Modern methods of surgical treatment of cancer of the pancreas and other organs of the gastrointestinal tract: an interview with oncological surgeon Andrey Lukashenko

Andrey Lukashenko is a Deputy Director of the National Cancer Institute for scientific work. He specializes in complex surgical interventions such as distal subtotal pancreatic resection or hemihepatectomy, as well as pancreaticoduodenal resections (performs the same number of operations per year as surgeons in specialized world centers).

In an interview for MedTour, Andrei Lukashenko talked about the possibilities and prospects of treatment of oncological diseases of gastrointestinal tract, as well as the state of oncological medical care in Ukraine today.

Introduce yourself please.

Andrey Lukashenko, head of the department of laparoscopic and minimally invasive surgery and interventional radiology. Most recently, I have been the Deputy Director of Science at the National Cancer Institute.

What is your education, internships, refresher courses?

I came to the National Cancer Institute in 2001 as an intern. Now my work experience is 20 years. I began my work and defended the ph d thesis in the thoracic department, then expanded medical expertise and continued scientific activity in the department of tumors of the abdominal cavity and retroperitoneal space. I had refresher courses in South Korea.

Tell us about your internships in South Korea, what did the experience give you?

I started abroad internships in 2007. It was not very common and seemed difficult. But it turned out that all large clinics are ready to cooperate. Now there is no longer a continent on which we would have no partners. All colleagues whom our specialists meet during the internship can be asked for a second opinion or consultation, regardless of whether they work in the same large clinic or have gone into private practice.

I deliberately chose South Korea for the internship. South Korea and Japan are countries that have outstanding achievements in the surgical treatment of malignant tumors of the hepatobiliary system and liver surgery for cirrhosis. I have learned a lot about laparoscopic treatment of liver metastases and the surgical treatment of cirrhosis in South Korea. And it became very useful for my work as an abdominal and oncological surgeon.

How can your patients deal with prevention and screening tests correctly?

There are no screening programs in Ukraine, but we are actively working on their implementation in the country. In European countries, cancer screening is an examination of healthy populations in order to detect malignant neoplasms in the early stages and precancerous diseases. If we talk about those diseases that are dealt with in our department, screening begins at the age of 40-50. Now this is usually a fecal occult blood test and a colonoscopy if it is necessary. This approach has reduced mortality from colorectal cancer by 20% in the Kingdom of the Netherlands in recent years.

What are the reasons for the increased incidence of cancer of the abdominal and hepatobiliary localization?

The number of cases of cancer on the planet is steadily increasing, and the only proven reason is the increase in life expectancy. Now, for the first time, we are in a situation where more than half of the world’s population is people over 55 years old. The peak incidence of cancer is 55-80 years. Also, primary liver cancer is a big problem, which correlates with the incidence of hepatitis B.

What has been new in your department in recent years, how did you manage to improve the treatment of patients?

The development of modern morphological diagnostics has significantly improved treatment options. The use of immunohistochemistry made it possible to establish indications for high-precision targeted therapy. Thus, some types of neuroendocrine tumors can be successfully treated with modern targeted drugs without surgical treatment at all. The ability to cure or significantly reduce such tumors with medication is also possible in the later stages.

At the end of the year, we are opening a huge super powerful molecular genetic laboratory – this is a public investment project. It will deal with the certification of the tumor and the manufacture of dendritic cell autovaccines – the own development of the Cancer Institute. This vaccine improves surgical results by up to 30%.

We also deal with local chemotherapy. In case of insensitivity to chemotherapy, a port is inserted subcutaneously. It is not visible, and in 50-70%, both according to literature data and according to our results, it is possible to overcome resistance.

Are clinical researches conducted in your department?

Yes, such research is carried out on the basis of our institution. On the website of the Cancer Institute, you can see which studies are being actively recruited. Now the main criterion is the lack of treatment before entering the study. We are fighting for the inclusion of our country in the examinations of patients with already treated pathology.

What options does a patient have, for example, with stage 4 pancreatic cancer?

