GIST Specialist for Sherman Oaks, CA
Some gastrointestinal stromal tumors sit in forgiving places. Others sit against the pancreas and the bile duct, where the difference between a limited resection and a major operation comes down to the surgeon. Joshua Ellenhorn, MD, FACS is twenty minutes over Coldwater Canyon.
- Published robotic resection of a duodenal GIST
- Clinical Professor of Surgery, Cedars-Sinai Medical Center
- Pancreas sparing approaches where the anatomy permits
- Records shared directly with your Valley physician
Where the Tumor Sits Decides How Big the Operation Is
A three centimetre GIST on the outer curve of the stomach is a wedge resection and a night in hospital. The same tumor in the second part of the duodenum is a different proposition entirely, because the duodenum is wrapped around the head of the pancreas and shares its blood supply, its bile drainage, and very little spare room.
The consequential question there is whether the tumor can be removed with a limited local resection or whether the anatomy forces a pancreaticoduodenectomy, the Whipple procedure. That is not a small difference. One is a few days in hospital and a straightforward recovery. The other is one of the largest operations in abdominal surgery.
What decides it is partly the tumor and partly the surgeon. Many duodenal GIST that get referred for a Whipple can in fact be taken out with the pancreas left intact, by someone who has done enough of them to know where the margin genuinely lies. Getting a second opinion before consenting to a Whipple for a GIST is, in my view, close to mandatory.
Why GIST Behaves Unlike Other Abdominal Cancers
GIST grows from the interstitial cells of Cajal, the pacemaker cells inside the wall of the digestive tract that set the rhythm of peristalsis. It is a sarcoma rather than a carcinoma, and that distinction has practical consequences.
It rarely spreads to lymph nodes, so the nodal clearance a gastric or duodenal adenocarcinoma would demand is generally unnecessary. That is precisely why a limited resection can be curative, and why a Whipple is often more operation than a duodenal GIST actually requires.
Nearly all carry a KIT or PDGFRA mutation locking a growth signal on, which is what makes targeted therapy effective. For a bulky duodenal tumor, several months of imatinib beforehand can shrink it enough to convert an impossible resection into a manageable one. Knowing when to use that lever is often more valuable than operative speed.
Establishing Exactly Where and What
Cross sectional imaging does most of the work in defining the relationship between the tumor and the surrounding structures, which for a duodenal lesion is the whole question. A good quality CT with appropriate phases, sometimes supplemented by MRI, is what determines whether pancreas preservation is realistic.
Endoscopic ultrasound adds depth information and allows controlled sampling where tissue is needed. Sampling is not automatic, since rupturing the capsule seeds tumor cells across the abdomen. But if preoperative imatinib is being considered, a biopsy with mutation testing becomes essential, because you cannot sensibly choose a drug and a dose without knowing the mutation subtype.
Bring what you already have from your Sherman Oaks gastroenterologist. Discs, reports, slides. A second reading of existing imaging frequently changes the proposed operation without a single new test.
A Duodenal GIST, Removed Robotically
The third video below is the operation this page is about. It is one of very few published recordings of a robotic duodenal GIST resection, narrated by the surgeon performing it.
Laparoscopic Resection of a Gastric GIST
A gastric GIST taken out through small incisions with the capsule intact.
Gastric GIST Resection: A Simplified Approach
A streamlined gastric approach that shortens operating and recovery time.
Robotic Resection of a Duodenal GIST
The duodenal case: removal with the pancreas and bile duct preserved, in the confined space around the head of the pancreas.
Ask Whether the Pancreas Can Stay
For a duodenal GIST, that single question can be the difference between a few days in hospital and one of the biggest operations in abdominal surgery. It deserves a second opinion from someone who does these regularly.
Certifications and Appointments
Two American Board of Surgery certifications, a Cedars-Sinai teaching appointment, and membership of the societies that set the standards for this disease.
- American Board of Surgery, certified in General Surgery
- American Board of Surgery, certified in Colorectal Surgery
- California State Medical License
- Florida State Medical License
Joshua Ellenhorn, MD, FACS
Dr. Ellenhorn is a surgical oncologist and Clinical Professor of Surgery at Cedars-Sinai Medical Center, and a collaborative member of the Samuel Oschin Comprehensive Cancer Institute. He is regarded as one of the leading GIST surgeons in the United States.
His practice concentrates on complex abdominal cancers and gastrointestinal stromal tumors rather than covering general surgery broadly, which is what allows the technical depth of his published operative videos and why physicians across the San Fernando Valley refer these cases to him.
He is certified by the American Board of Surgery in General Surgery and Colorectal Surgery, a Fellow of the American College of Surgeons, and a member of the Society of Surgical Oncology and the American Society of Clinical Oncology. He practises with the Surgery Group of Los Angeles.
What Patients Say
Reviews left by patients treated by Dr. Ellenhorn at the Surgery Group of Los Angeles.
★★★★★Very kind stuff, great service. Dr Joshua Ellenhorn is a very calm doctor who takes time with his patient.
Anita Lukacevic
★★★★★I was very pleased with the office staff, they were always very pleasant and helpful. I was very impressed with Dr. Ellenhorn as well. He was very friendly and addressed all my concerns regarding my surgery and aftercare and follow up.
Terry Jackson
Three Steps Over the Hill
Send the Imaging
Call (310) 356-3792 or book online, then forward your CT or MRI, endoscopy report, and any pathology. For duodenal tumors the imaging quality matters more than usual, so send the actual study rather than only the report.
Get the Operative Plan
You should leave knowing which operation is proposed, whether the pancreas is preserved, whether medication comes first, and what recovery realistically looks like.
Surgery and Follow Up
Resection at Cedars-Sinai with a defined surveillance schedule afterwards, and your Valley gastroenterologist or oncologist copied on everything.
Twenty Minutes Over the Hill
Coldwater Canyon south to Beverly Drive, then east through Beverly Hills to 3rd Street, is usually the most reliable line from Sherman Oaks. Laurel Canyon down to Fairfax and south is comparable and often better in the morning. The 405 to Santa Monica Boulevard east is fine off peak but the least predictable of the three.
The office sits in the medical plaza attached to Cedars-Sinai Medical Center, so imaging, pathology, and the operating rooms are all in one building. For anyone crossing the hill it is worth knowing that a single trip usually covers what would otherwise be three.
Patients from further out, including Arizona and Nevada, can have imaging and pathology reviewed remotely first.
8635 W 3rd St, Suite 880W
Los Angeles, CA 90048
Monday to Saturday, 11:00am to 8:00pm
Closed Sunday
Frequently Asked Questions
What is the best route from Sherman Oaks?
My GIST is in the duodenum. Why is that harder?
Will I lose part of my pancreas?
What is the role of robotic surgery here?
Can I be seen without a referral?
Do you work with hospitals in the Valley?
How large does a GIST have to be before it needs removing?
What happens at the first appointment?
A Duodenal GIST Is Not Automatically a Whipple.
If you have been told a tumor near the pancreas requires a major resection, have the imaging read by a surgeon who removes these with the pancreas intact before you agree to anything.
