A renowned pancreatic surgeon and surgical oncologist, Christopher Wolfgang, MD, PhD, joined NYU Langone Health in January 2021 as director of the new Division of Hepatobiliary and Pancreatic Surgery in the Department of Surgery. Dr. Wolfgang previously served as the John L. Cameron Professor of Surgery, chief of hepatobiliary and pancreatic surgery, and vice chair for surgical oncology at The Johns Hopkins Hospital.
Dr. Wolfgang, whose main area of expertise is pancreatic cancer, is among one of the most experienced pancreatic cancer surgeons in the world. He has performed more than 1,200 Whipple procedures, surgical procedures for cancer found in the head of the pancreas. He has expertise in removing “unresectable” pancreatic cancers—cancer that cannot be removed through standard operations—and has extensive experience in all aspects of pancreatic surgery, including the robotic approach.
Dr. Wolfgang discusses the Division of Hepatobiliary and Pancreatic Surgery and what it means for people with liver, bile duct, and pancreatic cancer; how his research at NYU Langone Health’s Perlmutter Cancer Center might help people with pancreatic cancer; and more.
You spent most of your career at Johns Hopkins. What attracted you to NYU Langone?
Johns Hopkins is a wonderful place, and I accomplished a lot of the things that I wanted to do there. I chose to come here mainly because of the vision of the leadership of Dr. Robert Montgomery (the H. Leon Pachter, MD, Professor of Surgery, chair of the Department of Surgery, and director of the NYU Langone Transplant Institute), Dr. Andrew Brotman (professor in the Department of Psychiatry, senior vice president and vice dean for clinical affairs and strategy, and chief clinical officer), and Dr. Robert Grossman (dean and chief executive officer). They have a vision of inventing the future, and I feel like I’m surrounded by like-minded people.
You are directing the new Division of Hepatobiliary and Pancreatic Surgery. What is your vision for what the new division will look like?
In the Division of Hepatobiliary and Pancreatic Surgery, we treat diseases of the liver, bile duct, and pancreas, which includes the gallbladder. We have several outstanding surgeons in that division. We also have a larger hepatobiliary group that encompasses Manhattan, NYU Langone Hospital—Brooklyn, and NYU Langone Hospital—Long Island, and we will function as a single team regardless of location. The group spans the institution and 4 divisions and includes 14 surgeons who specialize in surgical oncology, liver transplant, and robotic and minimally invasive surgeries. The list of providers can grow when I include all of our medical oncologists, radiation oncologists, and gastroenterologists. We need them all, and we work very much as a team.
This is a big group, but we’re all linked by being a hepatobiliary and pancreas surgery group. Our group is patient-centered because the way we’re aligned has to do with how the diseases present. That is, we are organized in a way that benefits patients by rapid diagnosis and transition to treatment, and further, having the ability to offer innovative treatment not provided elsewhere.
We have a multidisciplinary pancreatic cancer clinic, a multidisciplinary pancreatic cystic neoplasm program, and a multidisciplinary liver tumor clinic. When a patient has a tumor of the pancreas, they don’t think of themselves as having a hepatobiliary problem, they think of themselves as having a pancreas problem. We have established these clinics so that we are focused on the patient. We are not siloed into divisions or into institutions.
Both you and Dr. Diane Simeone are pancreatic cancer surgeons. In what ways will the two of you complement each other?
Dr. Simeone (the Laura and Isaac Perlmutter Professor of Surgery in the Department of Surgery, professor in the Department of Pathology, director of the Pancreatic Cancer Center, and associate director of translational research) is a rare combination of surgeon and researcher. There are wonderful pancreatic surgeons out there, and there are wonderful scientists, but to have someone who is a translational scientist and a surgeon is somewhat unusual. This brings a unique perspective to the research because she is in the trenches seeing patients, and she sees those problems firsthand. And because she’s a trained scientist and has published great work, she conducts research that impacts patients directly. I think I have some of those same aspects in that I’m a busy pancreatic surgeon, and I do translational research. So it is unique to have two people at the same institution who are internationally recognized as leaders in the field.
