Latest / Becker’s Healthcare Podcast / Surgical Oncology Innovation, Robotic Surgery, and the Future of Cancer Care with Dr. Moshim Kukar

Transcript

Surgical Oncology Innovation, Robotic Surgery, and the Future of Cancer Care with Dr. Moshim Kukar · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - upper right.
• 0:51
  - Hello, and thank you so much for tuning
• 0:53
  - in to the Becker's Oncology Leadership podcast. I'm
• 0:56
  - Elizabeth Gregerson,
• 0:58
  - assistant editor here at Becker's, and today, I'm
• 1:00
  - talking to doctor Mosheem Kukar.
• 1:03
  - Doctor Kukar is professor and chair of surgical
• 1:06
  - oncology
• 1:07
  - and program director of Complex General Surgical Oncology
• 1:11
  - Fellowship
• 1:12
  - at Roswell Park Comprehensive Cancer Center. Doctor Kakar,
• 1:16
  - thank you so much for taking the time
• 1:18
  - to speak with me today. Absolutely. Thank you
• 1:20
  - for having me. I'm really excited.
• 1:22
  - Perfect. And before I dive into my questions,
• 1:25
  - if you could share just a bit
• 1:27
  - about you, your role, and also
• 1:30
  - a bit of more about Roswell Park in
• 1:32
  - general for our listeners, I think that'd be
• 1:34
  - a great way to start the conversation.
• 1:38
  - Professor and chair, of surgical oncology here at
• 1:41
  - Roswell Park. We,
• 1:42
  - the surgical oncology department has, 16 faculty members
• 1:46
  - that, take care of patients with
• 1:49
  - different cancers.
• 1:50
  - We also have a
• 1:52
  - complex general surgical oncology fellowship where we train
• 1:55
  - four fellows a year for a two year
• 1:57
  - fellowship.
• 1:58
  - Little bit about myself, I I grew up
• 1:59
  - in India. I did my medical school there.
• 2:02
  - I did my residency training in in, at
• 2:05
  - Northwell and
• 2:06
  - Long Island, and I came to Buffalo about
• 2:08
  - fourteen years.
• 2:09
  - Did my fellowship here at Roswell Park and
• 2:11
  - then stayed back and kind of, you know,
• 2:13
  - moved up the ladder to be where where
• 2:15
  - I am today, and I'm, you know, really
• 2:17
  - excited to be in this role. I've been
• 2:18
  - the chair of the department now for a
• 2:20
  - little over two years,
• 2:22
  - and,
• 2:24
  - raised a beautiful family. My wife is, the
• 2:26
  - director of NICU
• 2:27
  - at Children's,
• 2:29
  - and
• 2:30
  - my... Well, you know, I have a, older
• 2:32
  - son who's a high schooler now, freshman, and
• 2:34
  - then my daughter was born here, and she
• 2:36
  - is in seventh grade now. So life's moving
• 2:39
  - fast. Wow. That's so exciting.
• 2:41
  - I appreciate you kinda setting the stage for,
• 2:43
  - you know, your experience and where you're coming
• 2:46
  - from.
• 2:46
  - It's kind of zooming in for life at
• 2:49
  - Roswell Park, specifically,
• 2:52
  - as chair of surgical oncology
• 2:54
  - at an NCI designated
• 2:56
  - comprehensive cancer center, you know, you're overseeing surgeons
• 3:00
  - across many cancer types and subspecialties who are
• 3:03
  - working, you know, at such a high level.
• 3:06
  - How do you hold
• 3:08
  - a department of that size
• 3:10
  - to a consistent
• 3:11
  - standard of quality?
• 3:14
  - Yeah. That's a great question. You know? And
• 3:15
  - I think it... It's... Makes it easy for
• 3:17
  - me because I'm privileged to work at such
• 3:20
  - an incredible institution that attracts amazing talent from,
• 3:24
  - not just local regionally, but I think nationally
• 3:27
  - and even internationally. Right? So when you're bun...
• 3:29
  - Working with a bunch of incredible talent, I
• 3:32
  - think it makes it easy. And I think
• 3:34
  - one thing that we focus on is is
• 3:36
  - setting up the culture. And I think three
• 3:38
  - things that sort of encompass, you know, who
• 3:40
  - we are within the department is that we
• 3:42
  - really built a culture of excellence. So within
• 3:45
  - surgical oncology, you know, we're all trained to
• 3:47
  - do operate on different organ systems for cancer,
• 3:50
  - but each of us, including my partners, we
• 3:53
  - focus on one to two organ systems.
