In regards to pancreatic oncological surgery, scientific studies have demonstrated that surgeons performing more than 14 pancreatic surgeries a year have superior results with their patients. Alden’s highly super-specialized practice performs significantly more than this amount of pancreatic surgeries a year: more than most oncological surgeons.

Dr. Dmitri Alden, liver cancer and pancreatic cancer surgery specialist, spearheads a highly specialized liver & pancreas surgery practice dedicated exclusively to surgery of the liver and pancreas. His team’s dedicated approach to cancer treatment has given new life to his patients.

Pancreatic Cancer and Staging

Pancreatic cancer is a term that includes several types of malignancies that start in the pancreas. The pancreas is a complex organ responsible for the production of insulin as well as digestive enzymes (substances that help digest food). Insulin is delivered into the bloodstream, but enzymes are secreted into the main pancreatic duct (duct of Wirsung) and then into the intestinal tract.

Because the pancreas has various functions, various types of tumors / cancers can grow there from different pancreatic cells. There are benign, malignant, and “pre-malignant” tumors. These pancreatic cancers cause different symptoms and begin in different locations of the pancreas. Each cancer requires different types of surgery, if any, and each type of cancer is associated with very different prognoses.

Dr. Alden is a fantastic surgeon who loves what he does. He loves a challenge and is obviously into constantly learning. I am in the medical field and taken care of many surgeons patients and I chose Dr. Alden to do my surgery. Everything went great and I never had any complications. He spent at least an hour with my husband and I in the office explaining what I had and showing us his research and why he believed he thought I had what I had. He really made me feel like I was in good hands and he would do whatever he could for me as a doctor. ~ Vitals

One of the most commonly diagnosed pancreatic malignancies is adenocarcinoma. This is the type of tumor that the general public commonly associates with the term “pancreatic cancer”. The vast majority of these cancers begin in the head of the pancreas, but they could be located in any part including the tail. The most typical presentation is painless obstructive jaundice (yellowish coloring of the skin), which happens when the tumor growth blocks the part of the bile duct that crosses the pancreas before entering the part of the intestine called the duodenum. Other symptoms include weight loss, fatigue, and back pain.

Pancreatic Adenocarcinoma Facts

• 33,730 Americans (17,150 men and 16,580 women) are diagnosed yearly with pancreatic cancer
• 32,300 American men and women die of pancreatic cancer each year
• The median age at diagnosis of pancreatic cancer is 72
• The overall 5-year survival rate from pancreatic cancer is 4.6%
• Only 7% of cases are diagnosed while the cancer is still confined to the primary site
• 52% of cases are diagnosed after the cancer has already metastasized (spread to other sites in the body)

Corresponding 5-year Relative Survival Rates of Pancreatic Cancer:

• 16.4% for localized tumors
• 1.8% for patients with distant spread

Diagnosis and Treatmentof Pancreatic Cancer / Pancreatic Cancer Surgery

Typically, the patient with painless obstructive jaundice is referred to a gastroenterologist, who performs an endoscopy and a procedure called ERCP (endoscopic retrograde cholangiopancreatography) that allows insertion of a stent (plastic or metal tube) into the bile duct to bypass the obstruction and relieve jaundice. Then the patient usually undergoes a EUS (endoscopic ultrasound), which could be done at the time of ERCP. A fine needle aspiration of the tumor could be done at the same time to confirm the diagnosis. EUS also helps to determine if pancreatic cancer surgery would be possible because it provides information on the tumor size, status of lymph nodes around the pancreas, and tumor involvement of major blood vessels surrounding the pancreas. In addition, a CT scan or MRI of the abdomen is performed. If tumor spread is suspected, further workup is usually ordered.

The staging of pancreatic adenocarcinoma is complex. Typically, it is based on TNM classification (Tumor, Nodes, Metastasis), or tumor size, lymph node status, and distant metastases such as spread into the liver, lungs, or any other organs. The TNM staging system is not perfect and it does not reflect many factors that play a role in deciding on treatment options.

