A world leader in
robot-assisted surgery (RAS), Roswell Park has treated more than 6,600 patients with this technique since 2004. RAS has led to shorter hospital stays, faster recovery and reduced pain for patients with many types of cancer: bladder, colorectal, gynecologic, head and neck, kidney and prostate. And it is routinely used for esophageal, stomach, and pancreatic cancer surgery. Now, thanks to the pioneering work of Moshim Kukar, MD, FACS, Department of Surgical Oncology , and his Roswell Park team, RAS is also the standard of care for eligible patients with gastroesophageal junction cancers. Roswell Park surgeons have performed more than 100 such procedures—one of the largest volumes at a U.S. center—and Dr. Kukar and his colleagues are helping advance the procedure regionally and nationally. gastroesophageal junction cancers are on the rise and are difficult to treat utilizing a multidisciplinary team approach and robotic approaches to self inject me and gastrectomy, we can improve patient outcomes. Hi, I'm marshall cu car. I'm the associate professor of oncology in the Department of surgical oncology and also the program director for the complex General surgical Oncology fellowship here at Roswell Park. My expertise is in treating esophageal gastric and pancreatic cancer utilizing minimally invasive and robotic approaches. So gastroesophageal junction cancers uh you know, a the incidence is on the rise just given the lifestyle increasing obesity. Secondly, it's extremely important because the gastroesophageal junction cancers are divided into three subtypes based on where they start, you know, so they could start in the esophagus, go down to the gastroesophageal junction or could just originate within the gastroesophageal junction nor start in the stomach and go up into the gastroesophageal junction. And I think that is critical before we embark on any any treatment process because these tumors, although sort of similar locations are treated differently based on what the origin of the tumor is. So at Roswell we have a unique multidisciplinary team care approach to these cancers. Uh you know, any anybody that walks through the door, We discuss them in a multidisciplinary tumor board where we look at their pathology review, the imaging review, the staging process uh and then embark on a more sort of an individualized treatment plan for for these patients. What we do here at Roswell is that we treat these tumors using a robotic assisted approach, often Asaf ejecta me or a gastrectomy. Some of the advantages using the robotic approaches, it's a stable platform, the precise uh suturing that you can do with this platform and also utilizing some of the more nuanced technology with the robotic platform. And just example of that is is what is called the firefly where you can actually look at the profusion of the stomach after you made a tube out of that stomach that you're gonna be utilizing to create the connection. So you can determine exactly how much of that tube is perf used and where the blood supply cuts off and and where you cannot use that portion of the stomach. What's unique to what we do is the systematic technique where we create the connection between the esophagus and the stomach. And traditionally this connection has been done in sort of an end to end fashion with a circular stapler, which gives you a diameter of 25 millimeters at the end. What we do here and what we've done even in the past is is utilizing a site to site stapled anastomosis. So that gives you a wide six centimeter anastomosis. And we published our own results with this, one of the largest series nationally, uh, utilizing the site to site six centimeter anastomosis, which shows A leak rate, which is less than 5% and also a stricture rate, which is about 5%,, which leads to, you know, faster recovery for these people. We've been performing these operations for for almost 10 years now. Uh, and I think over the span of time we've accumulated a wealth of experience. As you know, these are very complex procedures and there is clearly a volume outcome relationship for these complex procedures. The more you do, the better you get at that. So any senator that does more than 25 assault reject. Amis is considered a high volume center. Certainly at Roswell, we do close to about 70 of these operations a year. Unfortunately, most of these procedures are not done in high volume centers. Uh, and I think there's certainly a role for patient education, physician educations that these patients should be referred to specialty centers. So the key takeaway in the management of gastroesophageal junction cancer is that requires a true multidisciplinary approach, where it's important to decide what the origin of these tumors is, the choice of treatment that's utilized. The choice of chemotherapy, whether radiation is is a part of the treatment, and then also what the extent of the surgical resection is going to be, and then a referral to a high volume surgeon, where we can utilize minimally invasive and robotic approaches to the management of these cancers. Clearly utilizing the minimally invasive approaches the patients, the functional outcome is better. Uh We think that, at least in our experience, the oncological outcomes are better, although that randomized data is awaited uh and faster return to to normal function. And if if these patients need a german therapies, uh that we can potentially minimize the time of getting them to adjuvant treatments.