Early Friday in a small, brightly lit operating room in Johns Hopkins Hospital, a half-dozen doctors and nurses huddled over the gut of a cancer patient, quietly passing metal instruments and surgical sutures.
After more than four hours of cutting and sewing, the lead surgeon, Dr. John L. Cameron, lifted his slightly bloodied hands, thanked his colleagues and headed for the door. The 75-year-old immediately declared the complex, life-saving surgery "one of the simpler ones."
He should know. This was Cameron's 2,000th Whipple, a surgery that gives pancreatic cancer patients their only chance of long-term survival.
Cameron has not only greatly enhanced the odds of surviving the surgery at his own hospital, colleagues and surgeons outside of Hopkins say, but has also taught a generation of other doctors. And that has helped give some hope to those diagnosed with a disease that once was a certain death sentence.
"This has been a lifelong project of his," said Dr. Julie A. Freischlag, chair of Hopkins' surgery department and Cameron's successor in the position after almost two decades. "A lot of surgeons do the operation well because he trained them. He's probably responsible for more like 10,000 surgeries."
Pancreatic cancer remains one of the deadliest cancers, though it's not as common as many other types. About 95 percent of sufferers aren't alive five years after their diagnosis.
If they have the Whipple procedure, their five-year survival rate is closer to 20 percent, according to the National Cancer Institute. The institute estimates there will be nearly 44,000 new pancreatic cancer cases in the United States this year and more than 37,000 related deaths.
To survive the cancer, patients have to survive surgery. Since Cameron took up a scalpel in the 1970s, a lot more do.
The surgical death rate has dropped from a quarter in the mid-1980s to almost none today. The improvements have come from better selection of surgery candidates, improved anesthesia and post-operative care, and repetition, said Cameron and others familiar with the surgery.
"When I first became chair of surgery in 1984, I wanted to focus on an operation and a disease where there was a lot of room for improvement," Cameron said a day before his milestone surgery. "That led me to pick pancreatic cancer and the Whipple."
The pancreas is a gland behind the stomach that releases insulin to regulate blood sugar and digestive enzymes to help the body absorb food.
Symptoms of pancreatic cancer, such as pain, yellowing eyes and digestive issues, aren't obvious, so the cancer often spreads before it's discovered. Surgery is an option only when the cancer is caught early and hasn't spread. The Whipple can take from four to nine hours and typically involves removing the head of the pancreas and the tumor, as well as the gallbladder, the common bile duct and part of the small intestine.
The patient death rate remains high because the cancer frequently returns. But Cameron said he views every patient as the one who will survive.
"Every patient I see I think we're going to cure," he said. "I tell them that and I believe it. … It's what the patients want."
Cameron pointed to other advances that make his job easier, such as chemotherapy that keeps cancer from returning after surgery and shrinks tumors so more patients can have surgery in the first place.
A vaccine developed by another Hopkins doctor can keep the cancer at bay, he said. And then there is also a test in the works at Hopkins and elsewhere that someday may be used — like the PSA test for prostate cancer — to assess someone's risk for developing the disease and their need to be scanned regularly.
Cameron plans to slow his surgery schedule a bit this summer and go on the road, marketing the hospital and all it has to offer pancreatic cancer patients.
That means a change to a schedule he's kept for decades, rising at 4:30 a.m. and arriving at the hospital every day of the week at 5:15 a.m. He typically stays until 6 p.m., except on Saturdays and Sundays when he leaves around noon.
He still plans to perform surgery two or three days a week for the next year.
That probably doesn't mean any more time for golf or his four kids, seven grandkids or wife of 54 years, though he insisted they have not been neglected over the years. He has dinner every Sunday evening with the families of two of his children, who both work at Hopkins.
His son Andrew is a liver transplant surgeon, inspired, he said, by his father's unwavering enthusiasm for surgery — and by a good challenge. The senior Cameron said transplant surgery is more complicated than the Whipple. It's also frequently more successful in the long term.
But also, Andrew Cameron said, "When I was a kid, every once in a while someone would come up to my father and say you saved my wife's life or my child's life, and that caused me to think what he does at hospital was so wonderful."
He's no less impressed with his father's accomplishment now and believes the 75-year-old is "going on 50," and can continue to perform the hours-long surgery well.
"He's run quite a marathon, though I'm not sure what mile he's on," he said. "I'm glad to be here for the last number of them."
If it's a race, the doctor in second place may be Dr. Charles Yeo, a Cameron trainee who went on to become chair of surgery at Thomas Jefferson University Hospital in Philadelphia. Yeo said he's performed 1,119 Whipple procedures.
He's not sure he'll catch Cameron, but said the patients are the ones winning.
"The accomplishment of 2,000 is amazing, but more important is that he taught dozens of Hopkins residents to do the operation safely," he said. "Think of all the hours in the OR this represents. At five to seven hours per case, times 2,000 cases, he is one of the few people who exceed the 10,000-hour rule — to achieve 'expert' status."
Byron Mullings, the 2,000th patient, said that status is important to him. The 45-year-old New Carrollton man said he ended up in a Washington emergency room after his wife noticed his eyes were yellow. After his diagnosis, the doctors there told him about Cameron.
"This thing needs to go," he said on the eve of his surgery. "And Dr. Cameron was one who made it seem like it would be easy."
Dr. John L. Cameron
Title: Alfred Blalock Distinguished Service Professor of Surgery at the Johns Hopkins University School of Medicine, past chief of surgery at Johns Hopkins Hospital.
Education: Undergraduate degree from Harvard University in 1958; medical degree from Hopkins in 1962.
Specialty: Recently completed his 2,000th Whipple, surgery for pancreatic cancer.
Family: Married, four children, seven grandchildren.