• 3:55
  - So we can... We're really super specialized and,
• 3:58
  - you know, this helps us to build these
• 4:00
  - centers of excellence,
• 4:02
  - and most of us are members of these
• 4:04
  - national international societies for these particular disease sites.
• 4:08
  - That also helps us not treat patients with
• 4:10
  - more contemporary,
• 4:12
  - level care, but also allow us to shape
• 4:14
  - the way these these cancers are treated and
• 4:16
  - allows us to be at the forefront.
• 4:19
  - The second thing is this culture of teamwork.
• 4:20
  - You know, we don't... We really,
• 4:22
  - stress on that. We don't work in silos,
• 4:25
  - whether it's discussing cases before they go to
• 4:27
  - the operating room in what is called a
• 4:29
  - multidisciplinary tumor board,
• 4:31
  - asking for help in the operating room that
• 4:33
  - we're helping each other with complex cases, and
• 4:35
  - then also,
• 4:37
  - helping manage postoperative
• 4:38
  - patients that are sometimes complex and we're constantly
• 4:41
  - talking to each other to provide them the
• 4:43
  - best care. And the third thing is a...
• 4:45
  - As a as a very open transparent culture,
• 4:48
  - you know, where we're very receptive to critique.
• 4:51
  - We're always striving to learn from each other
• 4:53
  - and improve,
• 4:54
  - and, you know, we... Not just internally, but
• 4:56
  - we're also benchmarking ourselves to some of the
• 4:59
  - national standards,
• 5:00
  - and are constantly trying to improve ourselves. You
• 5:02
  - know?
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  - I I I think at the end of
• 5:05
  - the day, we all take pride in delivering
• 5:07
  - the care that we would deliver to our
• 5:08
  - family member, and I think that just allows
• 5:11
  - us to deliver exceptional care at all times
• 5:13
  - and at all levels.
• 5:15
  - Perfect. So you touched a little bit about,
• 5:19
  - you know, the talent at Roswell Park, not
• 5:22
  - just from local,
• 5:24
  - you know, physicians, but also kind of, attracting
• 5:27
  - talent from across, you know, the nation and
• 5:29
  - the world.
• 5:30
  - Often,
• 5:31
  - surgical oncology fellows can leave
• 5:34
  - for jobs at other institutions, you know, once
• 5:36
  - they finish their training.
• 5:38
  - In your role, how do you use Roswell
• 5:41
  - Park's fellowship program to kind of build and
• 5:45
  - retain
• 5:47
  - and, you know, strengthen your own surgical workforce?
• 5:51
  - Absolutely. I think our fellowship is, and kudos
• 5:54
  - to my predecessors. You know, we've had a
• 5:56
  - fantastic training program
• 5:58
  - since the late nineteen seventies.
• 6:01
  - And, you know, like I mentioned before, we
• 6:03
  - trained four CGSO fellows a year for a
• 6:05
  - two year fellowship.
• 6:07
  - And again, kudos to our exceptional team now
• 6:09
  - that we attract some really exceptional talent from
• 6:12
  - throughout the country.
• 6:13
  - Just as an ex... Example, our current class,
• 6:16
  - both second year, first year, we have fellows
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  - from
• 6:19
  - Cleveland Clinic,
• 6:20
  - McGill,
• 6:22
  - SUNY Upstate,
• 6:23
  - Yale,
• 6:24
  - University Baylor,
• 6:26
  - and NYU.
• 6:28
  - So I mean, you know, we really attract,
• 6:30
  - top class talent here.
• 6:32
  - Actually, my my issue is, I... If I
• 6:34
  - would keep more people here at Roswell, I
• 6:36
  - would love to keep more people. It's just
• 6:38
  - we're obviously limited, but that puts us in
• 6:40
  - a privilege that we can recruit amongst the
• 6:42
  - best.
• 6:43
  - And just within the last, I would say,
• 6:45
  - three to four years, we've had our own
• 6:47
  - fellows that were superstars,
• 6:49
  - trainees, and, we were able to recruit them
• 6:51
  - as as faculty. Doctor Zachary Styles, who does
• 6:54
  - majority of the hepatobility
• 6:56
  - work,
• 6:57
  - and doctor Patel, who does deal with peritoneal
• 6:59
  - surface malignancies and melanoma,
• 7:02
  - and they're doing exceptionally well as faculty members.
