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, Benjamin Golas, MD, spoke about the current treatment landscape for patients with peritoneal carcinomatosis, discussing how the use of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) may offer improvements in clinical outcomes.

Golas is the chief of Surgical Oncology of the Central Region for Hackensack Meridian Health.

According to Golas, standard therapeutic approaches include combining cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), which may cause collateral damage to healthy tissue while eliciting toxicities such as nausea, vomiting, and bone marrow suppression. Additionally, certain surgical procedures may last up to 14 hours and confer an extensive morbidity profile, thereby increasing complication rates.

Golas described how PIPAC, a minimally invasive laparoscopic technique, may help avoid pain and other adverse effects associated with surgery while facilitating more direct delivery of chemotherapy in the peritoneal cavity. He noted that treatment with PIPAC typically takes 45 minutes to an hour, allowing some patients to return home on the same day of the procedure.

Although clinicians are still learning the correct indications for PIPAC, Golas stated that any patient with peritoneal carcinomatosis should be a candidate to receive treatment with this strategy. Furthermore, he described how the next steps for improving outcomes in this population include finding new ways to incorporate PIPAC into more extensive treatment plans for patients.

“PIPAC is a new treatment and a new potential option that doesn't replace systemic chemotherapy, but I do think it can work in conjunction with systemic chemotherapy. We can offer this bimodal approach where we're directly treating the peritoneal disease and offering [intravenous] chemotherapy,” Golas stated. “We clearly have a long way to go in terms of clinical trials and learning what the best ways are to use this. But there are patients out there who will benefit from that, so I think referral to a center that focuses and has expertise in PIPAC for patients with peritoneal carcinomatosis is critical.”

Benjamin Golas, MD, discusses how the use of PIPAC may work in conjunction with systemic chemotherapy for those with peritoneal carcinomatosis.

Harnessing PIPAC to Improve Outcomes in Peritoneal Carcinomatosis

 visited Sibley Memorial Hospital of Johns Hopkins Medicine to speak with a variety of experts about therapeutic advancements and ongoing research initiatives across several different cancer fields. As part of each discussion, clinicians highlighted how collaboration across different departments has positively affected treatment planning, decision-making, and outcomes at their institution.

Rachit Kumar, MD, an assistant professor of radiation oncology and molecular radiation sciences at Johns Hopkins School of Medicine and a radiation oncologist specializing in genitourinary and gastrointestinal cancers at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center for Sibley Memorial Hospital and Suburban Hospital;

Michael J. Pishvaian, MD, PhD, director of gastrointestinal, developmental therapeutics, and clinical research programs and associate professor of oncology at Johns Hopkins School of Medicine;

Nina Wagner-Johnston, MD, a professor of oncology and the director of lymphoma drug development at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, director of Hematologic Malignancies National Capital Region, and codirector of clinical research for hematologic malignancies;

Valerie Lee, MD, an assistant professor of oncology at Johns Hopkins University School of Medicine and a medical oncologist at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital;

Armine Smith, MD, the director of urologic oncology at the Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital and an assistant clinical professor of urology at the Brady Urological Institute of Johns Hopkins University School of Medicine;

Pouneh Razavi, MD, the director for breast imaging in the National Capital Region and an instructor in radiology and radiological science; and

Curtiland Deville Jr, MD, medical director of the Johns Hopkins Proton Therapy Center and clinical director of radiation oncology at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital.

Altogether, their insights demonstrated how multidisciplinary teamwork has improved outcomes ranging from patient survival to health care resource utilization across a wide range of diseases, including breast cancer, gastrointestinal cancer, genitourinary cancer, and hematologic malignancies.

Experts from Sibley Memorial Hospital discuss how multidisciplinary work has enhanced outcomes such as survival and resource use at their institution.

Elevating the Quality of Cancer Care via Cross-Department Collaboration

, Leticia Nogueira, PhD, MPH, highlighted the 

findings and implications of a study she published

 that evaluated how exposure to wildfires affected post-operative length of stay (LOS) among patients who were recovering from surgery for non–small cell lung cancer (NSCLC). Data from this study showed that patients who underwent curative-intent surgery at facilities exposed to a wildfire disaster experienced a longer LOS compared with similar patients who received treatment during times when no disasters occurred.

