Pancreatic cancer is the fourth leading cancer killer in the U.S. and the treatment can be brutal. However, doctors say advancements in robotic surgery can lessen the pain, speed up your recovery, and possibly improve your chances of survival. We show you why in this medical breakthrough.
Bob Dies never skips the chance to dance with his wife. Earlier this year, Bob was diagnosed with pancreatic cancer and thought his dancing days might be over.
“It’s the worst type of cancer,” Bob Dies told Ivanhoe.
Bob underwent a complex surgery called the Robotic Whipple procedure. His gallbladder and large portions of his stomach, pancreas, and small intestine were removed and the remaining pancreas and digestive organs were rebuilt and reconnected.
“That’s why the operation is so complicated,” Mokenge P. Malafa, MD, a Surgical Oncologist at the Moffitt Cancer Center, told Ivanhoe.
That’s also why these two surgeons use this robot to get it done.
Dr. Malafa claims that, “This technology actually allows us to sometimes see better, to sew better, and to cut better with less trauma to the tissue.”
They also make several small incisions instead of one big one.
“There were four spots essentially where the arms of the robot went into my body,” Dies said.
These doctors say it leads to less pain, shorter hospital stays, faster recoveries, and “the wound infection rate is very low from this,” Kenneth Meredith, MD, FACS, Assistant Member Surgery and Oncology at the Moffitt Cancer Center, told Ivanhoe.
Bob says he was walking the day after surgery and is optimistic about a full recovery.
There are still side-effects to the surgery, including infection, bleeding, and trouble with the stomach emptying itself after meals. Not everyone is a candidate for this procedure, especially those who are obese and have had abdominal surgery before. Since this is a risky operation, the American Cancer Society says it’s critical that you have the procedure done at a specialized institution and with doctors who have the most experience.
BACKGROUND: The American Cancer Society estimates that there will be about 45,220 new cases of pancreatic cancer and about 38,460 deaths from pancreatic cancer in the United States in 2013. The lifetime risk of having pancreatic cancer is about one in 78. The pancreas contains two different kinds of glands. The exocrine glands make pancreatic “juice,” which have enzymes that break down fats and proteins in food. Most of the cells in the pancreas are part of the exocrine system. A smaller number of cells are endocrine cells. These cells are arranged by clusters called islets. They make hormones like insulin that help balance the amount of sugar in the blood. Both types of cells of the pancreas can form tumors, but tumors that are formed by the exocrine cells are more common. It is important to know if a tumor is from the exocrine or endocrine part of the pancreas. Each tumor has its own symptoms, is found using different tests, treated in different ways, and has a different outlook for prognosis. (Source: http://www.cancer.org)
RISKS FACTORS: Doctors are still unsure of what exactly causes pancreatic cancer, but there are some risk factors that have been linked to the disease. Recent research has proved that some of risk factors affect the DNA of cells in the pancreas, which can lead to abnormal cell growth and can cause tumors to form. Some risk factors include:
- Age: The risk of this cancer goes up as people age. The average age at the time pancreatic cancer is found is 71.
- Race: African Americans have an increased risk to have pancreatic cancer than Caucasians.
- Gender: Men are 30 percent more likely to get this cancer than women.
- Smoking: The risk is at least twice as high in smokers compared to those who never smoked.
- Diabetes: Pancreatic cancer is more common in people with diabetes. Most of the risk is in people with type 2 diabetes. (Source:
NEW TECHNOLOGY: Based on the stage and type of pancreatic cancer, patients may need more than one type of treatment. Treatment options include surgery, radiation therapy, chemotherapy and other drugs, and ablative techniques. Pain control is an important part of the treatment process for many patients. Statistics show a six percent chance of living five years once a patient develops the disease. Now, doctors are using robotic procedure to increase the survival rate to 25 percent. The Moffitt Cancer Center on the USF Tampa campus is the first hospital in Florida to conduct a robotic Whipple surgery and have now performed 16 total. The Whipple surgery involves gaining entrance through the abdomen with the goal of removing the head of the pancreas, with some later reconstruction of the intestines. Robotic surgeries offer less cosmetic scarring, faster recovery times, and less pain. “It’s kind of like playing a videogame. After the small incisions are made for the robot equipment to enter the patient’s abdomen, I go into another room and perform the surgery through viewing an HD camera. I insert my hands into a controller and perform the operation remotely. I am always in control,” Mokenge Malafa, MD, Chair of the Department of Gastrointestinal Oncology at Moffitt Cancer Center, was quoted as saying. The robotic Whipple surgery uses the da Vinci Surgical System, which is a system that allows doctors to view the procedure with an HD camera and a robotic hand that is capable of more motion than a human hand. Dr. Malafa said the da Vinci System was previously used for simpler surgeries, like gall bladder removal. “The bottom line is we are still in the early days of this technology. As people get more used to it, we should start to see a rapid expansion of at least partially robotic surgeries,” John D. Petrila, Professor in the Department of Health Policy and Management at USF, Tampa, was quoted as saying. (Source: http://www.usforacle.com/moffitt-performs-fully-robotic-whipple-surgery-1.2804356)
Mokenge P. Malafa, MD, Department Chair for Gastrointestinal Oncology, and head of the section of Hepatopancreatobiliary Oncology at Moffitt Cancer Center, and Kenneth Meredith, MD, Assistant Member Surgery and Oncology at Moffitt Cancer Center, talk about a new robotic procedure for people with pancreatic cancer.
Can you tell us about the Whipple procedure?
Dr. Meredith: Basically, the Whipple procedure involves removing the distal part of the stomach, the head of the pancreas and duodenum, bile duct, and gallbladder. It involves a very complicated reconstruction. Usually there’s an anastomosis or connection between the stomach and the small intestine. Then there’s a connection between the small intestine and the pancreas, and finally the small intestine to the bile duct. So, then basically the whole plumbing for the foregut is in a new position. This operation can vary in length, anywhere from four to eleven hours, depending on how complicated the operation gets. This operation is not for patients that have vein involvement or arterial involvement because the one disadvantage of the robot is that it lacks haptic feedback or the tactile sensation of manipulation of tissue. As you get further on in your robotic experience, and this is going sound very kind of futuristic, you begin to feel with your eyes. I started doing robotic procedures in 2009 in the GI tract. So, I have over time now developed a sensation where I can tell exactly how hard I’m pulling on tissue just based upon my sensory feedback from my eyes. People starting out in robotics really shouldn’t be doing very complicated procedures like this and this is very much a team approach. We both do different parts of this operation and to become proficient at the entire operation we flip on which part we do of the operation. For instance there’s an ablative phase then a reconstruction phase. At one area one surgeon will be doing the ablative phase and then the other surgeon does the reconstructive phase. Then we flip and the surgeon that did the ablative phase before will then do the reconstructive phase. This allows you to become proficient at the entire operation. The other thing is surgeon fatigue; this is a very long operation. Once you’ve reached that learning curve, then your times go down but also your length of hospitalization and everything related to a prolonged operation actually decreases as well.
So, who is an ideal candidate for this procedure?