• 7:05
  - So, you know, we we do... We also
• 7:07
  - like a little bit of, obviously, cross bleeding
• 7:09
  - of talent, not not all color inbred. So
• 7:12
  - I think our faculty kind of represents training,
• 7:15
  - from diverse backgrounds.
• 7:17
  - You know, we have faculty from Memorial Sloan
• 7:19
  - Kettering, MD Anderson,
• 7:22
  - City of Hope, Ohio State, you know, other
• 7:24
  - other,
• 7:25
  - renowned cancer centers as well.
• 7:28
  - So it's it's a diverse group.
• 7:31
  - Perfect.
• 7:32
  - I'd like to shift a little bit from
• 7:34
  - kind of the
• 7:36
  - leadership and fellowship
• 7:38
  - lens
• 7:39
  - to talking a little bit more about surgical
• 7:43
  - strategy in general. So in 2020,
• 7:46
  - I read that your team moved all, and
• 7:49
  - you're gonna have to accept my apology in
• 7:51
  - advance for how I'm about to pronounce this,
• 7:54
  - but esophagectomies
• 7:56
  - to a robot assisted approach? Perfect. Mhmm. Yes.
• 8:00
  - Which meant, you know, in 2020 when you
• 8:02
  - moved those to that robot assisted approach,
• 8:05
  - experienced surgeons then had to adopt a new
• 8:08
  - technique. And I can only imagine that this
• 8:10
  - is something that continues
• 8:12
  - to pop up in your day to day
• 8:15
  - operations
• 8:16
  - as innovation
• 8:17
  - just
• 8:18
  - keeps rolling forward.
• 8:20
  - So how do you as a leader bring
• 8:22
  - practicing surgeons up to speed
• 8:25
  - when standard of care changes or technology
• 8:29
  - changes? What does that look like?
• 8:32
  - Yeah. I mean, I think I've I've spent
• 8:33
  - two... Almost two decades of my career at
• 8:36
  - this particular procedure. Like, we were talking about
• 8:38
  - these centers of excellence.
• 8:40
  - You know, in my training, when I did
• 8:42
  - my residency training, we used to do this
• 8:44
  - operation with, you know, big cuts on the
• 8:46
  - belly, big cuts on the chest, you know,
• 8:48
  - patients in the ICU for a few days,
• 8:51
  - to... In my training in surgical oncology where
• 8:54
  - we were doing this laparoscopically
• 8:55
  - with sticks,
• 8:57
  - and then transitioning this procedure, doing it more
• 8:59
  - robotically, which is where we've seen sort of
• 9:01
  - the best outcomes,
• 9:03
  - doing this procedure.
• 9:05
  - And we've, you know, published in,
• 9:07
  - our outcomes with the... With this as well.
• 9:10
  - So, yeah, I think we went through... You
• 9:12
  - know, it's always a learning curve, and I
• 9:14
  - think it's important in that curve that you
• 9:16
  - are still delivering, you know,
• 9:18
  - contemporary care to the patient without,
• 9:21
  - any harm to the patient. Right? So that's
• 9:23
  - always difficult,
• 9:24
  - and I think this is where our team
• 9:26
  - concept is so critical.
• 9:29
  - And I think once we were able to
• 9:30
  - get through the learning curve and get to
• 9:33
  - where we think we were doing this procedure
• 9:34
  - safely,
• 9:36
  - then essentially, you know, there there are tools
• 9:38
  - and tips and tricks that we do where
• 9:39
  - we can break this procedure down into steps.
• 9:42
  - We have some models that that are outside
• 9:44
  - the Operating Room that we train the fellows
• 9:46
  - on, our trainees on, and then they slowly
• 9:49
  - come... They come into the Operating Room and
• 9:50
  - they start with doing some steps of the
• 9:52
  - procedure. Right? And they do that consistently. Once
• 9:55
  - they show some proficiency in those steps, then
• 9:57
  - we graduate to the next step. So this
• 9:59
  - way, we keep that consistent,
• 10:01
  - to make sure that we,
• 10:02
  - we have these... We have excellent outcomes from
• 10:05
  - these procedures.