Journal of the National Cancer Institute, 

the LOS was 7.45 days (SE, 0.22) for patients treated at facilities without wildfire exposure vs 9.42 days (SE, 0.25) among those who underwent surgery at facilities with exposure (

 <.0001). Sensitivity analyses showed no significant difference for in-hospital mortality among patients with (10.5%) or without wildfire exposure (10.8%; 

According to Nogueira, scientific director of Health Services Research at the American Cancer Society, future research may further assess whether a longer LOS may impact survival among this patient population. Additionally, other efforts may focus on determining strategies for protecting the health and safety of patients during a climate disaster.

Describing an “inescapability” of climate or environmental hazards across all populations, Nogueira emphasized the importance of collaboration among different medical and research institutions to improve disaster preparedness and mitigation strategies. These shared efforts may reduce the impact of wildfires and similar climate hazards across treatment facilities and patient populations.

“We know that disasters are becoming more common. We know that their frequency, their intensity, and their behavior continue to change. The only way that we can figure out what’s going to work and what’s going to improve quality of care and patient outcomes is knowledge,” Nogueira stated. “Prioritizing this type of research and understanding that all of us are a patient at some point, that we are all eventually vulnerable, [is important].”

Nogueira LM, Yabroff KR, Yates E, Shultz JM, Valdez RB, Nori-Sarma A. Facility exposure to wildfire disasters and hospital length of stay following lung cancer surgery. 

. Published online March 11, 2025. doi:10.1093/jnci/djaf040

The “inescapability” of climate hazards may necessitate prioritization of research to improve outcomes among vulnerable populations who require treatment.

Improving NSCLC Surgery Recovery After Climate Disaster Exposure

Through elaborate multidisciplinary collaboration, institutions with National Accreditation Program for Rectal Cancer (NAPRC) standards can deliver a “high level of care” in the surgical treatment of patients with rectal cancer, according to Steven Wexner, MD, PhD, and Arielle Kanters, MD.

, Wexner and Kanters detailed the history and advancement of the NAPRC as an interdisciplinary initiative to improve the outcomes of those undergoing surgery for rectal cancer.

Wexner is the chair in the Department of Colorectal Surgery and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic, Florida, the founding chair of the NAPRC for the American College of Surgeons Commission on Cancer, and part of the executive committee of the Commission on Cancer. Kanters is a colorectal surgeon, associate fellowship program director, and surgeon leader of the NAPRC program at Cleveland Clinic Main Campus.

Wexner spoke about the inspiration for developing the NAPRC as a mission to elevate the level of surgical outcomes in patients with rectal cancer across the United States to those he observed in European countries such as the United Kingdom and Scandinavia. He enlisted leaders from organizations including the Society of Surgical Oncology and the College of American Pathologists to outline and apply appropriate standards for surgical care in rectal cancer.

Additionally, Kanters highlighted how enforcing precise guidelines and compliance measures through the NAPRC program facilitates multidisciplinary efforts with colleagues who specialize in radiology and pathology. She stated that these principles help individuals develop their skills across each department, thereby maintaining a high level of treatment for patients with rectal cancer.

Journal of the American College of Surgeons

indicated that mortality and complication rates appeared to be lower for patients who received surgery for rectal cancer at NAPRC-accredited institutions compared with those who were treated at non-accredited practices.

Wexner and Kanters also discussed how potential advancements related to the use of neoadjuvant or adjuvant therapy may further improve patient outcomes in the field. Additionally, they spoke about updated research on immunotherapy and other modalities that they anticipate at the 

2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. 

. Published March 28, 2024. doi:10.1097/XCS.0000000000001064

Surgical oncologists from Cleveland Clinic discuss the National Accreditation Program for Rectal Cancer and its aim to improve patient outcomes.

Ensuring Quality Rectal Cancer Surgery at NAPRC-Accredited Institutions

 at John Theurer Cancer Center, Gregory Charak, MD, highlighted advancements in surgical treatment strategies for patients with colorectal cancer (CRC) as well as other ongoing challenges in the field.

