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3/15/2015
Surgeon’s arrival ‘a home run’ | Albuquerque Journal News
Dr. Itzhak Nir sits in an operating room at the UNM Cancer Center. Before he was hired there, patients had to go out-of-state to
get the specialized and complex surgeries that Nir performs. (Roberto E. Rosales/Journal)
The competition among the nation’s leading cancer centers to recruit the most talented physicians
and surgeons is intense.
That’s why Dr. Cheryl Willman says the University of New Mexico Cancer Center and School of
Medicine “hit a home run” when it recruited Israeli-born Dr. Itzhak Nir three years ago.
“We knew that he would be a fabulous cancer surgeon based on his outstanding medical training,”
says Willman, director and chief executive officer of the UNM Cancer Center. “We were thrilled to hire
him.”
Nir, 51, is one of only a handful of doctors in the country to have completed fellowships in both multiorgan transplantation surgery and surgical oncology — the former at Mount Sinai Medical Center, and
the latter at Memorial Sloan Kettering — both in New York.
He is also one of a select group of
doctors in the country who perform an
innovative dual cancer treatment.
“I thought New Mexico was the best fit
because it’s a designated National
Cancer Institute facility so it’s very clean
in the sense that I’m doing only cancer
surgery, and it has all the ancillary
services with everything under one roof,”
says Nir.
In addition, UNM Cancer Center is part of
a larger university setting with research
and teaching components. “You get to
train the next generation, so my personal
Israeli-born Dr. Itzhak Nir walks a hallway at the UNM Cancer Center. Nir
has completed fellowships in multi-organ transplantation surgery and
surgical oncology. He is one of a handful of doctors in the country
trained to perform very complex cancer procedures. (Roberto E.
Rosales/Journal)
impact is much greater here,” says Nir,
also an assistant professor in the Department of Surgery at the UNM School of Medicine.
Perhaps the biggest factor in accepting the job at UNM Cancer Center was because “there is a need
here,” says the soft-spoken physician.
A focus of Nir’s research is gallbladder cancer. “New Mexico is one of the global hotspots where
gallbladder cancer is endemic, particularly in Native American populations,” he says. “We don’t know
why, but if you compare it to the non-Native population, the incidence rate for gallbladder cancer is
nine-fold higher.”
This type of cancer is “very lethal, very aggressive” and can spread quickly, making the outcome of
surgical intervention “dismal,” he says.
Because people live easily without a gallbladder, the simple solution is to remove the organ preemptively.
“The trick is to identify those individuals who have the propensity to develop this type of cancer,” Nir
says. “You can’t just go to the Navajo Nation and remove 300,000 gallbladders, so we are doing
active research to better understand the causes of the disease, the mitigating factors and how to
identify those people who could be treated pre-emptively before they get the cancer.”
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3/15/2015
Surgeon’s arrival ‘a home run’ | Albuquerque Journal News
In addition, Nir is credited for developing
new surgical programs for cancer
patients “and bringing state-of-the-art
cancer surgery techniques to New
Mexicans,” Willman says.
One of these programs involves
surgically implanting pumps to deliver
chemo agents directly into the main
artery of the liver as a way to treat
inoperable patients whose colo-rectal
cancer has spread to the liver.
The UNM Cancer Center is a designated National Cancer Institute
facility. (Roberto E. Rosales/Journal)
Since coming to the UNM Cancer Center
in late 2010, Nir has performed more
than 350 major operations, many of them
complex.
He is also responsible for introducing New Mexico to the dual modalities of cytoreduction surgery
combined with hyperthermic (heated) intraperitoneal chemoperfusion, or HIPEC. It is performed on
select patients with widespread cancer of the lining of the peritoneal cavity, the abdominal space that
contains the stomach, spleen, gallbladder, liver and intestines.
The cytoreduction part of the procedure involves opening the peritoneal cavity and cutting away
visible tumors and cancerous tissue, and may require removing portions of some organs.
