NON-PROFIT U.S. POSTAGE PAID SIOUX FALLS, SD PERMIT NO. 7010
Avera McKennan 1325 S. Cliff Ave. Sioux Falls, SD 57105
Hours: 8 a.m. - 5 p.m. 605-322-7797 To learn more, visit our website at AveraDigestiveDisease.org
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15-GAST-4984
Facts and Stats About Pancreatic Cancer Pancreatic Surgery: High-Volume Center Offers Best Outcomes Pancreatic Cancer: Specialized Procedures Provide Minimally Invasive Intervention
INSIDE THIS ISSUE: DIGESTIVE DISEASES • SEPTEMBER 2015
DigestiveTrac
PANCREATIC SURGERY High-Volume Center Offers Best Outcomes Surgery is the best chance for long-term survival of pancreatic cancer, and pursuing surgical treatment at a high-volume center results in the highest outcomes and lowest rate of complications. At diagnosis of pancreatic adenocarcinoma, typical life expectancy is six to 12 months. If cancer is operable, five-year survival rate is 20 to 40 percent. “We do see patients who pass that five-year milestone and continue to do very well.”
Whipple surgeries, also known as pancreaticoduodenectomy, is indicated when the tumor is located in the head of the pancreas. This complex procedure typically involves removal of the head of the pancreas, gallbladder, common bile duct, portions of the duodenum and stomach, and regional lymph nodes, with subsequent reconstruction of the remaining digestive tract. A second common procedure is distal pancreatectomy, for malignancies involving the tail of the pancreas. For best outcomes, the National Comprehensive Cancer Network (NCCN) recommends that pancreatic resections, including Whipple and distal pancreatectomy procedures, be performed at a high-volume center that has multidisciplinary consultation and performs more than 15 pancreatic resections annually. Avera McKennan has met criteria as a high-volume center since 2012.
– Michael Person, MD, board-certified General Surgeon
Surgeons who offer Whipple Procedures at Avera Digestive Disease Institute: Michael Person, MD, FACS Dr. Person is a general surgeon who takes a special interest in hepatobiliary procedures, cancer-related surgeries and biopsies, and minimally invasive laparoscopic procedures. He completed medical school at the University of South Dakota Sanford School of Medicine at Vermillion, and residency in general surgery at Iowa Methodist Medical Center in Des Moines. He is certified by the American Board of Surgery.
Bashar Abdulkarim, MD, PhD, FACS Dr. Abdulkarim takes a special interest in transplant and hepatobiliary procedures. He holds a medical degree from Aleppo University Hospital, Syria, and completed surgical residency and fellowship in transplant surgery at University of Tennessee-Methodist Healthcare, Memphis. He is certified by the American Board of Surgery.
Jeffery Steers, MD, FACS Dr. Steers takes a special interest in transplant and hepatobiliary procedures. He earned a medical degree from the University of Kansas School of Medicine, and completed residency in general surgery at the University of Kansas Medical Center. His fellowship in liver, kidney and pancreas transplantation was completed at the Mayo School of Graduate Medicine in Rochester.
Contact Avera DDI through our Navigator: Liz Harden, CNP 605-322-7334 elizabeth.harden@avera.org
FACTS AND STATS About Pancreatic Cancer
Risk factors • Smoking • Family history • Personal history of chronic pancreatitis or diabetes • Obesity • Alcohol abuse • Lynch syndrome and BRCA1 and BRCA2 mutation
• 49,000 new cases per year • 40,000 estimated deaths per year
Hallmark Symptoms:
• Third leading cause of cancer all cancer deaths, behind lung, colorectal and breast
• Jaundice • Unexplained weight loss
• 85 percent of cases are adenocarcinoma of the pancreas; the minority of cases are neuroendocrine tumors of the pancreas
• Abdominal pain that radiates to the back • Occasionally the development of diabetes
• One-year survival rate: 28 percent (all stages)
Source: American Cancer Society
• Five-year survival rate: 7 percent (all stages) • 20 percent of cases are operable • More than half of cases diagnosed at a distant stage
Gastroenterology
Avera Digestive Disease Multidisciplinary Team The Avera Digestive Disease Institute brings together a multidisciplinary team to address cancer and other serious conditions of the digestive tract, all working toward the goal of seamless care and the best possible outcomes.
