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Pancreatic Cancer Q&A with Dr. Stauffer, Mayo Surgeon: May 29

Posted by Colleen Young, Connect Director @colleenyoung, May 19 1:09pm

Allow me to introduce you to Dr. John Stauffer, a hepatobiliary and pancreas surgical oncologist at Mayo Clinic in Florida, one of the country's highest-volume surgical programs for advanced pancreatic cancer.

On Thursday, May 29 from 1:30-2:30pm ET, Dr. Stauffer will host a Q&A about surgical management of pancreatic cancer.

After a pancreatic cancer diagnosis, many people have questions about treatment options, including surgical and nonsurgical approaches. You may also want to know how an integrated team – including surgical oncology, medical oncology, radiation oncology and gastroenterology specialists – works together to prevent further cancer complications and preserve your quality of life.

Please note that this hour-long Q&A is for informational purposes only, and any concerns you have should be addressed to your treating physician. If you would like to learn about pancreas cancer care at our integrated program in Florida, please visit this page for information.

Submit your questions in advance in the comments below and Dr. Stauffer will reply during the hour-long Q&A event. See you back here on May 29.

Go ahead, ask away!

Interested in more discussions like this? Go to the Pancreatic Cancer Support Group.

bishopa | @bishopa | May 29 12:08pm

As a PNet surgical success story I send hope to all. The team at Mayo is the best and Dr. Poruk saved my life with her high level of expertise, sprinkled with confident, calm compassion.

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1 reply
John Stauffer, MD | @johnstauffermd | May 29 12:33pm

Hi everyone, Dr. Stauffer here, I am ready to answer your questions! I will go through the list and comment on questions in the chat over the next hour. Thank you for taking the time to share your questions with us.

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John Stauffer, MD | @johnstauffermd | May 29 12:37pm
In reply to @deborahz "I have been diagnosed with 40 and 50 cm duodenal adenoma with focal high grade dysplasia..." + (show)
@deborahz

I have been diagnosed with 40 and 50 cm duodenal adenoma with focal high grade dysplasia after an egd with emr on April 23 where the local doctor was unable to extract them. Surgeon locally recommended Whipple within 3 weeks. Went to Mayo in Rochester for a second opinion and am scheduled for another EMR with Mayo doctor on June 24. I'm hoping it is successful, but if not, are there any options other than the Whipple? If successful but cancer is found, is Whipple still the recommendation?

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I recommend a whipple if the next EMR finds HGD or the margin is still positive due to the risk of malignant degeneration. Duodenal cancer is very survivable if found and treated at this early stage but can lead to uncurable metastatic cancer if undertreated.

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1 reply
John Stauffer, MD | @johnstauffermd | May 29 12:38pm
In reply to @carlajones101 "My pancreatic cancer has metastsized to the liver and I have started chemo Rx. If the..." + (show)
@carlajones101

My pancreatic cancer has metastsized to the liver and I have started chemo Rx. If the liver nodules resolve would I then be a surgical candidate? Is there a pathway from non-surgical to surgical treatment?

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In rare circumstances (oligometastatic PDAC), we would consider aggressive treatment of metastatic liver disease after a time period demonstrating disease stability and appropriate tumor biology (6-12 months).

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John Stauffer, MD | @johnstauffermd | May 29 12:39pm
In reply to @markymarkfl "Given the high rate of recurrence after Whipple, what are your thoughts on total pancreatectomy, especially..." + (show)
@markymarkfl

Given the high rate of recurrence after Whipple, what are your thoughts on total pancreatectomy, especially for younger patients or patients with mutations predisposing them to more PDAC development?

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A more aggressive resection (total pancreatectomy, vascular resection, extended lymphadenectomy, etc…) when a standard resection obtains negative margins has not been shown to improve survival. Experienced surgeons and teams carefully plan each operation to maximize the chances of cure without increasing the chances of surgical complications or poor quality of life after surgery.

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deborahz | @deborahz | May 29 12:39pm
In reply to @johnstauffermd "I recommend a whipple if the next EMR finds HGD or the margin is still positive..." + (show)
@johnstauffermd

I recommend a whipple if the next EMR finds HGD or the margin is still positive due to the risk of malignant degeneration. Duodenal cancer is very survivable if found and treated at this early stage but can lead to uncurable metastatic cancer if undertreated.

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I assume the next EMR will find HGD as it wasn't previously removed. How long can surgery be put off? I keep getting different opinions

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John Stauffer, MD | @johnstauffermd | May 29 12:40pm
In reply to @joiedevivre "After ⅔ of the pancreas was removed with good margins, if there is some sign of..." + (show)
@joiedevivre

After ⅔ of the pancreas was removed with good margins, if there is some sign of FDG uptake at the resected area, is it advisable to go in and cut more of the pancreas or remove the entire pancreas? There is no sign of spread anywhere else in recent PET scan and MRI but could the cancer be already in the blood? Chemo is ongoing from Feb 2024. Surgery was Dec 2023.

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I have found PET to be imperfect when identifying recurrent cancer within the abdomen. There are many cases of nebulous results which can be due to inflammation, infection, or some other cause of hypermetabolism and not due to recurrent cancer. At MCF, we use very high-quality MRI to better detect whether there is recurrent PDAC or not but even then, it is not entirely accurate.

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1 reply
John Stauffer, MD | @johnstauffermd | May 29 12:44pm
In reply to @kjc12 "Was wondering your thoughts/opinion on recent articles suggesting the use of Ivermectin and Fenbendazole in cancer..." + (show)
@kjc12

Was wondering your thoughts/opinion on recent articles suggesting the use of Ivermectin and Fenbendazole in cancer therapy. Thank you for taking the time to respond to all our inquiries, much appreciated.

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To be fair, I have not thoroughly reviewed these articles and data enough to definitively support or deny if they provide any additional benefits to our standard of care treatment of pancreatic cancer.

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John Stauffer, MD | @johnstauffermd | May 29 12:45pm
In reply to @bishopa "As a PNet surgical success story I send hope to all. The team at Mayo is..." + (show)
@bishopa

As a PNet surgical success story I send hope to all. The team at Mayo is the best and Dr. Poruk saved my life with her high level of expertise, sprinkled with confident, calm compassion.

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Yes, Dr. Poruk is an awesome surgeon and a great colleague!

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John Stauffer, MD | @johnstauffermd | May 29 12:46pm
In reply to @gamaryanne "When someone is NED, at what point do you feel the person is cured? 2 years?..." + (show)
@gamaryanne

When someone is NED, at what point do you feel the person is cured? 2 years? 5 years?

When someone is termed NED, do you recommend continuing interval chemo and for how long?

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For statistical purposes, we feel that the 5-year mark with NED is counted as cure. I generally do not recommend doing long term maintenance chemotherapy if someone is cancer free for a prolonged period of time after definitive treatment (surgery) of PDAC.

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