That is followed by the HIPEC treatment in which a sterile solution containing a chemotherapeutic
agent is heated to 42 degrees Celsius (107 degrees Fahrenheit) and continuously circulated and
agitated through the abdominal cavity for 90 minutes.
Bathing the cavity with the heated solution “enhances the permeability and absorption” of the chemo
agent, says Nir, and kills residual cancer cells while only minimally exposing the rest of the body to the
toxic effects of the drugs — one of the downsides of administering the drugs via transfusion or in pill
form.
In the last year, Nir has screened about 30 patients for the dual procedures but only 14 were deemed
appropriate candidates. Of them, four procedures were aborted because the cancer was too
advanced. Of the 10 remaining people who underwent them, one died, three still have cancer but
have experienced palliative benefits, and six people are disease-free.
“To me, it’s a cure,” says 47-year-old Greg Ramalho of Farmington, who was diagnosed with
appendiceal cancer last August.
The married father of two teenagers initially thought his only option was the more common protocol of
removal of the appendicitis followed by intravenous chemotherapy.
“So I went online and found out about HIPEC and learned that Dr. Nir was one of the people doing it
and he was at the University of New Mexico. I contacted him and decided it was a better way to go.”
Ramalho had the surgery in October. Luckily, the cancer was confined to the appendix and adjacent
gelatinous fluid in the abdominal cavity. Subsequent follow-up tests have detected no sign of the
disease.
“The procedure is fairly aggressive, compared to what they’ve done in the past, but it’s been around
for a number of years so it’s not experimental, and I’ve been told it’s now the standard of care for this
kind of cancer,” Ramalho says. “It’s just that not every cancer doctor is trained to do it. I was really
glad to find Dr. Nir. He’s awesome. There’s no telling what the outcome would have been if I’d gone
the traditional way of treatment.”
For Nir, who clearly loves what he does but is somewhat uncomfortable talking about himself, it’s all in
a day’s work. But he breaks into a broad smile when talking about his family.
When not at the hospital, he, his wife, Sharon, and their two children, ages 13 and 10, travel the state
to absorb “the magnificent landscape,” he says. The family has become a fan of winter sports, which
doesn’t have a large following in Israel. In their short time in New Mexico they have taken up and
become proficient at downhill and cross-country skiing.
“And of course, we also love the food,” Nir says. “My kids are addicted to chile and would put it on
anything. We went on a trip to Moab, Utah, and ate at a restaurant that was more Baja Mexico style.
They’re used to eating New Mexican food … The food there wasn’t hot enough.”
Patient ‘had total trust’ in doctor
Don Chalmers, former UNM regent and board member of the UNM Health Sciences Center, found
himself on the patient side of the table when he had to have a tumor “the size of a football” removed
from his abdomen at the UNM Cancer Center.
“He fixed me, I’ll say that,” says Chalmers of Dr. Itzhak Nir.
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3/15/2015
Surgeon’s arrival ‘a home run’ | Albuquerque Journal News
Chalmers, owner of a local Ford automotive dealership, has
had other surgical procedures in the past “but nothing this
major,” he says. He learned about Nir from Cancer Center
director, Dr. Cheryl Willman and then did some independent
research. “I had total trust. I don’t know that I was ever at as
much peace going into a surgery and knowing what I did
about the doctor.”
As a business leader and a higher education insider,
Chalmers says getting the best people for the job is “vitally
important.”
“If you want a first-class, No. 1 organization, you have to
recruit the right people, the right surgeons, the right
researchers. If you get the top people then you attract the top
students who want to study under them, so it becomes
somewhat synergistic.”
Albuquerque businessman Don Chalmers, a
current board member of the Albuquerque
Chamber of Commerce and a former UNM
regent and UNM Health Sciences Center board
member, says getting highly skilled doctors
attracts highly skilled students who want to
study under them. (Journal File)
— Rick Nathanson
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