Surgical Oncology Treatments and Procedures

UPMC Hillman Cancer Center's neurosurgical oncologists use many minimally invasive surgical techniques for brain cancer. They allow surgeons to approach tumors, once thought unresectactable, more safely.

Neuroendoport® surgery is an advanced technique where surgeons use an endoscope to gain access to deep regions of the brain.

During an awake craniotomy, the anesthetist keeps the patient awake but pain-free. This lets the neurosurgical team map areas of motor and speech before tumor removal. Surgeons can then remove a greater portion of the tumor and lessen damage to healthy tissue.

The surgical oncologists at the Magee-Womens Breast Cancer Program of UPMC Hillman Cancer Center have advanced training in minimally invasive breast cancer procedures.

Surgical options to remove cancerous and noncancerous tumors of the breast include:

• Lumpectomy or partial mastectomy — removal of a tumor and some surrounding normal tissue.
• Total mastectomy — removal of the entire breast, including the nipple and areola.
• Skin-sparing mastectomy — removal of breast tissue, preserving the skin of the breast but not the nipple or areola.
• Nipple/areola-sparing mastectomy — removal of breast tissue through an incision that preserves the nipple and areola.
• Sentinel lymph node biopsy — minimally invasive removal of the first few lymph nodes in the underarm to check for cancer cells.
• Axillary lymph node dissection — removal of lymph nodes in the underarm.

Plastic and reconstructive breast surgery options are also available.

Our endocrine and thyroid cancer surgery experts work together to devise a treatment plan for your specific situation. Treatments may include endocrine gland surgery, head and neck surgery, and dentistry and maxillofacial surgery.

UPMC's Endocrine Surgery Program is a national leader in the diagnosis and treatment of endocrine cancer.

The Multidisciplinary Thyroid Center's world-class surgeons have a proven track record in a variety of advanced surgical techniques, including:

• Intraoperative ultrasound lymph node mapping
• Lymph node dissection
• Minimally invasive thyroid surgery

Our surgeons are experts in highly specialized technologies and minimally invasive procedures to remove colorectal tumors.

UPMC Hillman Cancer Center offers many surgical options for colorectal and GI cancers, including:

• Coloanal J-pouch — surgical removal of the rectum.
• Esophagogastrectomy — surgical removal of the esophagus and part of the stomach. Surgeons then replace the esophagus using a section of the colon, or by moving the remaining part of the stomach up.
• Ileoanal J-pouch — removal of the entire colon and rectum, with connection of the small intestine to the anal canal.
• Laparoscopic colon resection — minimally invasive resection of part of the colon.
• Small bowel resection — removal of part of the small bowel.
• Sphincter-sparing surgery — surgery that preserves bodily functions.
• Total gastrectomy — removal of the stomach.
• Transanal endoscopic microsurgery — minimally invasive removal of rectal tumors.

Management of gynecologic cancer often includes surgical removal of the tumor. It may also include removing the pelvic organs.

Surgical oncologists at UPMC Hillman Cancer Center are experts in traditional, robotic, and minimally invasive techniques including:

• Total hysterectomy — removal of the uterus, including the cervix.
• Radical hysterectomy — removal of the uterus, cervix, and part of the vagina. In some cases, also removal of the ovaries, Fallopian tubes, or nearby lymph nodes.
• Unilateral salpingo-oophorectomy — removal of one ovary and one Fallopian tube.
• Bilateral salpingo-oophorectomy — removal of both ovaries and both Fallopian tubes.
• Omentectomy — removal of the omentum (a piece of the tissue lining the abdominal wall).
• Lymph node biopsy — removal of all or part of a lymph node.

Otolaryngologists and endocrine surgeons at UPMC Hillman Cancer Center have specialized training in minimally invasive techniques to remove head and neck tumors.

Traditionally, surgeries to remove cancer from these areas have resulted in large scars. They also diminished ability to breathe, swallow, or speak. Minimally invasive and robotic surgical advances allow qualified surgeons to perform head and neck cancer surgery with minimal scarring and disruption to functions.

Some tumors are too large or too entrenched for minimally invasive procedures. In these cases, our surgeons perform traditional open surgery. They keep incisions as small as possible to maximize the preservation of speaking, breathing, and swallowing.

The surgical oncologists of UPMC's Liver Tumor Program have vast experience in many techniques to treat liver cancer.

Some of these include:

• Complex open liver resections — removal of cancerous tissues of the liver through an incision in the belly.
• Chemoembolization — surgical blockage of blood flow to the tumor, or administration of anti-cancer drugs directly to the tumor.
• Hepatic arterial infusion chemotherapy — delivery of chemo through a surgically implanted catheter in the artery that feeds the liver.
• Minimally invasive and robotic liver resections — removal of cancerous tissue through small incisions, with or without robotic assistance.
• Radioembolization — surgical delivery of radioactive elements directly to the cancerous tissue through a catheter.
• Radiofrequency ablation — the use of heat through a probe to kill the tumor and seal the blood vessels.