Specifically, Charak, a board-certified colorectal surgeon at Palisades Medical Center and Hackensack University Medical Center of Hackensack Meridian Health, described how minimally invasive strategies such as laparoscopic and robotic surgery have become more prevalent in the field, which have appeared to confer improvements in pain and length of hospital stay for patients. Although these minimally invasive techniques are typically preferred in this population compared with open surgery, Charak stated that he would still employ the latter depending on factors such as tumor size.

Charak also discussed the rise in CRC incidence among younger populations, which has impacted how practices conduct screening. He highlighted that patients who are in their late 20s or 30s receive recommendations to undergo colonoscopy in the event of weight changes or blood appearing in their stool, noting that he would not hesitate to perform screening even if there’s a small but real possibility of disease.

Regarding other treatment modalities in this population, Charak emphasized the potential benefits of neoadjuvant therapy. Administering neoadjuvant treatment with agents including cytotoxic chemotherapy and immunotherapy, for example, may help achieve negative-margin resections, thereby yielding less morbidity for patients.

“It’s a very exciting time to be a surgical oncologist. [There are] tremendous new treatment modalities coming down the pike. Immunotherapy, in particular, is extremely exciting because it’s such an elegant way to treat cancer: to harness and augment the body’s own defense system to eliminate a cancer rather than using cytotoxic chemicals or invasive surgery,” Charak said. “It’s a beautiful thing. If we can get it to apply to more and more tumors and figure out how to make it work, it couldn’t be more exciting.”

Modern Surgical Oncology Shifts in Colorectal Cancer Practice

Gregory Charak, MD, discusses how modalities like laparoscopic surgery and neoadjuvant immunotherapy may benefit patients with colorectal cancer.

Leveraging Surgical Oncology Advances in Colorectal Cancer Care

 at John Theurer Cancer Center, Timothy Chen, MD, highlighted various novel treatment strategies that have impacted his care of patients with brain tumors and other types of cancer.

Chen, a board-certified radiation oncologist and medical director of the Central Nervous System Program at Jersey Shore University Medical Center and the director of Proton Therapy in the Department of Radiation Oncology at Hackensack Meridian Health, first discussed his use of the novel stereotactic radiosurgery modality ZAP-X for patients with brain tumors. According to Chen, this tool may allow for practices to administer radiation at submillimeter precision, which can spare normal tissue from receiving excess radiation.

Another technology that Chen highlighted included GammaTile, a radiation treatment that was developed for the management of brain tumors. He said that this collagen tile may help with administering strong radiation to precisely where the tumor is located, while also protecting healthy tissues to minimize the adverse effects from radiation therapy. Specifically, Chen stated that GammaTile may be beneficial for those with larger, difficult-to-treat tumors.

Finally, Chen discussed the potential applications of proton therapy and how it may improve outcomes in patients compared with standard radiotherapy. According to Chen, proton therapy serves a “great purpose” with what he described as a precise depth charge that can minimize toxicity during treatment.

Additionally, Chen described how proton therapy may help reduce the probability of developing mutations or secondary cancers among pediatric patients. He highlighted the potential benefit of this modality based on a specific case in which a pediatric patient with myxopapillary ependymoma experienced improvements in pain and urinary control following proton therapy.

Regarding these novel forms of therapy, Chen emphasized the notion of multidisciplinary care and said that practices should “work together as a team” when operating these technologies.

“[With] all this technology, it's not just used as it is; the technology brings us to work together,” Chen said. “I think multidisciplinary care is the future. People are no longer siloed…. We all work together.”

Timothy Chen, MD, highlights how technologies such as ZAP-X and proton therapy may improve outcomes for patients with cancer.


Applying Novel Radiotherapy Technology for Brain Tumors and Other Cancers

The robotic-assisted biopsy platform Ion is a “game-changer” for patients with lung cancer, as it provides a quicker, less invasive surgical method for conducting a lung biopsy, according to Richard Lazzaro, MD.

