Dream Team

At the new Minnesota Pancreas and Liver Center, physicians from the U and HCMC merge their strengths to deliver an unprecedented level of care.

By Patricia Kelly

She went in for a bile duct stent. She came out with her life.

In 2004, Jean Sullivan was referred to gastroenterologist Martin Freeman at Hennepin County Medical Center, desperately in need of palliative care. A malignant tumor in her pancreas was blocking her bile duct. Her doctor in Bismarck couldn’t get the stent through her tumor.

Freeman made sure she got the stent—and much more.

“Dr. Freeman was adamant that Jean have surgery to remove the tumor, and then chemotherapy,” says John Sullivan, Jean’s husband. “He said he would present her case at his Monday meeting—and insist that she get both.”

Every Monday night, Freeman and his fellow HCMC gastroenterologists met informally with a multidisciplinary group of University physicians to discuss specific patients and share opinions on treatment decisions. Freeman thought Jean’s age (52) and good health made her an ideal candidate for an experimental chemotherapy drug being administered through a clinical trial at the U. But because of her previous bout with breast cancer, Jean wasn’t eligible for the study.

The doctors decided to give her the drug anyway.

Today Jean is alive and well, with less than a 10 percent chance that her cancer will return.

“In my opinion,” says John Sullivan, “that meeting saved Jean’s life.”

Monday Night Huddle

The Monday night meeting still takes place, with many of the same physicians in attendance. But today they work as an official collaboration of the University of Minnesota Physicians, University of Minnesota Medical Center, Fairview, Hennepin Faculty Associates, and HCMC: the Minnesota Pancreas and Liver Center. The center brings together experts in gastroenterology, surgery, radiology, pathology, and oncology to diagnose and treat complex cancers and other diseases of the pancreas, liver, and biliary system.

The doctors often don’t start their Monday night huddle until 6 p.m., and they stay till the job is done—asking questions, debating protocols, working together to find the best answer for each patient. Administrative Director Barbara Elick stays late to attend every meeting, just in case something urgent comes up—which is often. “The most exciting thing to me is that these physicians are so excited,” she says. “They want to do everything and anything for these patients—and they want to do it right now.”

No More Ping-Pong

Freeman calls the center a “merging of complementary strengths.” The HCMC is expert in advanced endoscopic diagnosis and therapy of pancreas and biliary disorders; the U is a national leader in complex pancreatic and biliary surgery, with state-of-the-art programs in liver, pancreas, and auto-islet cell transplantation, and its Cancer Center is one of only 39 National Cancer Institute–designated Comprehensive Cancer Center in the United States.

“The unique thing is, we see patients at the same clinic, at the same time,” says Freeman. “That’s a very different model from almost anywhere else, which is more like a Ping-Pong game”—with patients often bounced from one specialist to another. “We come to an organic decision that is bigger than the sum of its parts,” he says.

And that decision often happens within a matter of days—even hours. When a patient has an undiagnosed mass in the abdomen, there’s often no time to lose. “A patient can get referred on Friday, see the doctors on Monday, have procedures on Tuesday, and be in surgery on Thursday,” says Elick.

Working for a Cure

Selwyn Vickers takes no credit for the center’s creation; the idea was already in the works when he joined the U as head of surgery in July 2006. But his status as one of the world’s leading pancreatic surgeons—and pancreatic cancer researchers—helped bring it quickly to fruition.

Before he came to the U, Vickers was one of the principal investigators for a $4.5 million pancreatic cancer Specialized Program of Research Excellence (SPORE) grant at the University of Alabama. That grant, along with the national Pancreatic Cancer Care Registry, is now established at the University.

Pancreatic cancer is the ninth most common cancer in the United States—but as a killer, it ranks fourth. A silent cancer, it typically withholds its symptoms until it is advanced. And even when detected early and removed, it often returns with a vengeance.

“Of all the cancers that people get, pancreatic cancer is one that we just don’t do well with,” says Shawn Mallery, chief of gastroenterology at Hennepin Faculty Associates. “Part of the strength of the center is to try to develop new approaches to the disease—to find something that is going to work on these people.”

At the same time, Mallery and his colleagues at the center are careful to treat the whole person—and to help with the emotional stress of a difficult diagnosis: “We spend time with patients here. We’re not going to run out of the room. I won’t talk to a patient with my hand on the door, ready to leave.”

The Last Stop

Fighting cancer is a major focus of the center, but no less significant is its treatment of benign disease—particularly recurrent acute pancreatitis, an extremely painful condition that can lead to death. “The traditional approach is pain meds, rest, take out the gallbladder, and hope it goes away,” says Freeman. “A lot of these people are diagnosed as malingerers or drug seekers. But they’re often just normal people with terrible chronic pain.”

Freeman and his center colleagues prefer a much more aggressive approach: detecting the cause of the problem through endoscopic ultrasound (EU) and MRI—and then treating it endoscopically by opening blocked valves and sphincters, removing pancreatic stones, and treating strictures.

Mallery is especially excited about the future of his specialty: endoscopic ultrasound. Developed as a diagnostic tool, it’s now being used to treat disease. “We’ve found ways to drain obstructed ducts that no one else can drain,” he says. ”We can drain collections of fluid in the pancreas with EU rather than through surgery. EU allows us to take people who are unable to be diagnosed and find a way to diagnose and treat them. I’m just thrilled by that.”

Says Freeman: “We specialize in the really tough technical stuff. The tough disease management. We’re the last stop. We’ll do things that nobody else will do.”

Group Dynamic

As much satisfaction as Freeman gets from solving puzzles himself, he says he gets just as much satisfaction—if not more—from referring patients to others in the group: “It gives me great pleasure to have a patient sent to me for endoscopic therapy, and I say, no, you need a pancreas resection, and send them to Eric Jensen or Selwyn Vickers or Todd Tuttle.”

Oncologist Edward Greeno says his work with the Minnesota Pancreas and Liver Center pushes him to think about patients in a new way. “I’m not just thinking about what I can do, but about what Marty can do and what Shawn can do and what Selwyn can do,” he says. “We take responsibility as a group—and that drives us to come up with new therapies.”

Today, Jean Sullivan sees Greeno every six months—and looks forward to even fewer visits once she’s been cancerfree for five years. “All of the people were just tremendous,” she says. “I just can’t say enough good about them.”

Says Mallery: “We take people who are told that they can’t be diagnosed, and we diagnose them. We take people who are told that there is no treatment for them, and we find treatments for them. We take the situations where there is no treatment for these people, and we try to find treatments for them, through research. We find out what’s wrong—and we fix it.”