• 10:06
  - So just as a reference,
• 10:08
  - you know, for this particular procedure, which is
• 10:10
  - the esophagectomy where we have to make a
• 10:12
  - a gastric tube, to replace the cancer in
• 10:14
  - the esophagus
• 10:16
  - and connect this gastric tube to the esophagus
• 10:19
  - after you remove the cancer,
• 10:21
  - the the the chances of the leak,
• 10:24
  - in that area is about... Nationally, that number
• 10:26
  - is anywhere from ten to thirty
• 10:28
  - percent or even internationally. And I think our
• 10:30
  - team has been able to achieve that,
• 10:33
  - number to less than one percent,
• 10:35
  - over the last three three hundred cases, you
• 10:37
  - know.
• 10:38
  - And that's just not the work of the
• 10:39
  - surgeon, but I think that's kudos to our
• 10:41
  - exceptional team, whether it's our peri op team,
• 10:44
  - nursing team in the operating room, our anesthesiologist,
• 10:47
  - our critical care team that's taking care of
• 10:49
  - these patients, and then clearly,
• 10:51
  - my my clinic team that has,
• 10:53
  - advanced practice providers and, nursing coordinators that do
• 10:57
  - an exceptional job at this. So Roswell Park
• 10:59
  - is also a, a training site for this
• 11:02
  - particular procedure, which is robotic assisted esophageectomy,
• 11:06
  - where we have,
• 11:08
  - surgeons,
• 11:09
  - that come in, they fly in, and they,
• 11:11
  - come observe our cases,
• 11:13
  - for one to two days, and then there's
• 11:16
  - an opportunity for, one of us to go
• 11:18
  - out there to their centers and proctor them,
• 11:22
  - as well.
• 11:23
  - I love that. And I love how... I
• 11:25
  - feel like your answer just perfectly encompass, you
• 11:28
  - know, those
• 11:29
  - priorities that you have to have when you're
• 11:31
  - thinking
• 11:32
  - operationally and building your teams, but then also
• 11:35
  - clinically
• 11:36
  - and surgically.
• 11:38
  - I think it just really, you know, sets
• 11:39
  - the stage for what Roswell Park is doing,
• 11:42
  - but also,
• 11:43
  - you know, something that leaders from all over
• 11:45
  - the country at their organizations can
• 11:48
  - can take back,
• 11:49
  - for their teams.
• 11:51
  - You know, when I think about kind of
• 11:53
  - that robot assisted approach, it reminds me of
• 11:55
  - all these conversations I have with cancer leaders
• 11:57
  - about
• 11:58
  - technology and whether that's AI or surgical innovation.
• 12:03
  - Everyone's excited, and everyone just feels it's happening
• 12:06
  - at such a rapid pace development and this,
• 12:09
  - discovery.
• 12:11
  - From your role at Roswell Park, whether that's,
• 12:14
  - you know, chair of surgical oncology
• 12:18
  - or program director for the fellowship,
• 12:21
  - what is giving you the most hope about
• 12:23
  - where cancer care is headed? And that can
• 12:25
  - be something with technology or not, but
• 12:28
  - as you look forward, you know, what's exciting
• 12:31
  - you the most?
• 12:33
  - Yeah. Absolutely. I mean, I I tell medical
• 12:35
  - students that are rotating on our services
• 12:37
  - that this is probably the most exciting time
• 12:39
  - to be in the field of surgical oncology.
• 12:42
  - You know, there's so much so much innovation
• 12:45
  - happening at at so many levels.
• 12:47
  - I think three things potentially that I'll probably
• 12:50
  - highlight I'm most excited about. I think this
• 12:52
  - is field called
• 12:53
  - cancer interception
• 12:54
  - where I think, that we're gonna... We're getting
• 12:57
  - to a point that we're able to recognize
• 13:00
  - cancers early on in the process.
• 13:02
  - As you know, majority of these cancers,
• 13:05
  - are recognized when they're causing symptoms to the
• 13:08
  - patient, and they've been in patient's body for
• 13:10
  - sometimes several weeks to months before we have
• 13:13
  - an opportunity to even identify them. So I
• 13:15
  - think the way the field is moving forward
• 13:17
  - is that we'll be able to recognize either
• 13:19
  - precancerous condition or early cancers,
• 13:22
  - and a field of, what is called endo...
• 13:24
  - Endoluminal robotics where we don't even have to
• 13:27
  - make cuts on the belly to be able
• 13:28
  - to do an operation. I'm a GI surgeon,
• 13:30
  - so you can actually do this with a
• 13:32
  - scope that has an advanced capabilities to do
• 13:35
  - stuff with, you know, putting a scope through
• 13:37
  - the mouth and to be able to do
• 13:38
  - that. So I think that's something that I,
• 13:41
  - the field of end aluminum robotics that's gonna
• 13:43
  - mature in the next three to five years.
