Liver cancer is a common form of cancer today, and a rapidly growing problem. Two Washington University Medical Center surgeons in the hepatobiliary pancreatic surgery section — Steven M. Strasberg, MD and David C. Linehan, MD — perform 100 liver resections each year for primary and metastatic tumors of the liver. The mortality rate for these resections is very low: around one percent.
“We are one of the largest-volume U.S. centers now,” says Dr. Strasberg, who is Washington University Pruett Professor of Surgery and head of the section of hepatobiliary, pancreatic and gastrointestinal surgery at the Medical Center. “We also combine clinical expertise with clinical and basic investigation, which sets our group apart from many others.”
His group is currently engaged in a number of clinical trials that are actively recruiting patients. For several years, they have been using cryosurgery to destroy tumors; now, they are testing radiofrequency (RF) ablation, plus a pump, in the treatment of certain patients with colorectal liver tumors. To qualify for the trial, patients must be ineligible for liver resection because they have too many tumors or because their general health and age contraindicate such surgery.
They have also embarked on a trial involving a new, saline-linked form of RF ablation aimed at surface tumors and resection margins. This RF ablation may be used as an adjunct to resection or as a sole treatment.
“Because of our advanced imaging for liver cancers — particularly PET scanning and intra-abdominal ultrasound — we have also been able to avoid doing futile hepatic resections,” adds Dr. Strasberg. “Our three-year survival for people who have had this kind of imaging and then a liver resection is 77 percent; in the literature, the median survival is about 44 percent. So we are seeing a huge improvement in our results because we do fewer futile surgeries.”
On the pancreatic side, they are also continuing with their prospective analysis of Whipple patients. The first 123 consecutive cases have been presented at the American College of Surgeons (ACOS) meeting, and the results were published March 2001 in the Journal of the American College of Surgeons. They have had only one mortality throughout this patient series, and just a 1.6 percent fistula rate — the lowest ever reported.
At the same time, these surgical team members continue with their research: working on a vaccine for pancreatic cancer, studying micrometastases, and investigating the basic mechanism that underlies pancreatic cancer and trying to shut off the specific genes responsible for the neoplastic growth of cancer cells through antisense oligonucleotides.
From BJC International Health Bulletin, November 2002 Regional/National Referrals
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