InsideTract
November 22, 2016

Johns Hopkins pancreas surgeons performed 500-plus operations last year.

In the late 19th century, William Stewart Halsted pioneered early pancreatic surgeries at Johns Hopkins. Since then, the hospital has remained at the fore of the field of pancreas surgery, with today’s survival rates hovering near 99 percent.

Patients who need pancreatic surgery face many difficult decisions. The first and most important is where to have the surgery.

Recent studies have shown that the best option for an optimal outcome happens at a so-called high-volume center.

“There have been multiple studies showing that the higher the volume of pancreas operations an institution does, the better the patient outcomes,” says Matthew Weiss, surgical director of the Johns Hopkins Pancreatic Cancer Multidisciplinary Clinic. “And we do more pancreas operations here at Hopkins than anyone else in the country.”

Last year, Johns Hopkins surgeons performed more than 500 pancreatoduodenectomies, or Whipple procedures, which involve the removal of the head of the pancreas, along with the duodenum, part of the common bile duct and sometimes part of the stomach. Many of these operations were done robotically or laparoscopically.

“Our center is the only one in the country that does pancreas surgery laparoscopically, robotically and open,” Weiss says.

Surgical techniques and expertise have been handed down throughout the history of Johns Hopkins, beginning with Halsted to renowned innovator John Cameron to today’s team of surgeons.

“Dr. Cameron has done more Whipple operations than anyone in the world,” Weiss says. “And we all learned from him. Most of us now have moved on to minimally invasive, where there’s less pain and the patients get out of the hospital sooner.”

In the surgical suites, Weiss says there can be three or four other Whipple operations being done at the same time. “We’re all partners,” he says. “We can help each other if we see something unusual.”

But Weiss says the surgical outcomes are about more than just surgery.

“While we do have a great team of surgeons,” he says, “it’s so much more than that. Our nurses and our care team are the best around.”

Patients leave the operating room and spend a night in the intensive care unit, where, says Weiss, “the nurses have taken care of thousands of our pancreatic surgery patients. So they know if things aren’t quite right, and they know early. The nursing staff is great at early detection, since they’ve seen so many patients over the years.

“And then, God forbid, if there is a problem, we have an intern and we have an interventional radiologist who can fix problems with drains and things.”

In the Johns Hopkins Pancreatic Cancer Multidisciplinary Clinic, individual cases are also looked at by a surgeon, medical oncologist, radiation oncologist, radiologist, pain specialist—even a nutritionist.

“The beautiful thing about that clinic is that patients come in and their cancer is treated ‘multimode,’” says Weiss. “It’s not just surgery, it’s not just chemo, and it’s not just radiation. Most people need at least two of those treatments.”

Weiss believes Johns Hopkins provides better outcomes because its clinicians recognize problems sooner.

“We know how to intervene, and we have surgeons, intervention radiologists, nursing staff and gastroenterologists, all of whom have taken care of these problems so many times. Between that and our constant work to get better, things in our clinic run just like clockwork.”