When surgeons from the Netherlands needed help establishing a national program for patients with hard-to-treat pancreatic cancer, they knew just whom to turn to: Marco Del Chiaro, MD, PhD, professor and division chief of surgical oncology in the University of Colorado Department of Surgery.
“I've become pretty well-known internationally as one of the few surgeons doing a very specialized operation for locally advanced pancreatic cancer, which is a tumor of the pancreas that extends into the big blood vessel around the pancreas,” says Del Chiaro, professor of surgery in the CU School of Medicine and member of the CU Cancer Center. “They generally are considered not suitable for surgical resection, but we have observed that, in selected patients, when those tumors are resected, the outcome is very similar to that of removing a ‘normal’ tumor of the pancreas. The only real problem is technical — the ability to resect the blood vessel.”
International expert
As a renowned expert for this type of surgery (known as a pancreaticoduodenectomy, or Whipple procedure), Del Chiaro was one of four international experts approached by the Dutch Pancreatic Cancer Group to lend his expertise to the national implementation program called PREOPANC-4, giving new hope to patients with locally advanced pancreatic cancer in the Netherlands. Del Chiaro has been meeting remotely with the Dutch surgeons over the past two and a half years, training them virtually in the delicate oncological and surgical care.
“We are proud to be one of very few centers around the world that have advanced capabilities in removing pancreatic cancers from patients that have few other options for potential cure,” says Richard Schulick, MD, MBA, chair of the Department of Surgery and director of the CU Cancer Center.
In January, two representatives from the Netherlands program — PhD candidate Thomas Stoop and surgeon Joris Erdmann — came to the CU Anschutz Medical Campus to meet Del Chiaro in person, sit in on an operation, and get hands-on training in the pancreatic cancer surgery.
“Over the past decade or so, in the Netherlands, we were a little bit reluctant to operate on patients with locally advanced pancreatic cancer, because at that time, the risks were higher than the benefits,” says Stoop, who will remain in the Department of Surgery as a visiting research fellow for the next 12 months. “But around 2010, there started to be some new therapies on the market that worked better. And there were international experts, including Dr. Del Chiaro, who showed that when you select your patients very carefully and give them the right chemotherapy, then a substantial group of patients can be resected. You can give them the opportunity for long-term survival.”
The importance of patient selection
In addition to showing them how to perform the operation, Stoop says, Del Chiaro also is teaching medical specialists from the Dutch Pancreatic Cancer Group how to identify patients who are best qualified for successful resection.
“We know, thanks to Dr. Del Chiaro, that radiological imaging is not reliable after treatment with chemotherapy,” Stoop says. “You have to select much more on biology, on tumor markers in the blood, even when there is still a lot of vascular involvement on the scan. We also learned that you have to select on conditional status — if a patient improved during the chemotherapy. It's a complex interaction of a lot of factors. A process of longitudinal shared decision-making and counseling of patients is very important.”
Though he had already trained with Del Chiaro virtually, Erdmann says the chance to work with the CU surgeon in person was invaluable, likening the experience to that of a chef visiting an acclaimed restaurant in another city.
“If you're a cook and you visit someone else's kitchen, it's not that you’re learning how to cook, because you know how to cook,” Erdmann says. “But you see the small differences, and that makes you think, ‘Why are they doing it like this?’ Maybe there is a better solution for the problem than what we do. So that's really nice. This is very exceptional surgery, and it's not available in most countries or most cities around the world.”
Worldwide example
Erdmann and other members of the Dutch team will visit other international pancreatic surgery experts over the coming year, Stoop says, “all with the aim to improve the care for locally advanced pancreatic cancer not only in the Netherlands, but around the world in the long term. I hope that we can function as an example of how you can improve the care for this very complex group of patients on a national level.”
Del Chiaro, who says is he learning just as much as he is teaching during his webinars with the Dutch surgeons, says it is rare for a country to create a national program to address a condition such as locally advanced pancreatic cancer, and he is excited to see the CU Department of Surgery represented as one of the international authorities on treating locally advanced pancreatic cancer.
“Being identified as one of the four centers in the world leading this kind of surgery is a great honor,” he says. “This is proof of the University of Colorado’s international reputation for treatment of pancreas cancer, especially for locally advanced pancreatic cancer, which still remains untreated in too many places still in the United States and across the world.”
Photo, from left: Richard Schulick, MD, MBA; Thomas Stoop; Joris Erdmann; Ana Gleisner, MD, PhD; Marco Del Chiaro, MD, PhD.
