IU Health Goshen Center for Cancer Care
Surgery is one of the oldest forms of treatment for cancer and offers the greatest chance for diagnosis and cure for many types of cancer. Advances in surgical techniques and equipment have allowed surgeons to successfully operate on a growing number of patients with cancer. Most people with cancer will have some type of surgical procedure to resect, prevent, detect, stage, cure, debulk, provide pain relief, support other treatments or reconstruct tissues. Our fellowship-trained surgical oncologists at Indiana University Health Goshen Center for Cancer Care perform advanced surgical procedures and offer patients the latest techniques that preserve as much normal function as possible.
Procedures listed below are in addition to standard surgical resections for head and neck, thyroid, lung, esophagus, hepatopancreaticobiliary, gastrointestinal/colorectal, breast, melanoma and sarcoma. Minimally invasive and robotic techniques are used when applicable.
New and cutting-edge procedures in surgical oncology
- HIPEC (Hypertheric Intraperitoneal Chemotherapy) – This is a strategy for treating tumors that have spread to the lining of the abdominal wall. The operation entails stripping of the lining of the abdominal wall and then the infusion of heated chemotherapy via a pump while the patient is asleep in the operating room. This procedure is only performed in select centers in the United States, and IU Health Goshen Center for Cancer Care is the first center in the area to offer this new and exciting cancer modality.
- Isolated Limb Infusion – The use of catheters to infuse heated chemotherapy into a limb; both the heat and the chemotherapy kill cancer cells. This is an effective treatment for patients with advanced melanomas who have limited alternative options.
- Advanced Hepatic, Pancreatic and Biliary Surgery – Portal vein embolization makes more patients surgical candidates. Some patients cannot have their liver cancers removed because there would be insufficient normal liver remaining. Portal vein embolization is a technique of altering the liver's blood flow so that targeted areas of the liver can grow, making more patients suitable for operative resection.
- Staged Liver Resections – Historically patients with tumors in many areas of the liver could not have resections because insufficient normal liver would remain. Staging the liver resections allows surgeons to clear one side of the liver at a time. This affords time for the cleared portion of the liver to hypertrophy so that the other side of the liver might be addressed at a second operation. This is commonly performed in conjunction with portal vein embolization.
- Extended Pancreatic Resection – Traditionally, superior mesenteric or portal vein involvement would be considered unresectable. Though technically demaining to perform, surgical oncologists now understand that if these veins can be resected along with the tumor, it affords the patients the best chance at a good, long-term outcome. These procedures would typically not be attempted in community hospitals, but they are offered at IU Health Goshen Center for Cancer Care.
Minimally Invasive Surgery
- Endobronchial Ultrasound and Navigational Bronchoscopy – These are new diagnostic tools available to surgeons, which facilitate less invasive diagnosis of lung tumors and other tumors of the chest. Endobronchial ultrasound utilizes a scope that has an attached ultrasound probe to look at tissues next to the airways and biopsy them. This often replaces older surgery called “mediastinoscopy” which requires a cut on the neck. Navigational bronchoscopy utilizes a computer to map out the path to biopsy a lung lesion that could not otherwise be reached with the regular bronchoscope. This may mean earlier diagnosis for lesions that would otherwise be difficult to biopsy, and also has lower risk of puncturing a lung compared to transthoracic biopsy techniques.
- Minimally Invasive Parathyroid Surgery – The traditional surgical approach to parathyroid disease would be to look at all four glands, although the vast majority of parathyroid problems are caused by only one gland. At Goshen, we often can localize the abnormal gland before surgery and use a very small incision. We use intraoperative hormone blood tests to ensure that the parathyroid problem has been fixed prior to the patient leaving the operation.
- DaVinci Robotic Assisted Surgery – When conducted by an experienced surgeon, robotic-assisted surgery is a much more accurate operation than traditional open surgery. The 3-D view provided by DaVinci’s camera and the dexterity of the robotic hands allow the surgeon to maneuver through and around all those important nerves and vital structures.
- Accelerated Partial Breast Irradiation – Historically, patients who have had a lumpectomy have required radiation treatment to the entire breast which can take up to six weeks to complete. At Goshen, some patients are found to be candidates for a one-week short course of radiation, which treats only the portion of the breast that has cancer and spares the remaining breast from the side effects of radiotherapy.