Lung and esophageal cancer surgeons at UPMC Hillman Cancer Center perform many minimally invasive techniques to remove cancerous tumors.

Treatments and technologies for lung and esophagus cancers include:

• Lung cancer resection — removal of lung cancer using small incisions and a tiny camera, when possible. This helps minimize injury to the ribcage.
• Bronchoplastic lung-sparing techniques — removal of a tumor with little damage to healthy tissue. This preserves lung function without compromising cancer care.
• Sublobar resection and intraoperative brachytherapy — combines a lesser resection of lung tissue with the implantation of radioactive brachytherapy seeds along the edge of the resection.
• Radiofrequency ablation — the placement of a probe in the tumor through a catheter. Electrical heat energy through the probe then kills the cancerous cells.

Often, the first line of treatment for people with melanoma is surgery to remove the primary tumor and some surrounding tissue.

If the cancer has spread to the lung or stomach, the Melanoma and Skin Cancer Program at UPMC Hillman Cancer Center works with specialists to offer minimally invasive surgical options.

• Advanced plastic surgery techniques may avoid the need for skin grafting and allow easier recovery with less scarring.
• Sentinel lymph node mapping acts as a minimally invasive tracking system to locate melanoma that has spread to the lymph nodes.

The surgical oncologists at UPMC Hillman Cancer Center have extensive skill in a variety of advanced pancreatic cancer surgery techniques.

About 80 percent of our pancreatic cancer patients undergo the Whipple procedure. And, up to 85 percent slated for the Whipple procedure are candidates for the robotic option. UPMC is one of only a handful of hospitals in the United States to use the robotic Whipple procedure.

The UPMC Pancreatic Cancer Treatment Program provides clinical services and leading-edge treatments, including:

• Appleby operation — resection of locally advanced cancers of the body of the pancreas that have infiltrated the celiac or hepatic artery.
• Distal pancreatectomy — resection of the tail and some of the body of the pancreas in an open surgery.
• Laparoscopic and robotic pancreatectomy — minimally invasive resection of the tail and body of the pancreas through small incisions, with or without robotic guidance.
• Pancreas-sparing tumor resection — removal of the tumor without removing the pancreas.
• Portal vein resection and reconstruction — resection of the top of the hepatic portal vein, with construction of a new blood pathway to the liver.
• Whipple (pylorus preserving pancreaticoduodenectomy) — open or minimally invasive removal of a tumor in the head of the pancreas, along with the attached duodenum, bile duct, gallbladder, and part of the stomach.

UPMC Hillman Cancer Center urologic surgeons developed and refined several innovative surgeries for prostate and urologic cancers.

Surgical options for prostate and urologic cancers include:

• Inguinal lymph node dissection — removal of one or more lymph nodes of the groin.
• Laparoscopic and open partial nephrectomy — minimally invasive or traditional removal of a kidney tumor.
• Laparoscopic and open radical nephrectomy — minimally invasive or traditional removal of a kidney.
• Nerve-sparing radical prostatectomy — removal of the prostate with sexual function preservation.
• Nerve-sparing retroperitoneal lymph node dissection — removal of abdominal lymph nodes near the testes, with sexual function preservation.
• Partial and radical penectomy — amputation of some or all of the penis.
• Radical cystectomy with continent urinary diversion — removal of the bladder, nearby lymph nodes, part of the urethra, and nearby organs, with rerouted urinary function.
• Radical cystectomy with neobladder reconstruction — removal of the bladder, nearby lymph nodes, part of the urethra, and nearby organs, with creation of a new bladder from part of the small intestine.
• Radical nephrectomy with caval thrombus excision — removal of a kidney along with a clot within the inferior vena cava.
• Radical orchiectomy — removal of one or both testicles.
• Robotic-assisted laparoscopic radical prostatectomy — removal of the prostate gland.

UPMC Hillman Cancer Center surgeons have extensive skill in treating and managing bone and soft tissue sarcomas.

Many sarcomas require surgical removal along with chemotherapy and radiation therapy to prevent the cancer from returning.

Our orthopaedic surgeons use limb-sparing techniques to remove sarcomas when appropriate. This approach spares healthy surrounding tissue allowing for a quicker recovery with less postoperative pain.

Sarcoma Specialty Care and Treatment Program surgeons also have expertise in a number of highly specialized technologies.

These include:

• Isolated limb perfusion
• Isolated hepatic perfusion
• Laparoscopic surgeries for metastatic disease
• Limb and pelvic reconstruction