, Lazzaro, the chief of Thoracic Surgery at the Southern Region of RWJBarnabas Health, spoke about his experience with adopting the Ion robotic bronchoscopy platform for the early detection of lung cancer at Monmouth Medical Center. He highlighted how the tool may enable practices to acquire tissue and perform disease staging with fewer complications, which may particularly benefit those who plan to undergo induction chemotherapy or immunotherapy.

In terms of other potential advancements in the lung cancer surgery field, Lazzaro discussed how he anticipates the use of video-assisted thoracoscopic (VATS) surgery to evolve. Specifically, he mentioned the development of technologies such as augmented reality as tools that may help minimize the variability of surgical procedures.

Regarding his practice, Lazzaro highlighted how a multidisciplinary thoracic tumor board—including medical oncologists, radiologists, pathologists, and pulmonary physicians, among others—has helped in producing long-term survival improvements. He emphasized collective discussions and shared decision-making as part of determining appropriate courses of care for his patients. When it comes to a multidisciplinary approach, Lazzaro stated that “you want to take care of patients” like they were part of “your family.”

Overall, Lazzaro noted how the lung cancer treatment landscape has changed over time. He emphasized referring patients for CT scans as well as evaluations at nodule or thoracic oncology clinics as part of a multidisciplinary strategy.

“The management of lung cancer is different than it was even 5 years ago. If we can detect lung cancer early, we have options for treating patients today that we never had before,” Lazzaro said. “This is the time where we really need to make a huge difference in lung cancer.”

Latest most advanced treatments for lung cancer now available at Monmouth Medical Center. News release. RWJBarnabas Health. January 22, 2024. Accessed April 17, 2024. https://tinyurl.com/ty8st3hm

Richard Lazzaro, MD, discusses how a robot-assisted platform has impacted his thoracic surgery and highlights other potential advancements in the field.

Moving The Needle in Lung Cancer Management With Robotic-Assisted Surgery

2024 Society of Surgical Oncology Annual Meeting (SSO), 

 spoke with a variety of surgical oncology experts regarding the topline data they presented. Each conversation also expanded upon how these results can be implemented into the clinical space and the next research steps.

, a complex general surgical oncology fellow at Moffitt Cancer Center, discussed findings from her presentation highlighting responses to neoadjuvant immune checkpoint inhibitors among select patients with mismatch repair deficient (dMMR) gastroesophageal cancer.

Looking ahead, Shannon described her aim to optimize treatment strategies for this patient population, which may include assessing whether single-agent treatment can be efficacious while avoiding toxicity associated with combination regimens.

, an associate member in the Gastrointestinal Department, section leader for Peritoneal Disease, and the program director for the Complex General Surgical Oncology Fellowship at Moffitt Cancer Center, spoke about his session, which was aimed at determining appropriate conditions for using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for those with colorectal cancer (CRC) and peritoneal metastases.

Dineen highlighted that there is “good evidence” in support of HIPEC as a “valid treatment option” and emphasized the need to encourage medical oncologists to refer patients for consideration of surgery. Additionally, he spoke about other advancements he hopes to see in this patient population, including the development of markers of various disease volumes that can help identify potential recurrence in those who receive surgery.

, a research fellow in the Department of Surgical Oncology at City of Hope National Medical Center in Duarte, California, detailed findings from a retrospective analysis indicating disparate treatment access and cancer-related mortality based on racial-economic segregation.

Specifically, data showed that those who lived in Black and poor majority areas were less likely to receive care that was in accordance with various treatment guidelines while having worse overall survival outcomes. Regarding the next steps, Waheed described his intentions of sharing his findings with policymakers who may create legislature intended to mitigate the disparities observed in the analysis.

Shannon AB, Mehta RJ, Mok SR, et al. Pathologic response to neoadjuvant immunotherapy in DNA mismatch repair protein-deficient gastroesophageal cancers. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. Abstract 94.

Dineen S. Optimal tumor burden for CRS/HIPEC in colorectal cancer. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA.

Waheed MT, Sullivan KM, Haye S, et al. Impact of racialized residential segregation on guideline concordant cancer care and survival. Presented at the Society of Surgical Oncology (SSO) 2024 Annual Meeting; March 20 – 23, 2024; Atlanta, GA; abstract E126.

