Innovations in Surgical Oncology Innovations in Surgical Oncology Sricharan Chalikonda, M.D. Surgical Oncology Director Gen.Surg Robotics Program Cleveland Clinic Sricharan Chalikonda, M.D. Surgical Oncology Director Gen.Surg Robotics Program Cleveland Clinic
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Innovations in Surgical Oncology - clevelandclinic.org · Ascites Inanition ... Retroperitoneal Sarcoma Usually grow to a large size before presentation Require multivisceral resection
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Innovations in Surgical OncologyInnovations in Surgical Oncology
Sricharan Chalikonda, M.D.Surgical Oncology
Director Gen.Surg Robotics ProgramCleveland Clinic
Sricharan Chalikonda, M.D.Surgical Oncology
Director Gen.Surg Robotics ProgramCleveland Clinic
Cancer is confined to peritoneal cavitySurgeon can take down adhesions, cytoreduce tumorsHeat has effect on cancer cells“Targeting” and localizing the principal effect of a multi-modality treatment
Cancer is confined to peritoneal cavitySurgeon can take down adhesions, cytoreduce tumorsHeat has effect on cancer cells“Targeting” and localizing the principal effect of a multi-modality treatment
Multi-Modality TreatmentMulti-Modality Treatment
CYTOREDUCTIVESURGERY
INTRAPERITONEAL HYPERTHERMIA
CHEMOTHERAPY
Verwaal et al. 2003
Verwaal et al. 2003
Improve SurvivalImprove SurvivalPeritonealCancer
Average Life expectancy with standard therapy
With “HIPEC”
Colon 6 mos. 18 – 36 mos.
AppendixPMP
10 mos.5 -10 yrs.
30 mos.10 – 20 yrs.
Mesothelioma 12 – 21 mos. 34 – 92 mos.
Ovarian 6 mos. 25 – 28 mos.
Gastric 1 mos. 14 – 24 mos.
Before/After Cytoreductive Surgery
Before/After Cytoreductive Surgery
Cytoreductive SurgeryCytoreductive Surgery
The first and most important stepThe goal is to remove all visible disease.This would leave microscopic and small surface tumors.
The first and most important stepThe goal is to remove all visible disease.This would leave microscopic and small surface tumors.
Approach to Patients with Peritoneal CarcinomatosisApproach to Patients with Peritoneal Carcinomatosis
Recommend Biopsy of nodules and peritoneal washingsNo need to resect primary unless perforatedNeoadjuvant chemo followed by cytoreductive surgery with HIPEC if possible
Recommend Biopsy of nodules and peritoneal washingsNo need to resect primary unless perforatedNeoadjuvant chemo followed by cytoreductive surgery with HIPEC if possible
Retroperitoneal SarcomaRetroperitoneal Sarcoma
Usually grow to a large size before presentationRequire multivisceral resection to remove completelyHigh recurrence rate
Usually grow to a large size before presentationRequire multivisceral resection to remove completelyHigh recurrence rate
Treatment OptionsTreatment Options
Neoadjuvant radiation followed by resection
Bowel and other structures protected by tumorDifficult to focus on margin
Resection followed by radiationBowel exposed to radiation which limits dose
Neoadjuvant radiation followed by resection
Bowel and other structures protected by tumorDifficult to focus on margin
Resection followed by radiationBowel exposed to radiation which limits dose
Resection with periop radiationResection with periop radiation
Tumor resectedBowel packed awayCatheters placed at margin and radiation administered over next 36hoursComplete treatment achieved during one hospitalization
Tumor resectedBowel packed awayCatheters placed at margin and radiation administered over next 36hoursComplete treatment achieved during one hospitalization
Case reportCase report
60 year old with abdominal fullness and vague pain
60 year old with abdominal fullness and vague pain
Surgical ResectionSurgical Resection
ColectomyNephrectomyCholecystectomyPlacement of Catheters
ColectomyNephrectomyCholecystectomyPlacement of Catheters
ResultResult
RoboticsRobotics
Robotic Liver ResectionRobotic Liver Resection
Pancreatic SurgeryPancreatic Surgery
Biliary DissectionBiliary Dissection
55 Year old female with abdominal pain. Found to have choledochol cyst during routine IOC.
55 Year old female with abdominal pain. Found to have choledochol cyst during routine IOC.