THE LACNETS PODCAST
Episode 3: Surgery for NETs
ABOUT THIS EPISODE:
To cut or not to cut? A crossroad many neuroendocrine cancer patients are faced with along their journey. NET surgeon Dr. Gagandeep Singh of City of Hope answers the top 10 surgery questions for NETs.
MEET DR. GAGANDEEP SINGH
Gagandeep Singh, M.D., is an internationally recognized liver and pancreas surgeon. He is head of hepatobiliary and pancreatic surgery service City of Hope, a National Cancer Institute-designated comprehensive cancer center. He is also the surgical director of the Neuroendocrine Tumor Program and is the lead for the gastrointestinal disease team.
He started his faculty academic career at Keck School of Medicine of USC in Los Angeles. From there, he was appointed as director of the Liver and Pancreas Center at the John Wayne Cancer Institute, Santa Monica, California, where he also served as chair of the Cancer Committee and vice president for Fellowship Education. In 2010, City of Hope asked Dr. Singh to spearhead the liver and pancreatic cancer program. He was appointed clinical professor of surgery and as the new chief of the Division of Surgical Oncology (2011 to 2019) and hoisted the program to national recognition. He has an extensive referral base that reflects peer recognition of his clinical acumen and surgical expertise and is listed in “America’s Top Surgeons,” “Best Doctors of America,” “Super Doctors” and “Top Doctors of America.”
Prior to his tenure in the Unites States, he earned is his medical degree from the Mahatma Gandhi Institute of Medical Sciences in India, and then trained at some of the finest cancer centers and hepatobiliary institutes around the world. These international institutions include: Tata Memorial Hospital and Cancer Center (Bombay, India), René Descartes University - Hôpital Cochin (Paris, France) and the Royal Liverpool University Hospital (England). In the U.S., these institutes include: Marion Bessin Liver Center at the Albert Einstein College of Medicine (New York), Maricopa Medical Center (Phoenix) and the University of Iowa Hospitals & Clinics (Iowa City). Dr. Singh is a board-certified surgeon, a diplomate of the American Board of Surgery and a fellow of the American College of Surgeons. He is a member of some of the top elite surgical societies and has served as invited speaker/chair at several national and international conferences. He is also a panel member of the National Comprehensive Cancer Network for Hepatobiliary Cancers, that lays down the guidelines for the standard of care for these cancers; providing direction to both patients and physicians across the U.S. and the rest of the world.
Dr. Singh has a very thoughtful, effective and yet forceful approach to beating cancer, in a systematic fashion working with an outstanding multidisciplinary team. Dynamic and compassionate, he is a skilled and an accomplished surgeon. He has extensive experience in liver and pancreatic diseases and other gastrointestinal cancers. His work is very well published with numerous publications in prestigious journals. His publications encompass complex liver resections for liver metastases, management algorithms for neuroendocrine tumors, vascular reconstructions following difficult pancreatic surgery for pancreatic cancer, and advanced robotic surgery. Currently, his group is advancing the scope and providing leading-edge surgery for complex liver and pancreatic operations using minimally invasive surgery techniques with the 3D high-definition da Vinci robotic surgical systems. His work in robotic surgery has been presented on the national podium at the Society of Surgical Oncology, Americas Hepato-Pancreato-Biliary Association, Society of Laparoscopic & Robotic Surgeons and other national meetings.
An innovator at heart, Dr. Singh is in constant pursuit of enhancing the surgical experience and developing technical innovations in liver and pancreatic surgery. He has collaborative endeavors with engineers from California Institute of Technology (Caltech) & Harvey Mudd College. He has several invention disclosures and patents.
In addition to a large clinical practice, Dr. Singh is passionately advancing leading-edge translational research. He collaborates with City of Hope’s molecular biologists, X-ray crystallographers, structural chemists and superresolution scientists. A visionary clinician, he is developing novel targeted molecules for neuroendocrine tumors, pancreatic cancers and metastatic colon and rectal cancers. He believes early detection is critical and is authenticating an early detection blood test for pancreatic cancers and colorectal cancers.
TOP 10 SURGERY QUESTIONS
1. Should all NET patients have surgery? How do I know if I’m a candidate for surgery? If 1 surgeon says I’m not, would another surgeon say something different?
2. How much control would a patient have regarding the approach and extent of surgery?
3. How do you control for carcinoid crisis during surgery?
4. Should all NET patients have their gallbladder removed? If mine wasn’t removed in my initial surgery, would you recommend going back to have it taken out?
5. If there are already liver mets, would you recommend having surgery? If so, how much should be taken out? Is there a role for taking out the primary tumor when there are liver mets?
6. Is there a role for surgery if there are bone mets?
7. What is the role of liver transplantation?
8. What are the risks of scar tissue from multiple surgeries? What can be done about it? (how many surgeries can a body handle?)
9. What is the role of adjuvant therapy for net? (Please also explain what adjuvant therapy is.)
10. What treatment or other development in this field are you most excited about? (What hope might you offer to those living with NET or their loved ones?)