The treatment choices for pancreatic adenocarcinoma / pancreatic cancer are surgery and chemotherapy. Tumors that do not have any contraindications are usually selected for surgical treatment. The type of pancreatic cancer depends on the tumor’s location. Many doctors today select a neo-adjuvant chemotherapy approach. Neo-adjuvant chemotherapy stands for chemotherapy before surgery. The idea is to decrease the size of the tumor first, thus making for an easier surgery. In some cases, tumors that are initially not operable might shrink with the treatment and the patient then may become a candidate for the curative operation. As new medications become available and technologies advance, more and more patients are candidates for surgical treatment that was not possible before. One of these technologies was pioneered by us and involves re-opening blood vessels that are blocked by a tumor, followed by chemotherapy. If the tumor responds to the chemotherapy, then surgery is performed at a later date.

Many resources on the web discuss pancreatic adenocarcinoma. Some are reliable sources and some are not. If you or your loved one is diagnosed with pancreatic cancer, please talk with a healthcare professional who has extensive experience in dealing with this issue. Ideally, this problem should be handled by specialists who regularly perform pancreatic surgery and work with an oncology team that specializes in this field.

Are You a Candidate for Oncological Pancreatic Surgery?

Determining whether a patient is a candidate for pancreatic surgery is a multistage process. First, the disease itself is thoroughly studied; this involves CT scans, MRIs, endoscopic evaluation, ultrasounds, and various other procedures.

Once the NYC pancreatic cancer surgeon determines the tumor itself meets the criteria for surgical intervention, other factors are considered. It is important to confirm whether the pancreatic tumor is confined to that organ or if it has spread into distant lymph nodes and other organs. For example, pancreatic adenocarcinomas are usually operated on only if they are confined to the pancreas and have not spread.

However, different types of pancreatic cancers are treated differently. For example, in some neuroendocrine cancers of the pancreas, surgery for the primary tumor in the pancreas as well as the removal of metastases from the liver is considered a “standard of care.”

Next, the best in class NYC pancreatic surgeon and his world-class team determine whether the patient is a candidate for surgery. Multiple medical and social factors play a role in this decision-making process. It is very important to tell your surgeon all your current and past medical conditions, including any past surgeries. Past surgeries may affect your current situation, including whether you are a candidate for minimally invasive laparoscopic or robotic surgery.

Medical conditions such as heart disease, prior heart attacks, high blood pressure, and diabetes, just to name a few, may affect recovery after a major operation. We also review the list of your current medications. Some conditions and medications may dramatically increase the risk of postoperative complications and prolong healing after surgery. For example, steroid medications alter the immune system, making the patient much more susceptible to postoperative infections and delaying the healing of the new internal connections and surgical wounds.

Typically, the decision regarding surgery is based on the opinions obtained from all the doctors involved in your care and is coordinated with your primary care physician, cardiologist, and other specialists.

In short, pancreatic cancer is a complex problem that requires a multidisciplinary approach before making any decisions regarding treatment.

Dr. Dmitri Alden has extensive experience in diagnosing patients, establishing who is a candidate for liver and pancreas surgery, and successfully performing highly complex surgical procedures in this field. Dr. Alden uses the latest state-of-the-art technology and instruments to treat various cancers and benign conditions including laparoscopic and robotic liver and pancreatic surgery.

Your treatment options depend on the type and location of the pancreatic cancer, how advanced the cancer is, and the age and general health of the individual.

• Patients and medical professionals from America and around the world seek out Dr. Alden’s specialized best in class individualized pancreatic cancer surgery treatments and services including his expert surgical management of the patient’s condition.
• Patients referred to Dr. Alden have access to a vast array of specialists who are some of the best in their field in the country (and possibly in the world).

Please note: Dr. Alden accepts insurance if he participates with your plan. Additionally, if Dr. Alden does not participate with your insurance plan, Dr. Alden’s office is frequently able to obtain pre-authorization from your insurance plan based on the uniqueness of his specialty. We will contact your insurance company to understand your benefits and additionally submit them for you. You will enjoy the luxury and benefit of academic medicine in a top rated concierge environment without the hassle of long hospital waiting room times and paperwork. Most policies reimburse patients for most of the cost of surgery. Our surgical coordinator will help you with a quote.

In addition to an office-based consultation, the NYC liver cancer & pancreatic cancer surgeon offers remote consultations to patients and medical professionals anywhere in the world. Please call our office for details.

For more information pertaining to Pancreatic Cancer Surgery and/or Pancreatic Staging or for a consultation with the best in class liver surgeon, please feel free to contact the NYC Liver, Pancreatic & Bile Duct Oncological Surgeon, Dmitri Alden, MD, FACS, today by phoning his New York office (212) 434-6216 or contacting us online.