Dr. Fabian Emura, of the EmuraCenter


Dr. Fabian Emura, of the EmuraCenter

is a gastroenterologist and general surgeon here in Bogota, who specializes in the detection and treatment of digestive cancers.  Along with his clinic, he has also created two separate divisions; a foundation for promote the prevention and detection of digestive cancers, and a medical education division – which supports training physicians world-wide in the endoscopy techniques he currently uses.

Currently, Dr. Emura is the only physician outside of China, Korea and Japan (where gastric cancer is endemic, and accounts for 20% of all cancers) who is treating early stage (stage I) cancers with endoscopic surgery versus a more radical gastrectomy.  This procedure has already been well validated in Asia, where it has been used for over a decade.

Dr. Emura has also created and implemented a classification system for the grading and staging of digestive lesions.

By using chromography endoscopy (or chromoendoscopy) and a wax dye,  doctors such as Dr. Emura are better able to visualize lesions that might otherwise be missed.

His research has also focused on differentiating colon lesions endoscopically, (to prevent unnecessary surgery for benign lesions).

He is currently working on screening guidelines (particularly for populations with higher incidence of gastric cancers such as in Colombia) because one of the main problems that still exists – is that the majority of patients with stomach cancer – are diagnosed late – when treatment options are limited and noncurative.

In the OR with Dr. Buitrago, in the dentist’s chair and more


Spent the morning at Shaio, in the operating room with Dr. Ricardo Buitrago.. Either my gringa accent is improving (doubtful) or I really have become a familiar face around there..  Observed Dr. Buitrago perform a couple of cases; the second was a VATS thymectomy, which definitely ranks above the traditional sternotomy.

Dr. Buitrago, thoracic surgeon

Ran into some strangely reticent native english speakers in the halls of Shaio today.. (Usually Americans, Brits and the like get real familiar with each other when we see another..) Didn’t introduce themselves even after I made a point of introducing myself.. Something’s up over at Clinica Shaio.. Is it a medical tourism company, or an impending branding agreement?  I’ll see what I can find out.

Next I checked in with Dr. Gamboa, DDS – for those of you reading from afar – dental evaluations are completely different – they require an actual patient visit (no observation here.)  Now that all of my family, friends, classmates and housemates have served as confederates for dental visits – I knew what was next when I cracked a tooth last week.. (Just so everyone knows how dedicated I am to my research – I had several dental repairs without anesthesia of any sort.. (no local, nada).   And truthfully, it went very well.. (and my teeth look / feel great..)

Dr. Gamboa, DDS

last, but certainly not least for today was Dr. Fabian Emura, MD, PhD.  He didn’t have a lot of time today, so I am going back Wednesday so I can tell you more about him, and the Emuracenter, which is doing a lot of interesting things for the diagnosis and treatment of gastric cancers..

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy


I’ve been wanting to write more on this topic since I initially discussed it with Dr. Fernando Arias, MD but first, I had to educate myself more on the topic, before I could present it here. After some additional reading, and lots of additional questions for Dr. Arias – here we go…

When I first heard about this treatment being offered here in Bogota – I knew I had to tell you all about it: since this treatment is used to treat patients that are otherwise out of options.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is used to treat patients with advanced abdominal cancers such as digestive or gynecological cancers that have spread inside the peritoneum (abdominal cavity). In many cases, these patients would otherwise receive either standard chemotherapy (not very effective) or palliative treatment only at this point – and had a very dismal** prognosis.
Now obviously, this isn’t some sort of miracle cure for everybody, and it isn’t easy, or complication-free – in fact, it is an intensive, radical approach with serious side effects, and potentially lethal complications
but it is a chance to try and aggressively pursue treatment for patients who would otherwise have little or no hope.

Some of the long term data have been very encouraging, showing significant five year survival benefits, but some of the reseach doesn’t. Some of the long term data is marred by changing techniques, administration and chemotherapy dosing.. A lot of the research, such as the Dutch trial showing 8 year follow up is plagued by small sample sizes, which limits our ability to draw strong conclusions about therapy. However, in a few of the articles I reviewed, the “c” word (Cure) was used selectively.

This treatment has been around for about ten years, but it isn’t widely available. It’s only offered at about 14 centers in the USA, a few in Europe and three in Latin America (one being here in Bogota).

So what is it? HIPEC or the short hand for this complex mouthful is surgery (laparoscopic surgery here in Bogota) to remove all visible of cancer tissue, while infusing HOT (hyperthermic) chenotherapy to kill all the cancer cells that are microscopic or not visible to the naked eye in surgery. The advantage of instilling chemotherapy right into the abdomen is that treatment is directed at the site of the disease. The warm solution promotes more effectively killing of cancer cells, and by combining surgery with chemotherapy, doctors are able to treat more advanced cancers with more effective treatment modalities (in cancer-speak: being able to surgically remove cancer is always more effective that treating it with drugs, but with standard treatments doctors could only treat limited disease (disease that had not spread). It sounds pretty simple, but it’s actually a fairly complex, drawn out process that takes multiple, multiple hours in the operating room and requires patients to be hospitalized for at least a week.

So far, Dr. Arias, and the oncologist he works with (sorry, I am blanking on the spelling of his name) started a program to offer this treatment in Bogota in 2009. Since then, they have performed over 30 cases (which if you look at the research, you’ll see is actually a fairly large number) since then.

** ‘dismal’ and ‘very dismal’ is not my editorializing; this language was used in several of the articles I read.

I’ve included some references for more information on this treatment for my readers, at the bottom of the page.

Additional References: (links to original research articles)

1. If you are only going to read one article; read this french one (in english) called:Hyperthermic Intraperitoneal Chemotherapy in Advanced
Gastric Cancer: The End of Skepticism?
It gives a good overview of WHO benefits from this treatment in regards to patients with gastric cancers.

2. Ten year’s experience of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy – San Guiseppe Hospital, Italy

3. Hyperthermic Intraperitoneal Chemotherapy – this is a technical article that explains the rationale of treatment, and the actual methods of treatment with discussion for other medical personnel.

4. A very small Dutch trial with 8 year outcomes