Pancreatic Tumors and Cancer: How Modern Surgery Can Make a Big Difference | Prof. Alexis Ulrich

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00:00:35: Nowadays, anyone who is in need of a surgical procedure Is not operated on by just any surgeon But by highly trained specialists In their own specific surgical fields.

00:00:46: Professor Alexis Ulrich is the chief physician Of The clinic for general and visceral surgery At the Lucas Crankenhaus Of the Rhineland Clinicum Nois.

00:00:55: He specializes in oncological surgery And is therefore also responsible For pancreatic cancer.

00:01:02: Professor Ulrich I think we both know that survival rates for pancreatic cancer are, unfortunately generally not very good at all.

00:01:11: So if i may let me ask you quite directly in your professional opinion can surgery actually make a significant difference?

00:01:24: Surgery, in particular can make a difference.

00:01:26: The prognosis for pancreatic cancer is so poor because eighty percent of patients can no longer be operated on at the time of diagnosis as the tumor is too advanced and For those patients in particular who can undergo surgery there Is even a chance of a cure?

00:01:42: Of course we cannot promise a cure to everyone but that is not what one would call A miracle.

00:01:47: rather There are many.

00:01:49: We Can help And above all we can gain a great deal of Time.

00:01:54: As you mentioned, pancreatic cancer is unfortunately often detected late in many patients.

00:02:01: What criteria must be met for you to be able to operate on a pancreatate carcinoma?

00:02:08: First of all it's essential that the tumour has not spread.

00:02:11: You may have heard that tumours can also form secondary growths in your body.

00:02:16: These are commonly referred as metastases.

00:02:20: This means there are metastasis or the lungs, and then it is no longer a local disease but a systemic one.

00:02:30: Surgery is generally only able to treat.

00:02:43: Furthermore, there are several major blood vessels that run in very close proximity to the pancreas and if these structures are involved it can often mean a tumor is initially considered inoperable.

00:02:57: These vital vessel supply for example liver or digestive organs including small intestine and various parts of large intestine.

00:03:07: The pancreas is somewhat hidden in the abdominal cavity behind the stomach between the spleen and duodenum.

00:03:16: You just mentioned blood vessels, isn't it difficult to reach it surgically?

00:03:21: You are absolutely correct about that!

00:03:24: When you look inside human abdomen simply do not see the pancrease.

00:03:30: therefore we must carefully dissect surrounding structures holding them aside.

00:03:37: However, as experienced surgeons we have specific routes to reach that area quickly.

00:03:44: Do you actually have to remove the entire pancreas when dealing with a case of pancreatic cancer which does have a vital function after all or can you just remove specific parts from your organ?

00:03:56: Well it depends entirely on where the tumour is located.

00:03:59: if the tumours are in head of the pancrease its usually sufficient for removing the head along with duodenum.

00:04:07: If it is located in the area of the pancreatic tail, meaning more on the left side of the body.

00:04:13: It may well be sufficient to remove only the tail and preserve the head.

00:04:18: However if the tumour is located at the middle of a pancreas that can also happen.

00:04:27: In what specific clinical scenarios would you choose to perform a robotic assisted surgical procedure for patient with Pancreatic Cancer?

00:04:36: It is important to understand that not every tumor is suitable for robot-assisted surgical procedures.

00:04:42: For left sided tumors, meaning those in the body or tail of the pancreas it's generally no problem at all and can be performed very well using a robot with tumours on head of the pankreus always depends how extensive they are.

00:05:04: It is said that approximately twenty to twenty-five percent of tumors in the head of the pancreas can generally also be removed using a robot.

00:05:14: What are the primary advantages of being able to perform robotically assisted surgical procedures for patients diagnosed with pancreatic cancer?

00:05:24: The advantages are, we can perform this in minimally invasive way.

00:05:28: This means only need small incisions at least for preparation.

00:05:31: Of course We have remove the specimen and tissue which was removed through a slightly larger incision afterwards, but that can be positioned so it is virtually invisible to the patient.

00:05:42: Generally speaking however when we utilize minimally invasive surgical procedures patients are able get back on their feet much faster than before.

00:05:50: this effectively means periods of post-operative pain are significantly shorter you're ready start moving around sooner and essential bodily functions like bowel movements return to normal more quickly.

00:06:04: As you were pointing out just a moment ago in certain clinical scenarios for instance, when dealing with metastases systemic therapy is often the more logical approach.

00:06:14: Would chemotherapy also be considered medically advisable option either prior to or following a surgical procedure?

00:06:22: That varies from person-to-person.