I am extremely excited to work with her and others at Perlmutter Cancer Center. We will be able to support each other’s work and accomplish more together than we could as individuals. Our research interests overlap enough that we can help and support each other, yet they are complementary and do not directly overlap. For example, she is very much focused on early detection, which is important to me, but not the main focus of my research. I can do things to support that a hundred percent. I’m more interested in systemic control of disease in people whose cancer can be surgically removed because that’s how we fail as surgeons. There is a lot of overlap with the work that she does, but systemic control is not her main interest. To me, this is the perfect scenario, where two people with the means to move the field forward work together on complementary projects.
Can you talk more about systemic control of disease and what it means for people with pancreatic cancer?
There are two problems that we need to solve to cure pancreatic cancer: early detection and improved systemic control. The reason that this will solve the problem is that first, most patients, by the time they receive a diagnosis, have systemic disease, meaning metastatic or stage IV, and they have no chance at a cure. Nothing is going to solve that problem, except detecting tumors before they become metastatic. Early detection is important, and that’s what Dr. Simeone’s working on, and that in and of itself will be a huge step forward in curing more patients.
A minority of patients present with clinically localized disease, and as surgeons, we have the potential to cure them by removing their tumors. Unfortunately, 80 percent of these patients will have a recurrence. But these cases really aren’t “recurrences”—rather, they stem from residual disease that is left behind. We call this micrometastatic disease or disease that we can’t see. That is the second problem we need to solve. In those patients who are diagnosed with relatively early-stage cancer and we’ve removed the tumors, how do we best prevent reappearance of disease?
I should mention that much of the research in pancreatic cancer is focused on the primary tumor. And it is very important to understand that primary tumor. Yet, if you think about it from a surgeon’s perspective of how we fail with metastatic disease, which is the number one pattern of failure, it’s not the tumor we take out, the part that’s been studied very well. It’s what we leave behind that is going to cause a recurrence. The seeds of recurrence, which are called circulating tumor cells and disseminated tumor cells, that’s how the patient’s cancer recurs.
The focus of my research is to understand what we leave behind, the micrometastatic disease. The reason that that’s important is that it turns out those cells are very different than the primary tumor. So it’s not surprising that immunotherapy doesn’t necessarily work on them. Some of those cells escape, go into the liver and evade the immune system. Some of these cells have stem cell–like characteristics and they’re resistant to chemotherapy.
Now that we know those things, and as we further study these cells, we can understand what therapy is going to be better in preventing recurrences or progression of disease in surgical patients. Put early detection and better systemic control together, and we will be able to cure many more people with pancreatic cancer if we solve those problems. And getting back to what Dr. Simeone is doing and what I’m doing, what I think are the two most—and I think most people will say are the two most important aspects of pancreatic cancer—we have two people at Perlmutter Cancer Center who are focused on each one of those.
Can you talk about your commitment to training the next generation of hepatobiliary surgeons?
I knew a long time ago as I was going into medicine that I wanted to be an academic surgeon because I am enthusiastic about what we call the tripartite mission of the academic clinician. The first part is excellence in clinical care, which is easy to understand. It means to be an excellent surgeon. The second is to promote research and innovation, which is something I embrace. I have a very inquisitive personality and I want to do research that improves outcomes for our patients. The third part, which is very near and dear to me, is that I can also extend my impact by teaching the next generation how to do what I do. And not only do what I do but be better than I am.
I can only help one patient at a time, but I can extend my impact by training the next generation of people to take care of multitudes of patients and to do it better. One of the things that gets me up in the morning and brings me to work is the ability to operate and to teach the residents. And I’m looking forward to training fellows in both the lab and in the clinical setting.
You are collaborating with the NYU Center for Innovation. What are you working on?
We are working with Dr. Insoo Suh (member of the faculty in the Department of Surgery and associate vice chair, surgical innovation) in using artificial intelligence to read CT scans of pancreas tumors as well as doing work in three-dimensional rendering of the CT scans. We also are collaborating with researchers at Johns Hopkins on the Felix Project, an initiative that is using artificial intelligence to read these CT scans.
Combining those things with our experience as robotic surgeons will enable us to take data from CT scans that are stored in the robot and use deep learning to understand those data and apply them to robotic surgery. We want to be able to perform computer-augmented surgery, so that the robot is not doing the operation, but the operation and the surgeon are augmented by getting computer input based on deep learning. In computer-augmented surgery, the robot uses anatomic information from the CT scan to help guide the surgeon. The surgeon’s skill and judgment are important, but they are augmented objectively by what the robot can do.