Experts discuss findings related to gastrointestinal cancer outcomes as well as treatment inequalities presented at the 2024 SSO Annual Meeting.

Surgeons Talk Key Treatment and Institutional Advances Across Oncology Care

Rian M. Hasson Charles, MD, MPH, FACS, spoke about her career in thoracic surgery

 and her visions for increasing equitable care in the field as part of a new, first-of-its-kind role at Brigham and Women’s Hospital. She will serve as the inaugural vice chair for Diversity, Equity, and Inclusion (DEI) in the Department of Surgery as well as an associate surgeon in the Division of Thoracic Surgery.

Hasson contextualized the acceptance of her new role by highlighting her previous experiences in lung cancer surgery, which included pursuing a psychology major at University of California, Berkeley and working as an attending physician at Dartmouth Hitchcock Hospital. At Dartmouth, she formed a DEI program for the public health school and pursued initiatives designed to spread access to care for patients with lung cancer.

As part of her new role at Brigham and Women’s Hospital, Hasson aims to reduce significant disparities in care across areas surrounding the academic center, grow a diverse workforce, and form connections with members in the community.

Hasson also described some of the barriers she experienced and overcame as a woman in oncology. She offered advice to other aspiring surgeons in the field, emphasizing the importance of paying attention to the family, friends, and partners who can support them during their journey.

“The world is your oyster. This position is a dream position for me because it’s bringing together everything that I love to do,” Hasson said.

“I encourage people to find their focus, find their passion, find the thing that keeps them up at night or that wakes them up in the morning. You can do whatever you set your mind to. With today’s resources, there should be nothing that limits you. There may be things that seem like they’re discouraging, but you have the power to overcome those and collaborate with people that will help generate success,” she added.

Rian M. Hasson Charles, MD, MPH, FACS, discusses advances in equitable lung cancer screening and her experiences as a woman in thoracic oncology.

Achieving Health Equity in Lung Cancer Surgery

Starting April 1, 2024, Diane M. Simeone, MD will start her new position as director of the University of California San Diego (UCSD) Health Moores Cancer Center.

, Simeone highlighted her excitement to be working with an institution that she said aligns with her goals and values. During her time as director, she said that she wants to focus more on early detection of pancreatic cancer, which may help save many patients. Additionally, some of her short- and long-term goals include submitting a Cancer Center Support Grant to the National Institutes of Health and expanding clinical trial efforts at UCSD. She also discussed ongoing projects she will aim to work on, such as the UC Pancreatic Cancer (UCPCC) Consortium and the Pancreatic Cancer Early Detection (PRECEDE) Consortium.

Prior to beginning her new position at UCSD, Simeone has been the Laura and Isaac Perlmutter Professor of Surgery, director of the Pancreatic Cancer Center, and the associate director of translational research at Perlmutter Cancer Center at New York University Langone Health. Additionally, she was previously the chair of the scientific and medical advisory board of the Pancreatic Cancer Action Network and a member of the scientific advisory board for the Let’s Win Pancreatic Cancer online community.

“It was clear that everybody is aligned with this mission and understands the importance of how we care for patients with cancer and do research at the cancer center,” Simeone said during the interview. “There seems to be a clear commonality of thinking on their vision of being at the forefront of advancing science and, most importantly, how we apply to take care of patients. Patients are always the driving force. That's always the center of what we need to be thinking about.”

World-renowned surgeon named new director of Moores Cancer Center at UC San Diego Health. News release. University of California San Diego. January 8, 2024. Accessed January 25, 2024. http://tinyurl.com/4986f4cb

UC Pancreatic Cancer Consortium. University of California Health. Accessed January 25, 2024. http://tinyurl.com/3szdvyxv

PanCAN’s Precision Promise adaptive clinical trial platform –. Pancreatic Cancer Action Network. Published April 27, 2016. Accessed January 25, 2024. http://tinyurl.com/fpax5hhd

Diane M. Simeone, MD highlights the importance of multidisciplinary care, surgical practices, and early detection in pancreatic cancer care. 

Surgery

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