Dr. Ryan Holbrook, surgical oncologist and pioneer in innovative cancer operations, retires

Spokane surgical oncologist Dr. Ryan Holbrook is called a pioneer in innovative cancer operations, a title that doesn’t begin to describe his singular approach that began in 1995 – and remained – under a self-imposed goal.

Yes, Holbrook pioneered several procedures regionally, including one called HIPEC that combines surgery to remove abdominal cancer followed by warm chemotherapy infused and circulated with tubes into the abdomen for 90 minutes. He also introduced sentinel lymph node biopsy and liver ablation here for cancers.

Holbrook, who retired from Cancer Care Northwest April 7, mainly specialized in surgeries for all cancers of the intestinal tract, particularly of the liver and pancreas. He also did melanoma surgical treatment.

But 28 years ago, some general surgeons weren’t quick to welcome him or his procedures, then typically done in major cities. He and his wife felt drawn to Spokane, but he couldn’t find a job in the specialized cancer surgery he sought, so he opened a solo practice. Back then, people seeking specialized cancer surgeries traveled to Seattle, Los Angeles, New York or Chicago.

“I felt really strongly that the vast majority of cancer care should be delivered in communities, not just in universities or academic centers,” said Holbrook, 67.

“I tried finding a job, and there were hardly any surgical oncologists in private practice anywhere in the nation.”

At first, his practice was slow, with few local referrals. But patients started hearing about Holbrook. Before long, he did surgeries for people from here, outlying areas and other states. After five years, GYN-oncology surgeon Elizabeth Grosen joined his practice, and they worked together for two years. They merged the practice with Cancer Care Northwest, where Holbrook remained for 21 years. Grosen now is with Providence Health Care.

That 2002 merger also was unusual. Holbrook said no cancer care centers in a community setting existed then with all three types of specialists in one place: medical oncologist, radiation oncologist and surgical oncologist.

“There were surgeons at the time who did surgeries at the hospital, or they were in private practice and then they worked with those specialties, but none of them were integrated into a group.”

Holbrook grew up from age 12 in Great Falls, Montana, until college at BYU. He laughs about his one distraction then: ski racing. “I was skiing, like, six days a week in the winters, so then it took six and a half years to get through undergraduate work.”

Deciding to be a doctor, he got focused. Holbrook graduated from Northwestern University medical school, followed by surgery internships in Boston and Portland. He did fellowships at Roswell Park Comprehensive Cancer Center, Virginia Mason Medical Center and Massachusetts General Hospital.

Overall, it was nine years of surgery training, and cancer cases grabbed him. “I was interested in the whole biology of cancer and how it behaves. That just drew me in, and I said, ‘OK, I’m going to be a surgical oncologist.’ ”

In practice, Holbrook had heard about HIPEC, or hyperthermic intraperitoneal chemotherapy, as groundbreaking work and research by Dr. Paul Sugarbaker. After Holbrook asked Sugarbaker about it at a conference, that surgeon returned with papers and a manual, and told him to call if he needed help.

Holbrook successfully applied it. He did more than 700 HIPEC procedures. They can last six to 14 hours. Often, it required him as the surgeon to remove parts of the intestines, spleen or section of stomach to “debulk all visible tumors,” followed by the heated chemo.

But the approach made a difference.

“Typically, when we’re trained as surgeons, when you open up and see tumors all over, you close up and say, ‘Sorry, nothing we can do,’ ” Holbrook said. “But Dr. Sugarbaker said, ‘That’s not acceptable,’ so he did all this research and over time started seeing great results.”

In one case, Holbrook spent more than 13 hours to do a HIPEC for a woman with extreme abdominal tumors.

“It’s not a cure for a lot of people. This lady lived around 31/2 years after this, but she was so extensive that you just can’t get every little thing, there are nooks and crannies, or the tumors are just resistant to that chemo, but she got more than three years with her grandbabies and family,” he recalled.

“A few weeks ago, I saw someone in the office who I did a HIPEC on 17 years ago, and she’s been perfectly clean ever since. Hers was appendix, and they do the best.”

The use of sentinel lymph node biopsy for breast cancer and melanoma, “changed the face of how we treat those diseases.” Previously, surgeons would remove the breast tumor and take all the lymph nodes under the arm.

“Now, it’s just one or two lymph nodes, in the majority of cases,” he explained.

Radiofrequency ablation for liver cancers was another advancement.

At Cancer Care Northwest, he and other specialists coordinated care: whether it was best to do chemotherapy and radiation first, followed by surgery, or surgery first followed by chemotherapy, or other combinations. “Surgery plays a critical role in helping patients get the best outcome,” he said.

He also did a specialized Whipple procedure for pancreatic cancer.

“I did, like, 600 of those overall. The five-year survival rate at best is, like, 20%, even with surgery, but I’ve got a bunch of long-term survivors. You take out the head of the pancreas and then you reconstruct everything, so it’s complicated.”

He’s kept in touch with patients, even after they “graduated” from yearly follow-ups. Cancer care has changed in nearly three decades, with advances in chemotherapy and radiation, he said. Surgeries now bring in more robotics and laparoscopic procedures.

A letter read at his retirement party described how Holbrook wasn’t hired by a general surgery group here in the 1990s, because practice members felt only 5% of cancer cases would require such expertise. Today, Spokane has nearly 20 surgical specialists for various cancers.

His wife, Michele, described Holbrook as humble. She offered an accolade for him.

“If I had a dollar for every time someone said to me, ‘Your husband is the nicest man, doctor, surgeon I’ve ever met,’ I would be a very wealthy woman,” she said.

They have three sons, a daughter and another son they consider adopted. The couple plan to travel, ski, backpack and do a few medical missions to use his surgical skills. When asked about a career milestone, Holbrook doesn’t name surgeries.

“Any time that I could make a patient’s life better, and they could have long-term survival, that’s why I did this. That was the best.”