Pancreatic Cancer Group: Introduce yourself and connect with others

I meant to ask you since it sounds like you have had both open and robotic surgery if you have a strong preference for one or the other. My surgical oncologist at Moffitt only does it open, but the surgical oncologist at UC would do it robotically.
I have been previously advised, whatever skill set a surgeon is most comfortable with should be the determining factor.
But I have been researching that the recovery time from an open surgery would be longer, more painful and associated with increased complications, compared to robotic. Do you have any thoughts about that?

Hello, I just joined this blog and find it to be extremely helpful. I am have been very fortunate in how my stage one pancreatic cancer was diagnosed. In August 2023, I had an unrelated intestinal surgery and three weeks later I developed a fever and pain. So I had a CT scan September 11, which showed an abscess from the prior surgery. It also showed the presence of a 14 mm pancreatic tumor in the neck of the pancreas. Follow up CT on 9/13/23 & MRI imaging 09/26/23 showed the 1.4 cm lesion was totally contained without vascular involvement. The recommendation was neoAdjunctive therapy followed by surgery. I was started on Gemzar/ Abraxine , 3 wks on, 1 wk off, starting 9/29/23 where I am currently residing in Cincinnati Ohio.
We are actually Florida residents, so after completion of the first chemo cycle, flew down to Tampa for a second opinion at the Moffitt’s Cancer care center and was seen by their surgical and medical oncologist on October 18, 2023. This was the day after they repeated lab work, did another CT scan and pet scan. The pet scan was negative, but the CT scan now showed that there was contact between the lesion, measured ant 1.8 cm and branching was less than 180 degrees. So in just 3 weeks, this was a new finding. But the cancer was still contained in the pancreatic neck.
My Ca 19-9 was initially 345 on 9/13/23, then 575 on 9/29/23 in Cincinnati. Mayo measured it on 10/17 as 745.
My medical oncologist in Cincinnati repeated it yesterday. His thinking is if it is not going in the right direction to either change chemo to Folfirinox , which would increase chemotherapy duration to mid December prior to next surgical consult at Moffitt. Which would delay the surgery until at least mid- late January.
The other option is to discontinue chemo now and wait the required four + weeks and proceed with surgery, which would be around late November. The tumor is located in the neck of the pancreas, and directly underneath lays an intersection of blood vessels. Moffitt has already informed me if I stick to the current plan, they would repeat the CT in December to see IF I STILL AM a surgical candidate. I NEED TO BE A SURGICAL CANDIDATE!!. So to me, it seems my best option is to stop the chemo and get the surgery done ASAP. The surgical oncologist at Tampa is rated extremely highly. He has been doing the procedures for 20+ years. However, he only does an open approach. My surgical oncologist here in Cincinnati is younger and has 8-9 yrs of experience, He seems very knowledgeable and well respected. He says he does 52 pancreatic surgeries per year. And he would do it robotically. According to Pan Can , University of Cincinnati performs 150 pancreatic cancer surgeries on an annual basis. I am sure it is much higher at Moffitt but have been unclear on getting exact numbers. According to the Moffitt website, they claim for stage one they can increase the survival percentage from 40% to 60%.

So my questions for this group are the following:
1. Opinions - regarding rather than trying the Folfirinox , which were delay surgery until mid or late January, IF I am still considered resectable by then,
my thinking is to ask for surgery now. I also had started my second cycle with my first treatment yesterday of Gemzar/Abraxane , I suppose I would still need to wait four weeks before surgery. But would need to check with my medical and surgical oncologist about that, I guess.
My hesitation about trying the FOLFIRINOX is I know it is associated with a lot more toxicity, which would make it harder for me to regain my strength to get ready for a long eight hours arduous surgery.
2. My other question is regarding where to have the surgery done. Opinions, please, if I would be better off having it at Moffitt, which is a high-volume pancreatic cancer center, performed by a highly rated pancreatic cancer specialist surgical oncologist, even though he only performs open procedures.
The other option would be to have it done at the University of Cincinnati, with the younger surgical oncologist, who performs 52 robotic pancreatic surgeries per year. So he must do roughly 1/3 of all the surgeries at that center.
Any comments in a timely fashion would be much appreciated as my medical oncologist will be calling me on Monday with the latest CA, 19/9 results. Even if it has decreased, I don’t think that would affect my desire to have the surgery done ASAP. I have read online where you can go from stage one to stage four in a matter of months.
Any comments would be greatly appreciated, thank you!

I meant to ask you since it sounds like you have had both open and robotic surgery if you have a strong preference for one or the other. My surgical oncologist at Moffitt only does it open, but the surgical oncologist at UC would do it robotically.
I have been previously advised, whatever skill set a surgeon is most comfortable with should be the determining factor.
But I have been researching that the recovery time from an open surgery would be longer, more painful and associated with increased complications, compared to robotic. Do you have any thoughts about that?

@mbcfl
I am a stage IV patient diagnosed 11/2021. I am not a medical professional but I am associated with a pancreatic center of excellence in atlanta and have also ventured other places for consults. I am currently NED. I have seen through the actions of the multidisciplinary tumor board that reviews my case; they want datapoints (CA19-9 and CT DNA) as low as possible when they operate. Surgery can be curative! But, if the tumor is “alive” when removed, cells have spread and there will be recurrences elsewhere. My surgeon is skilled at the DaVinci (laperoscopic) approach as well as open(which I just had) but only wants to operate when my values are as low as possible. why? Because depending on your overall health and recovery, chemo cannot begin again for 4-8 weeks! A lot can happen elsewhere in that timeframe .

I understand your anxiousness for surgery! I was elated to schedule my pancreadectomy! But it came only after 14 rounds of Fulfurinox. I started at CT19-9 of 23,000. At surgery I was down to 45. My pancreas tumor was dead on arrival.
SO-I would either get a third opinion for a tie breaker or stay on chemo if it appears to be working.

NOTE:all of our situations are different based on health, age, pre-existing conditions, etc. Just my food for thought! Pls keep us in the loop on your decision. Prayers for you and this tough decision.

@mbcfl
I am a stage IV patient diagnosed 11/2021. I am not a medical professional but I am associated with a pancreatic center of excellence in atlanta and have also ventured other places for consults. I am currently NED. I have seen through the actions of the multidisciplinary tumor board that reviews my case; they want datapoints (CA19-9 and CT DNA) as low as possible when they operate. Surgery can be curative! But, if the tumor is “alive” when removed, cells have spread and there will be recurrences elsewhere. My surgeon is skilled at the DaVinci (laperoscopic) approach as well as open(which I just had) but only wants to operate when my values are as low as possible. why? Because depending on your overall health and recovery, chemo cannot begin again for 4-8 weeks! A lot can happen elsewhere in that timeframe .

I understand your anxiousness for surgery! I was elated to schedule my pancreadectomy! But it came only after 14 rounds of Fulfurinox. I started at CT19-9 of 23,000. At surgery I was down to 45. My pancreas tumor was dead on arrival.
SO-I would either get a third opinion for a tie breaker or stay on chemo if it appears to be working.

NOTE:all of our situations are different based on health, age, pre-existing conditions, etc. Just my food for thought! Pls keep us in the loop on your decision. Prayers for you and this tough decision.