If we are talking about stage IV pancreatic cancer, we need to know that it is pancreatic cancer. Making such a diagnosis is extremely technologically challenging. To do this, you need to get a high-quality biopsy from a hard-to-reach area (we are doing this) and perform a high-quality morphological study with immunohistochemistry, so as not to treat a neuroendocrine tumor like pancreatic cancer.

If we talk specifically about stage IV pancreatic cancer, the only treatment is chemotherapy, and it does not give satisfactory results.

The best results that can be achieved are long-term remission. A few patients go into long-term remission for years.

The most preferred treatment for ductal carcinoma of the pancreas is in clinical trials. The results of therapy are largely dependent on the clinic that first performed the treatment. A correctly prescribed therapy after an incorrect one gives half the effectiveness of the possible.

What is the average survival rate for patients with advanced stages, such as bowel cancer, achieved with the right treatment?

We can effectively treat this problem even at stage IV. Most often stage IV bowel cancer is manifested by metastases to the liver, since the liver is the first organ of venous outflow from the intestine. The treatment of such a pathology requires a complex set of surgical measures and a large number of chemotherapy courses, which takes from six months to a year. After such a treatment, recovery can be achieved in half of the patients.

The most important limiting factor is that the patient’s condition should allow him to transfer all stages of treatment.

What activities help to improve the quality of life in patients with cancer?

We are beginning to deviate from the postulates of the Soviet school, when, apart from the treatment of the underlying disease, nothing was taken into account. But if the patient spends the rest of his life in misery, is it a treatment?

Now we are increasingly thinking about the quality of a patient’s life. It is always easier for the surgeon to remove the entire organ. But this increases the operation time and requires a higher qualification of the surgeon. So now there is a tendency towards organ-preserving operations, especially when we are talking about preserving the rectum.

Also, we never perform the removal of the entire stomach in the early stages. Of course, such operations are possible if they do not harm the oncological results.

What is the average cost of treating a GI tumor for a foreign patient at your department?

For patients from Ukraine, all treatment is free.

The cost for non-residents of the country is approved by the economic department, taking into account all the laws of Ukraine, and it is approximately the same. Treatment of an advanced form of intestinal cancer is near 50-60 thousand UAH. Treatment of intestinal cancer with a combined metastatic lesion of the liver is a more technologically complex procedure, such treatment starts from 100 000 UAH. The cost of chemotherapy starts from 15 000 UAH per course.

Are there any big differences in what medicine can offer in Ukraine and in European countries for the treatment of cancer of abdominal localizations?

At the moment, we can provide all the conditions necessary for diagnosis and treatment to the same extent as in developed countries. We began to treat according to international protocols in 2009, and already in 2011, colleagues from Pittsburgh, Italy and the United States came to us and operated in comfortable conditions. We still have the practice of inviting colleagues from Italy, Japan and America to exchange experience at the National Cancer Institute.

In order to be able to fully develop with them at the same level in oncological and surgical terms, we send each employee of the department for an internship for 1-2 months a year in other clinics in the world. Also, young employees once a week find out some innovations in the field of oncology and share with others.

Regarding what international centers can offer and we cannot – this is radiosurgery and radiopharmaceuticals for the diagnosis of rare tumors. We are working on this and hope to introduce such capabilities in our facility within the next year.

What are your scientific and clinical plans for the next 5 years?

We have signed a cooperation agreement with universities in Japan and the United States. Our main interests now are in the field of minimizing surgical trauma. We are improving our skills and developing the capabilities of laparoscopic surgery for locally advanced cancer and stage IV diseases. Also, an important topic of our research is the removal of a malignant intestinal tumor and liver metastases laparoscopically at the same time.

The Anesthesia Service specializes in providing anesthesia to patients with severe cardiac pathology and diabetes.

We are also working with our Ukrainian colleagues to expand the National List of Medicines to include immunotherapy and provide Ukrainian patients with access to modern free treatment.

To sign up for a consultation with Dr. Lukashenko leave a request on the MedTour website. The coordinating doctor will contact you shortly and help you to organize your trip to the clinic.