Oncologic Surgery at Upstate Cancer Center: Advanced Approach, Healing Touch

By Jennifer Webster
Monday, October 30, 2017

The fellowship-trained surgeons at SUNY Upstate Medical University’s Cancer Center perform advanced procedures, offer clinical trials and embrace unparalleled cooperation with their colleagues. Their care for each patient as a whole person sets the program apart.

Professor and Chair of Radiation Oncology and Upstate Cancer Center Interim Director, Jeffrey Bogart, MD

Jeffrey Bogart, MD, Professor and Chair of Radiation Oncology, is Interim Director of Upstate Cancer Center. He is responsible for coordinating the many activities and relationships that structure care for the center’s patients.

If a referral for surgery is a patient’s first point of contact with the Upstate Cancer Center, he or she will be cared for by cancer-specialized surgeons in a true multidisciplinary environment, explains Dr. Bogart.

“This means every patient receives personalized and comprehensive care — from the most advanced surgical techniques, to cutting-edge imaging and molecular diagnostics, to state-of-the-art medical oncology and radiation oncology treatments, including the latest in clinical trials,” Dr. Bogart says. “It’s all delivered by a team that is dedicated to the patient’s specific type of cancer.”

Some of the experts from different fields who make up the Brain Tumor Research Group. From left are: (front row) Ed Rice, Lawrence Chin, MD, Mariano Viapiano, PhD, and Russell “Rick” Matthews, PhD; (second row) Robert Corona Jr., DO, Charles Danko, PhD; (third row) Malvina Prapa, PhD, Sharon Longo and Nandhu Mohan Sobhana, PhD; (fourth row) Prajna Behera, Lina Barrera Arenas, Ashis Sinha and Geoffrey Eill. Rice and Danko are from Cornell, while the rest are from Upstate Medical University.

Brain Trust

For more than a quarter of a century, the Brain Tumor Cell Bank at Upstate Medical University has maintained a collection of brain tumor samples. Recently, researchers from Upstate Medical University and Cornell University have formed the Brain Tumor Research Group to use this valuable resource to test new treatments for brain cancer.

“We perform leading-edge research into finding the causes of brain tumors,” says Lawrence Chin, MD, Chair of Neurosurgery and Robert B. and Molly G. King Endowed Professor of Neurosurgery at Upstate Medical University. “Using an advanced molecular diagnostic test, we analyze every brain tumor to understand its genetics. Our goal is to draw on that information to find the best treatment for each patient.”

A Strong Team

Lawrence Chin, MD, Chair of Neurosurgery and Robert B. and Molly G. King Endowed Professor of Neurosurgery at Upstate Medical University, presides over some of the most crucial, and perhaps most frightening, events his patients will ever experience — surgery to remove and diagnose their tumors or other lesions.

Lawrence Chin, MD, Chair of Neurosurgery

“For most patients, fears about brain surgery are unfounded. The majority of people do quite well after a brain tumor operation,” Dr. Chin says. “We perform surgery in the safest way possible, using the best equipment available, and we’re with patients every step of the way.”

The etiology and variety of brain lesions are numerous, and that variability is matched by the wide experience of Upstate Cancer Center’s neurosurgeons. The center’s large, highly skilled team and state-of-the-art equipment ensure that the Department of Neurosurgery has deep expertise to draw upon.

“For brain, pituitary and skull-base tumors, the experience and expertise of an academic medical center — including the experience of the ICU nurses, which is critical — creates an environment where brain tumors are best treated,” Dr. Chin says. “Here, there are always team members available, including pediatric and adult neurosurgeons, who are experts in dealing with brain tumors and whom I can consult with.”

Upstate Cancer Center is home to the only intraoperative MRI suite in upstate New York and is equipped to administer radiosurgery with the advanced Gamma Knife Perfexion system. The center also acquired a laser interstitial thermal therapy (LITT) system, which uses thermal energy to treat tumors, epilepsy and other conditions.

“Our experience in radiosurgery is unmatched in the region,” Dr. Chin says. “I have been performing radiosurgery for nearly 25 years, treating thousands of patients. Studies show that patient results are directly dependent on the experience of the surgeon as well as the volume of procedures at the medical center.”

Access to Clinical Trials

In addition to the depth of experience found at the academic medical center, Upstate Cancer Center offers unparalleled access to clinical trials, which can both benefit individual patients and further health care’s ongoing mission to defeat cancer.

Jason Wallen, MD, Chief of the Thoracic Surgery and Thoracic Oncology Program

Jason Wallen, MD, Chief of the Thoracic Surgery and Thoracic Oncology Program, helps ensure his program offers many such opportunities. Staff in the multidisciplinary center review the profiles of each patient, compare their situations against inclusion and exclusion criteria for trials, and make recommendations promptly for each person.

“Many patients with advanced cancer will qualify for immunotherapy,” Dr. Wallen says. “We also have a trial where we are creating a panel of surgery patients who may be eligible for immunotherapy in the future if their condition changes.”

Screenings, such as low-dose CT scans used to detect lung cancer, help qualify patients for clinical trials and connect them with leading-edge procedures earlier in the disease cycle.