• 13:46
  - But within just the robotics that exist, the
• 13:48
  - space that exist, I mean, ten years ago,
• 13:50
  - we had one robotic platform, and now we
• 13:52
  - have at least about
• 13:54
  - 50 of these internationally that are in some
• 13:57
  - shape or form that are available and functioning.
• 13:59
  - So,
• 14:00
  - just a plethora of platforms that are available
• 14:02
  - and and different... And how they kind of
• 14:05
  - apply, you know, coming to our practices and
• 14:07
  - how we utilize them, I think that's a
• 14:08
  - field of,
• 14:09
  - constant discussion and, you know,
• 14:11
  - and it's still sort of in its infancy,
• 14:13
  - but it'll be interesting in the next few
• 14:15
  - years.
• 14:16
  - But even with advanced robotics, I think our
• 14:19
  - capability to visualize things well,
• 14:21
  - real time detection of cancer margins, all that
• 14:24
  - is gonna obviously get better with time.
• 14:26
  - But then what's also evolving is this tele...
• 14:29
  - Feel of telesurgery where,
• 14:31
  - you know, we can be at a place
• 14:32
  - and then operate several, you know, 100 miles
• 14:35
  - or even,
• 14:36
  - across the continent. I think this was,
• 14:39
  - this is something that's a reality at this
• 14:41
  - point. So imagine somebody that's, you know, that...
• 14:44
  - That's sitting in, you know, Midwest,
• 14:46
  - rural America that doesn't have to travel two,
• 14:48
  - three, four, five hours away to get their
• 14:50
  - cancer care.
• 14:51
  - How can we work with their teams locally
• 14:53
  - to be able to provide them the best
• 14:55
  - care possible? Because, you know, at Roswell, we
• 14:58
  - have this unique
• 14:59
  - opportunity where we have a pretty big catchment
• 15:02
  - area that we get patients from, not just
• 15:04
  - obviously Western New York, but, you know, Central
• 15:06
  - New York, Upstate, Northern Pennsylvania, Northern Ohio,
• 15:10
  - and, and even patients traveling sort of nationally,
• 15:13
  - to get to get some of these procedures.
• 15:15
  - So I think telesurgery will certainly be... Will
• 15:17
  - have a big presence in the future.
• 15:20
  - And then in general, I think there's... With
• 15:22
  - with, you know, with the pharmaceutical industry, there's
• 15:24
  - a plethora of targeted therapies and immune based
• 15:27
  - therapies, and,
• 15:29
  - and majority of them are started... You know,
• 15:31
  - we start to use them in in what
• 15:32
  - is called metastatic setting where the cancer has
• 15:34
  - already spread to other parts of the body.
• 15:36
  - But how do we take those
• 15:38
  - medications and drugs that are treatments that are
• 15:40
  - available, and how do we utilize them more
• 15:42
  - in the perioperative setting so we can sequence,
• 15:45
  - you know, we can sequence these therapies to
• 15:48
  - get the best cancer outcomes.
• 15:49
  - So I think that would be, that... That's
• 15:51
  - something that's already happening, and I think it's
• 15:53
  - probably gonna happen more and would be very
• 15:55
  - exciting.
• 15:56
  - I'm excited to to see all that. I
• 15:59
  - feel like, you know, your answer encompass so
• 16:01
  - much about, what there is to look forward
• 16:03
  - to.
• 16:04
  - I hope that we can connect again soon,
• 16:07
  - you know, in the next months or hopefully
• 16:09
  - years and and talk about all those innovations.
• 16:12
  - Thank you again for taking the time to
• 16:15
  - speak with me and to share your insights
• 16:16
  - with our listeners.
• 16:18
  - Absolutely. This this was this was a pleasure.
• 16:20
  - Thank you so much.
• 16:22
  - And thank you to our listeners for tuning
• 16:24
  - in to Becker's Oncology Leadership podcast.
• 16:27
  - I invite you all to check out even
• 16:28
  - more Becker's Healthcare Podcast
• 16:30
  - at beckerspodcast.com.
• 16:33
  - Thank you again to doctor Kukar for joining
• 16:36
  - me today and to our listeners. Have a
• 16:38
  - great day.