Cutting-Edge Surgery for Pancreatic Cancer

7/16/2013

The region's first portal vein replacement to treat pancreatic cancer was recently performed at Lafayette General Medical Center. Surgical oncologist Jason A. Breaux, M.D., with assistance from cardiovascular surgeon Mo Allam, M.D., successfully treated a pancreatic cancer patient. This innovative procedure is considered the most significant advancement in surgical treatment of pancreatic cancer in the last 10 years.


The patient, a male in his 60s, was diagnosed with a tumor on the pancreas that also invaded the portal vein – an essential blood vessel that supplies over 50 percent of blood and oxygen to the liver. The pancreas wraps around the portal vein, and traditionally, tumors involving this vein were considered incurable. Surgically resecting and replacing the portion of the vein invaded by tumor was not considered effective.


In cases where a tumor of the pancreas intrudes on the portal vein, only specially trained surgeons can remove the tumor and the portion of the vein attached to it. Treatment for advanced pancreatic cancer such as this is truly a team approach. The patient undergoes chemotherapy and radiation treatments to shrink the tumor before surgery. In this case, Salman Malad, M.D., an oncologist at Cancer Center of Acadiana, coordinated this aspect of treatment. Afterwards, during surgery, the tumor was carefully dissected off all other structures leaving only its attachment to the portal vein in place. Dr. Breaux then clamped off each end of the exposed portal vein for a short time. With Dr. Allam's assistance, Dr. Breaux replaced the missing portion, in this case 3 to 4cm in length, with a section of the patient's internal jugular vein taken from his neck. "It's almost as if the jugular was made for this purpose," says Dr. Breaux. "It's a perfect fit, proportionate to the patient's size."


Specially trained to perform complex cancer surgeries, Dr. Breaux participated in many portal vein replacements. He gained experience during residency training at Ochsner Medical Center, special rotations at M.D. Anderson Cancer Center and during his fellowship in surgical oncology at the University of Pittsburgh Medical Center in Pennsylvania.


Surgeries on pancreatic cancer patients have been more exploratory in the past. Now, with improved imaging techniques, surgeons know before surgery the precise location of the tumor and whether a vein replacement is warranted.


"About 10 years ago, patients with portal vein invasion were sent home with only a three to six-month survival rate," says Dr. Breaux. Currently, the average survival rate of pancreatic cancer involving the portal vein treated with a multi-disciplinary approach, including chemotherapy/radiation, followed by surgical resection and portal vein replacement, is 18 months. "Now that we're able to remove these tumors and replace the vein, the patient has a 20 percent chance of five-year survival," says Dr. Breaux. Pancreatic cancer remains a very aggressive type with a high chance of recurrence.


Researchers, oncologists and surgeons hope to further improve survival rates with ongoing research and more effective chemotherapies. "To be able to include these pancreatic cancer patients in the surgical arm of treatment is a milestone," says Dr. Breaux.


Dr. Jason Breaux is officed with General Surgeon Paul Breaux III, M.D., and Oncology Surgeon Henry Kaufman IV, M.D., at 457 Heymann Blvd. in the Grant Molett Medical Arts Center.

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