“We are identifying more cancers at earlier stages in the screened population, shifting the curve from stage 3 and 4 to the more treatable and curable stages 1 and 2,” Dr. Wallen says. “I want as many patients as possible to have the option of surgery. At Upstate Cancer Center, we can perform most lung cancer procedures in a minimally invasive fashion, often using a robotic-assisted procedure. As we shift more patients to surgery, those patients will not require chemotherapy or immunotherapy.”

Personalized Care

Taking a patient-specific, patient-centered approach is vital to treatment at Upstate Cancer Center. This includes medicine tailored to the patient’s tumor and offering a wide range of treatment options to each patient.

Lisa Lai, MD, Assistant Professor of Surgery and Medical Director of the Breast Cancer Program

Lisa Lai, MD, Assistant Professor of Surgery and Medical Director of the Breast Cancer Program, is a fellowship-trained breast surgeon with a practice devoted exclusively to the treatment of breast disease. She guides each of her patients through the many choices available to women and men with breast cancer.

“We take many things into consideration — the breast cancer subtype and stage, the patient’s age and overall health, their family history of cancer and their treatment goals,” Dr. Lai says. “When appropriate, genetic testing is performed as the first step in an individualized care plan to help us understand if there is an inherited cause of the cancer.”

Working together in a multidisciplinary clinic, Dr. Lai and her colleagues prepare a range of treatment options for each patient. The tumor board is central to this process. During these gatherings, breast surgeons, medical oncologists, radiation oncologists, radiologists and pathologists review the patient’s diagnosis and collaborate on treatment options. Each treating physician then meets with the patient to discuss his or her recommendations. It can be a long visit for the patient and their family, but it is very helpful as both the patient and the medical team leave with a specific plan in mind.

“Breast cancer treatment has changed remarkably in the last few decades,” Dr. Lai says. “We have highly effective adjuvant therapies and can offer patients excellent aesthetic results, including breast reconstruction and nipple-sparing surgery. At Upstate Cancer Center, we also offer a wide range of clinical trials. These trials benefit the patient who participates as well as future patients by advancing cancer treatment even further. Many patients come to us for treatment so they can participate in one of our trials.

“There is quite the dichotomy when treating patients with cancer,” she explains. “We love our patients dearly but hate cancer so much. We are here to get them through it. There is a bell in the Cancer Center for patients to ring when treatment is complete. There is no greater sound to be heard.”

Listen and Respond

Brisk responsiveness is another hallmark of Upstate Cancer Center’s patient-centered approach. When a patient calls for an appointment or is referred, he or she is typically seen within a week after the initial contact, says Ajay Jain, MD, Chief of Surgical Oncology and Associate Chief of Hepatobiliary and Pancreatic Surgery at Upstate Cancer Center. Nurse navigators make scheduling especially efficient for patients.

Gail Brehm with her surgeon, Ajay Jain, MD, Chief of Surgical Oncology and Associate Chief of Hepatobiliary and Pancreatic Surgery at Upstate Cancer Center

“Our nurse navigators take the burden off patients,” Dr. Jain says. “We provide them and the patient’s referring physician with the treatment summary. The navigator knows what treatments, in what order, the patient should receive.”

At Upstate Cancer Center, a multidisciplinary approach helps address the many, varied nuances present in Dr. Jain’s specialty, which is surgery for liver, gallbladder and pancreatic cancer.

“Depending on how cancer presents, surgery may not be an option, or it may not be the right first option — we may need to shrink tumors with chemotherapy or radiation first,” Dr. Jain says. “Making these distinctions can be very challenging. We approach and manage each patient’s cancer as a team, working in tandem with referring physicians and always putting the patient first.”

Communication Is Key

Like his colleagues, Gennady Bratslavsky, MD, Professor and Chair of the Department of Urology at Upstate Medical Center, offers advanced procedures to remove cancer. He also performs necessary reconstruction afterward. Trained at the National Cancer Institute, Dr. Bratslavsky points out that he and most of his fellow urologic surgeons — the number has grown from two to more than 20 in the past six years — have completed specialized fellowships.

Gennady Bratslavsky, MD, Professor and Chair of the Department of Urology at Upstate Medical Center, speaks with a patient.

“We all provide groundbreaking and lifesaving surgeries using the most modern techniques, including robot-assisted surgery for patients with prostate, kidney, bladder and testis cancer, as well as adrenal tumors,” Dr. Bratslavsky says. “While robotic surgery may be available at other institutions, it is the specialized training, including fellowships with a focus on cancer and reconstructive surgery, that make the robotic surgery at Upstate Cancer Center extraordinary. Our additional training provides a deep understanding of the disease processes and knowledge of additional tricks that may be used intraoperatively. That, along with our multidisciplinary collaboration and our tumor boards across numerous subspecialties, improves patient outcomes and allows us to offer the highest level of care.”

As his department opens practices across central and upstate New York, Dr. Bratslavsky embraces a process for ample, near-instantaneous communication with referring providers. EMR is central to that process. The EMR system sends notes to the entire care team, including referring physicians, after each patient visit.

“Finally, we have a format known as ‘rich communications,’” Dr. Bratslavsky says. “When people are connected, it allows for maximal exchange of information.”

He says he is proud that members of his team serve on national research consortia and committees and are among the “leading scientific minds in their field.” This, he says, provides deeply personalized expert care to patients that, along with near-instantaneous communication to colleagues and referring physicians, allows patients to reap the benefits as cancer care continues to progress.

To learn more, visit upstate.edu/cancer.