00:06:24: so If the tumor is very large, specifically locally advanced meaning it reaches the arteries those major blood vessels then It makes perfect sense to pre-treat The patient to potentially shrink the tumor with chemotherapy in order To have better options for surgical removal.

00:06:43: Basically For almost all malignant pancreatic diseases that Have been operated on at the very least as a follow up measure we still recommend That you undergo chemotherapy.

00:06:54: Typically, this begins six to eight weeks after surgery and the chemotherapy treatment lasts for six months.

00:07:03: The aim is at least minimize risk of tumor recurring particularly in the form secondary tumors such as metastases or peritoneum.

00:07:16: How taxing is that combination?

00:07:19: I mean, first chemotherapy then surgery or perhaps first surgery followed by another long round of chemotherapy.

00:07:27: What is the quality of life like afterwards?

00:07:30: It goes without saying that the surgery depending on specific cases quite taxing especially when it involves head-of-the-pancreas.

00:07:36: after all its considered a major and highly complex abdominal procedure.

00:07:40: nevertheless patients recover very well within few weeks.

00:07:46: we also operate in patients who are over eighty years old because many people think that perhaps it can only be done up to a certain age.

00:07:54: No, that is not the case!

00:07:56: It's really more about overall condition than chronological age.

00:08:00: so biological age is more important.

00:08:03: then chronological Chemotherapy, of course also has its side effects.

00:08:09: There are different types of chemotherapy to choose from.

00:08:12: there Are very aggressive chemotherapies which naturally offer a better chance Of success and they're less aggressive forms.

00:08:20: this depends heavily on the patient's age And overall condition and must be discussed with them On a highly individual basis.

00:08:30: however The patients quality of life is restored To a good level afterwards And there is a specific reason for performing this surgery or combination of treatments.

00:08:39: The goal is to gain life expectancy and, if at all possible... ...to be cured!

00:08:44: If you were not suffering from this condition You obviously would NOT choose to undergo such procedure.

00:08:50: However even with that in mind when we follow up the patients later on.. ..the vast majority of those individuals will certainly opt through this same process once more.

00:08:59: How safe is medical procedure?

00:09:03: and what are the specific risks or various potential complications that might be involved?

00:09:09: I already mentioned, it is one of most major procedures especially when removing head of pancreas.

00:09:15: The main risk, actually is that the connection between the pancreas and the intestine fails to heal properly.

00:09:22: We have to reattach this small intestine into the pancreates so that secretions from remaining part of the pancreatis can flow back in to the intestine And we need these secretion for digestion.

00:09:37: This occurs about five percent cases at least major medical centers.

00:09:42: In this regard it also depends quite a bit on the surgeon's level of expertise.

00:09:48: The more of these specific connections they have performed, the safer the entire procedure becomes Also when the left side of the pancreas is removed.

00:09:58: so-called pancreatic fistulas can occur because the head section is closed usually with surgical stapler and then secretions still leak out through the closed duct.

00:10:10: However, this is generally not very dangerous because the enzyme or rather the secretion... ...is NOT activated.

00:10:18: It's only activated upon contact with the intestine as we have it in connection between the pancreas and the intestine but not if we simply severed the pancreates blindly.

00:10:28: What are actual long-term implications for daily life?

00:10:32: And essential bodily functions of a human being?

00:10:35: If a surgeon were to remove a portion?

00:10:37: Of

00:10:41: course there are some adjustments you'll need to get used especially in the beginning.

00:10:46: You will want avoid sugary, very fatty and spicy foods And also take pancreatic enzymes for at least six months To give rest of your pancreas a bit break and help support digestion.

00:11:04: If you are already diabetic or borderline, it is of course possible that the diabetes will be exacerbated by the fact that parts of the tissue are being removed.

00:11:14: But if you weren't beforehand very few patients become diabetic afterwards So most people remain healthy in terms of their blood sugar levels?

00:11:25: If your entire pancreas must be surgically removed You will inevitably become diabetic and you will certainly be required to inject insulin daily while also adhering to a strict dietary regimen, to ensure that you do not consume an excessive amount of sugar at once.

00:11:40: Otherwise the quality of life for most patients is very good!

00:11:44: I'm sure many of you know patients without even realising it and don't notice these major procedures have been performed on them.

00:11:53: If cancer were back which would mean there's recurrence.

00:11:57: Would be feasible perform another surgical procedure in this situation or would it be more advisable to explore a completely different method of medical

00:12:24: treatment?

00:12:26: However, if it is very localized and easily accessible then in individual cases It may mean that surgery as a viable option.

00:12:35: however.

00:12:35: It must be clearly stated That the latter does not apply to most patients.

00:12:41: Thank you so very much professor Ulrich for sharing all of this information.

00:12:46: Yes thank You So Much.

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