Surgery

ABOUT THIS EPISODE What do you call NETs in the liver? How often do NETs spread and what causes NETs to spread? How do you determine if surgery is an option? Dr. Xavier Keutgen from the University of Chicago brings clarity to NET tumors found in the liver and describes how surgery fits in with other treatments for metastatic NETs. MEET DR. XAVIER KEUTGEN Xavier M. Keutgen MD is a board-certified, double-fellowship trained surgeon who specializes in the treatment of gastro, entero, pancreatic neuroendocrine tumors and neoplasms of the thyroid, parathyroid and adrenal glands. A native from Belgium, Dr. Keutgen graduated magna cum laude from the University of Heidelberg Medical School in Germany and completed a general surgery residency and surgical oncology research fellowship at New York Presbyterian Hospital-Weill Cornell Medical Center. He then completed a hepato-pancreato-biliary fellowship at the University Hospital of Zurich in Switzerland as well as an endocrine oncology and surgery fellowship at the National Cancer Institute, National Institutes of Health (NIH) in Bethesda, Maryland. Dr. Keutgen currently serves as the director of the Neuroendocrine Tumor Program, director of the Endocrine Research Program and co-director of the Von Hippel-Lindau Clinical Care Program at the University of Chicago Medicine. Throughout his career Dr. Keutgen has developed a particular interest in clinical, translational and basic science research. His laboratory specializes in investigating the role of radiation therapy and DNA damage repair in pancreatic, lung and small bowel neuroendocrine tumors, discovering new actionable molecular targets for neuroendocrine tumors, and elucidating new mechanisms of drug delivery for endocrine malignancies. TOP TEN QUESTIONS 1. What is liver NETs? How often do NETs spread? Is it expected that NETs will eventually spread? 2. If the primary tumor was already removed, do you now call this liver NET or do you still refer to it by the primary site of origin – and why? How is this different from liver cancer? 3. What causes NETs to spread? Is there anything that is done to cause NET tumors to spread? Is there anything that can be done to keep them from spreading? 4. How do you determine if surgery is an option? What is involved in evaluating metastases? What scans or labs are needed? 5. How do you decide what the “tumor burden” is? 6. How do you weigh the grade or ki67? How do you weigh tumor size? Is there a cut-off for tumor size or the number of tumors that is too much to operate? 7. How does one decide between surgery versus other options? How often can surgery or other treatments be done? How safe is liver surgery? 8. How do you approach surgery for someone with liver tumors who also has tumors in the tail versus the head of the pancreas? 9. When someone has had a Whipple surgery and later is found to have tumors in the liver, what are the options? 10. What advances in the field are you most excited about? For more information, visit https://www.lacnets.org/podcast/27.

Join us to hear renowned liver and pancreas surgeon Dr. Gagandeep “Gaugs” Singh discuss the evolving algorithms in the management of NET liver metastases. Dr. Singh, Chief of Surgical Oncology at City of Hope® Cancer Center in Phoenix, asks the question of whether it is prudent to be aggressive surgically or if it is all about timing and strategy. For more information, visit LACNETS.org.

"Surgical Treatments" • Alexandra Gangi, MD • 2023 NET Cancer Day Symposium • Santa Monica, CA Speaker: Alexandra Gangi, MD Surgical Oncologist Cedars-Sinai For more information, visit LACNETS.org.

6) Understanding Carcinoid Crisis • 2024 Neuroendocrine Tumor Patient Conference Our 2024 LACNETS Neuroendocrine Tumor Patient Conference is designed for neuroendocrine cancer (NET) patients and caregivers to deepen your understanding of NETs. Whether you are newly diagnosed or have been living with NET for many years, we encourage you to attend: - Learn from top NET experts from across North America on a range of topics relevant to the NET patient journey. - Topics include work-ups, scans, surgery, carcinoid crisis, liver-directed therapy, PRRT, systemic treatments, treatment sequencing, NET guidelines, and clinical trials. - Gain insight into NET decision-making through the NET tumor board panel discussion. - Hear stories from NET patients and caregivers. - Join virtually, where you can pause, rewind, or replay. - There is no cost to attend. This event is made possible by the generosity of donors and sponsors. #LACNETS #neuroendocrinecancer #clinicaltrials #lungcancer #NETcancer #Letstalkaboutnets For more information, visit LACNETS.org.

5) Understanding Surgery for Liver NETs • 2024 Neuroendocrine Tumor Patient Conference Our 2024 LACNETS Neuroendocrine Tumor Patient Conference is designed for neuroendocrine cancer (NET) patients and caregivers to deepen your understanding of NETs. Whether you are newly diagnosed or have been living with NET for many years, we encourage you to attend: - Learn from top NET experts from across North America on a range of topics relevant to the NET patient journey. - Topics include work-ups, scans, surgery, carcinoid crisis, liver-directed therapy, PRRT, systemic treatments, treatment sequencing, NET guidelines, and clinical trials. - Gain insight into NET decision-making through the NET tumor board panel discussion. - Hear stories from NET patients and caregivers. - Join virtually, where you can pause, rewind, or replay. - There is no cost to attend. This event is made possible by the generosity of donors and sponsors. #LACNETS #neuroendocrinecancer #clinicaltrials #lungcancer #NETcancer #Letstalkaboutnets For more information, visit LACNETS.org.

