor markers
            Treatment Options

Liver resection
– Lobectomy or segmental resection
– Open or laparoscopic
Microwave ablation/ RFA
Chemoembolization
SIRS spheres
Portal vein embolization
Open Liver Resection
Laparoscopic Liver Surgery
Laparoscopic Liver Surgery
Microwave Ablation
Microwave Ablation
Shortcut to TALON08b.lnk
 Colon and Rectum Surgery
Colorectal Cancer
Colorectal polyps
Familial adenomatous polyposis
Lynch syndrome
Inflammatory bowel disease
          Diangnostics
Endoscopic evaluation and biopsy
Endoscopic ultrasound
CT scan
MRI with rectal coil
PET CT scan
Genetic testing and counseling
        Surgical Options
Colon resection open or laparoscopic
Abdominoperineal resecion open or
laparoscopic
Total proctocolectomy with J pouch
anal anastomosis open or
laparoscopic
Transanal endoscopic Microsurgery
(TEMS)
Transanal Endoscopic Micro
     Surgery (TEMS)
       Indication for TEMS
 Early rectal cancer
 Patient unfit for major
Surgery
 High grade dysplasia
 Post Neoadjuvent treament

         NO Surgical wound
         Earlier Recovery
        Adjuvant Therapy
Adjuvant chemotherapy
Neoadjuvant chemoradiation
Molecularly directed therapy (e.g.
cetuximab)
Metastasectomy
– Liver resection and ablation
– Lung resection and ablation
Intraperitoneal Heated chemoperfusion
Management of Peritoneal
 Surface Malignancies
Patient Population With Peritoneal Disease


                 – Gastric/Pancreatic/Small Bowel/Gallbladder
Aggressiveness




                      2003 ~ 18,200 Patients
                 – Colon/Rectal
                      2003 ~ 20,400 Patients
                 – Appendiceal
                      2003 ~ 1,150 Patients
                 – Ovarian
                      2003 ~16,200 Patients
                 – Mesothelioma
                      2003 ~600 Patients
                 – Pseudomyxoma
                 Represents ~55,000 patients annually
Description: Cyto-Surgery + IPH
Exploratory laparotomy, lysis of
adhesions, tumor debulking
Insertion of cannulas and temperature
probes
“Temporary” close
Connect perfusion circuit to ThermoChem
HT System
Circulate and heat for 120 minutes
Open and irrigate
Reconstructive surgery & close
CT of peritoneal carcinomatosis
   “   Bad”                         “   Ugly”




 • SB well contrasted       • SB poorly contrasted
 • SB pushed centrally      • SB “mixed” w/tumor
 • No SBO                   • Multi-level SBO
 • No obvious tumor on SB   • Tumor deposits on SB
Greater omentum




Lesser omentum
        Palliative Therapy
Palliative chemotherapy
Palliative chemoradiation
Palliative surgery
– Bypass
– Diverting colostomy or ileostomy
Endoscopic stent placement
Clinical trials
  Belly-Button Access Surgical
            Oncology
SINGLE INCISION LAPAROSCOPIC SURGICAL
ONCOLOGY (SILSO)




                  Gall bladder, Appendix
                  Liver, Pancreas, Spleen, Stomach
                  Adrenal, colon, staging
Gastric Cancer
Surgical Staging
Pyloric preservation & Surgical
          Specimens
Sarcoma & melanoma
                  Other tumors
Breast tumors ( benign & malignant)
– Stereotactic breast localization/ Oncolastic breast resection
– Sentinel lymph node
– Simple mastectomy, radical mastectomy
Head & Neck tumors
–   Oral cavity SCC
–   Oropharynx tumors
–   Hypopharynx tumors
–   Laryngeal tumors
–   Various neck dissections ( Radical, modified, selective)
Thyroid and parathyroid
Parotid tumors
Robotic Surgical Oncology
  Robotic Surgical Oncology
Robotic esophagogastrectomy
Robotic hepatobiliary surgery
Robotic pancreatectomy
Robotic adrenalectomy
Robotic splenectomy
Robotic colectomy
Robotic thyroidectomy / parathyroidectomy
Oncoplastic Breast Surgery
         Thyroid tumors
Minimally invasive
thyroidectomy
Central compartment node
dissection
Robotic thyroidectomy
      Parathyroid Disease
Minimally Invasive parathyroidectomy
Intraoperative parathyroid hormone assay
Robotic parathyroidectomy
Head & Neck Cancers
     Melanoma
Head & Neck Cancers

								
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