July 05, 2012
Eugene Allen, a retired police officer and teacher from Sicklerville, N.J., had a decision to make in February, after an MRI revealed a precancerous cyst in his pancreas. It had to be removed, but the question was how?
The active 60-year-old wanted to get back to the long walks with his dog and taking care of his in ground pool. He could go the traditional surgery route to remove the cyst or he could be the first patient at Thomas Jefferson University Hospital to have a surgeon perform a distal pancreatectomy and splenectomy with the da Vinci robot.
“It was a no-brainer,” says Allen, whose surgeon Harish Lavu, M.D., FACS, an assistant professor in the Department of Surgery, performed the procedure in late March. “I wanted to get back to my life as quickly as possible. It was no doubt the right choice because the recovery time was cut in half.”
A distal pancreatectomy, often used to treat pancreatic tumors and cysts, is a procedure in which the body and tail of the pancreas are removed, usually along with the entire spleen.
Allen could have undergone open surgery, which would have removed the cyst just as successfully, but it would have required a larger incision and longer recovery.
“This procedure is opening up doors in different ways,” said Dr. Lavu. “It’s making it easier on the patient because it offers up shorter hospital stays, less risk of infection and less scarring and bleeding. Most importantly, it gets the patients back to their daily activity quicker.”
Only a few centers in the United States have performed a robot-assisted distal pancreatectomy.
With the robotic arms, a surgeon can perform delicate operations through tiny incisions, which are used to introduce miniaturized wristed instruments to remove the cysts or tumors and a high-definition 3-D camera to view a magnified image of the surgical site, enhancing visualization.
In Allen’s case, the procedure, in which Dr. Lavu took 40 percent of his pancreas, was a preventative measure, removing a precancerous cyst that could have developed into a tumor. That cyst was found by his urologist after he had bladder stone surgery last October. His doctor then ordered an MRI and CT scan to get a better look. The tests later revealed the cyst, so he came to the Jefferson Pancreatic, Biliary and Related Cancer Center to see a surgeon.
Surgeons at the Center have extensive experience in performing pancreatic and related surgeries, the success of which clinical studies have shown is significantly improved when performed at high-volume centers such as Jefferson.
In a typical year, Jefferson surgeons perform over 200 pancreatic resections, including more than 120 pancreaticoduodenectomies—commonly referred to as Whipple procedures—and dozens of distal and central pancreatectomies.
Cysts can be benign, precancerous or cancer, but all represent a red flag. Catching any suspicious activity early increases the patient’s chances of preventing any pancreatic cancer that may occur.
“These are the patients we can cure of pancreatic cancer,” said Dr. Lavu. “The average age for pancreatic cancer diagnosis is 65, so catching this cyst and removing it at age 60, like in Allen’s case, is pivotal. We removed that cyst before it had a chance to develop into anything more.”
About 80 percent of diagnoses of pancreatic cancer are patients whose disease has progressed into the advanced stages, making it more difficult to treat. The remaining 20 percent of people who are diagnosed early with some form of pancreatic cancer are candidates for surgery.