ABOUT THIS EPISODE How do surgeons decide the type, extent, and approach of NET surgery? NET surgeon Dr. Alexandra Gangi of Cedars-Sinai answers 10 common questions about what to expect before, during, and after NET surgery. Gain insight on preparing for surgery and what is important for your surgeon to know about your recovery goals. Dr. Gangi’s comprehensive approach illustrates why surgeons are an integral part of your NET medical team. MEET DR. ALEXANDRA GANGI Dr. Alexandra Gangi is a board-certified surgical oncologist at Cedars-Sinai Medical Center in Los Angeles. Dr. Gangi completed a general surgical residency at Cedars-Sinai and completed her surgical oncology fellowship at the H. Lee Moffitt Cancer Center in Tampa, Florida. She currently serves as the director of the Gastrointestinal Tumor and Cancer Regional Therapies Programs with specialization in Pancreatic and GI Neuroendocrine tumors, Metastatic colorectal cancer, and Peritoneal Surface Malignancies. Her research focuses on understanding GEPNET heterogeneity between and within tumors subtypes and mechanisms of chemotherapy induced liver injury. TOP 10 QUESTIONS 1. How do you decide if the tumors can and should be cut out? How does tumor location, tumor size, and amount of tumors factor into your decision? 2. How do you decide if someone should have a laparoscopic surgery versus open surgery? What about robotic surgery? 3. How do you decide whether or not to remove the ileocecal valve? 4. What work up should NET patients have before surgery? Should all NET patients have an echo? 5. What is the risk of carcinoid crisis with a dental procedure, a biopsy, or with surgery? How do you manage this? 6. Should NET patients be on somatostatin analogs before surgery? What about after surgery? If so, when would you restart it? 7. When would you want someone on chemotherapy or PRRT to shrink a tumor before surgery? When might you want to do surgery first followed by another treatment? 8. When would you recommend imaging after NET surgery? What type of imaging would you order? 9. Why are there differing opinions from NET specialists, specifically about surgery and what treatment should be offered as the next option? 10. What questions would you recommend NET patients ask at their surgical consultation? For more resources and a transcript of this episode, visit https://www.lacnets.org/podcast17.

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.” 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?) For more resources and a transcript of this episode, visit https://www.lacnets.org/podcast3.

Join LACNETS to hear NET expert Dr. Eric Liu of Rocky Mountain Cancer Centers discuss “Surgery: The What, Where & When.” To learn more, visit LACNETS.org.

Watch 'A Conversation with Three NET Surgeons' featuring Dr. Callisia Clarke, Dr. Alexandra Gangi and Dr. Daniel Anaya Saenz. This presentation is part of the 2023 LACNETS Neuroendocrine Tumor Patient Education Conference held on June 17, 2023. For more information, visit LACNETS.org.

NET patient Julie’s “show and tell” of tips, tricks, and specific items she found useful during her hospital stay and recovery at home Click here for a list of the items Julie mentioned in this video: bit.ly/3vEenQf Read our blog post, 'Practical Tips for Patients Preparing for Surgery" here: bit.ly/3Ac0xHF For more information on LACNETS, visit www.LACNETS.org.

Dr. Callisia Clarke addresses surgery for neuroendocrine cancer including decision-making & preparing for surgery. Presenter: Callisia Clarke, MD Surgical Oncologist Medical College of WI 2022 LACNETS NET Patient Conference Presented by LACNETS For more information, please visit www.LACNETS.org. @LACNETS (Facebook, Twitter, Instagram) Video produced by tvplive.com.

"Surgical Resection/Cytoreduction - The Best Treatment Option for GI NETs - Why? & How?" Speaker: Yi-Zarn Wang, DDS, PC, MD, FACS Surgical Oncologist, Chairman of the NET Research & Treatment Center,  Sammons Cancer Center,  Baylor University Medical Center

Surgery - Liver + Pancreas: Kambiz Kosari, MD, FACS Kambiz Kosari, MD, FACS Surgeon, Cedars-Sinai Medical Center 2019 Annual Los Angeles NET Patient Education Conference Saturday, June 8th www.LACNETS.org

Surgery - GI: Farin Amersi, MD Farin Amersi, MD Surgical Oncology, Cedars-Sinai Medical Center 2019 Annual Los Angeles NET Patient Education Conference Saturday, June 8th www.LACNETS.org

LACNETS - "Defining Order Beneath the Chaos - Living with NET Liver Metastases" with Dr. Gagandeep Singh (City of Hope) SPEAKERS: Gagandeep Singh, MD, FACS, Liver & Pancreatic Surgeon, City of Hope Daneng (Dan) Li, MD, Medical Oncologist, City of Hope Date: Saturday, March 9th, 2019 Location: City of Hope (Duarte, Calif.) To learn more about LACNETS, please visit www.LACNETS.org.

Surgical Management: Girgis, Agopian Mark Girgis, MD Assistant Professor of Surgery at the David Geffen School of Medicine, UCLA Health Vatche G. Agopian, MD Assistant Professor of Surgery, Department of Surgery, David Geffen School of Medicine at UCLA

Virtual 2020 Los Angeles Neuroendocrine Tumor Patient Education Conference Presented by LACNETS Presentations & Times: LACNETS Conference Welcome (0:00 - 5:44) Lindsey Jeu De Vine, Director of Communications, LACNETS Lisa Yen, NBC-HWC, Program Director, LACNETS "Finding a NET Expert" (5:44 - 22:25) Cindy Lovelace , Executive Director Healing NET Foundation "Surgery for NETs" (22:25 - end of video) Alexandra Gangi, MD , Surgical Oncology Cedars-Sinai Medical Center For more information, please visit www.LACNETS.org. @LACNETS (Facebook, Twitter, Instagram) Video produced by tvplive.com.

2021 Los Angeles Neuroendocrine Tumor Patient Education Virtual Conference Presented by LACNETS Presenter: Callisia Clarke, MD Surgical Oncologist Medical College of WI For more information, please visit www.LACNETS.org. @LACNETS (Facebook, Twitter, Instagram) Video produced by tvplive.com.