Avera gastroenterologists ensure that each
Navigator
patient affected by digestive disease is treated with the fullest extent of expertise and the latest medical technology, including advanced endoscopy.
The DDI navigator serves as an access point for all questions, concerns and issues and follows all patients with a digestive system cancer.
MEDICAL ONCOLOGY
Be A Survivor Learn more about successfully dealing with a colorectal cancer diagnosis. BeASurvivorAveraColon.com
Avera medical oncologists are experienced in treating pancreatic cancer patients who are candidates for surgery with neoadjuvant or adjuvant chemotherapy. Aggressive chemotherapy protocols may be considered to treat unresectable tumors and metastatic disease.
Surgeons Avera’s surgeons offer specialized training and experience in pancreatic surgery. Avera McKennan is recognized as a highvolume center for Whipple procedures, which is recommended by the NCCN for best outcomes.
PANCREATIC CANCER Specialized Procedures Provide Minimally Invasive Intervention
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Advanced endoscopy procedures are utilized for highly specialized diagnostic and treatment needs. They may provide more conclusive results than imaging alone, yet are less invasive than surgery. - Towner Lapp, MD, Gastroenterologist and Specialist in Advanced Endoscopy
When pancreatic cancer is suspected, timely and accurate diagnosis is critical. The earlier the patient is treated, the greater chance exists for prolonged life and improved quality of life.
These capabilities allow EUS to be a minimally invasive alternative to exploratory surgery for tissue acquisition of pancreatic masses in many cases.
Two specialty procedures available through Avera Digestive Disease Institute are endoscopic retrograde cholangiopancreatogram (ERCP) and endoscopic ultrasound (EUS).
EUS techniques also are used in certain treatments, such as draining pancreatic pseudocysts, a rare complication of acute pancreatitis, in a procedure called cystgastrostomy.
Avera recently welcomed a specialist in advanced endoscopy, Towner Lapp, MD. In addition to specializing in internal medicine, Dr. Lapp has completed fellowships in gastroenterology and hepatology, and the subspecialty of advanced endoscopy.
Whereas EUS is typically a diagnostic tool, ERCP most often is reserved for therapeutic procedures. However, it can also be used to obtain a biopsy or brushings of the common bile duct for diagnostic needs.
“In addition to diagnostics, these specialized procedures also allow us to perform therapeutics for certain issues, for example, opening a blockage in the common bile duct,” Dr. Lapp said.
ERCP is typically performed with anesthesia sedation. The endoscope is inserted through the mouth to the area of the ampulla in the second portion of the duodenum. Small catheters and guidewires are then advanced into the common bile duct and/or pancreatic duct to perform therapies.
EUS provides a standard for diagnosing pancreatic cancer. EUS also offers an opportunity to sample pancreatic masses with a fine-needle aspiration after a mass is typically detected on CT or MRI to confirm a diagnosis. EUS is performed under conscious sedation or sedation with anesthesia. An endoscope equipped with ultrasound technology allows imaging of the pancreas, liver and nearby lymph nodes through the small intestine and stomach. A needle can be passed through the walls of the digestive tract to obtain a tissue sample.
605-322-7797
ERCP also uses fluoroscopy to obtain images during the procedure and guide placement of catheters, guidewires, biopsies and/or stent placement. “Advanced endoscopy allows us to confirm diagnoses and, in some cases, treat conditions of the pancreas and hepatobiliary system, that in the past may have required surgical intervention,” Dr. Lapp said.
To learn more, visit our website at AveraDigestiveDisease.org