Sentara Surgery Specialists
Medical Director, Sentara Cancer Network
Surgical oncology wasn’t Rick Hoefer’s first choice for a career. A lifelong athlete, he liked working in the training room as much as playing the sports; and at Gettysburg College, where the training room was much better equipped than his high school’s, he became enthusiastic about coaching and physical therapy. In fact, when he entered graduate school at the University of Pennsylvania, his sights were set on a degree in physical therapy. But he soon discovered he was much more drawn to his anatomy lessons, and decided to pursue a career in medicine, and to become a surgeon.
He earned his medical degree from the Philadelphia College of Osteopathic Medicine. While a medical student, he was assigned to Dr. C. Everett Koop’s Pediatric Surgery Service at Children’s Hospital of Philadelphia. “Dr. Koop and his chief fellow at the time, Dr. Moritz Ziegler, were wonderful to work with,” Dr. Hoefer says. “Their influence was profound.” Both pediatric surgeons, they motivated Dr. Hoefer to want to become a pediatric surgeon. Ultimately, he chose surgical oncology, he says, because he wanted patients he could talk to. After medical school, he completed an internship at the Malcolm Grow Medical Facility at Andrews Air Force Base in Maryland, followed by a second internship and residency at Wilford Hall Medical Center at Texas’s Lackland Air Force Base. He then served a fellowship in surgical oncology at M. D. Anderson Cancer Center.
Following his fellowship, Dr. Hoefer served at David Grant USAF Medical Center and Wilford Hall USAF Medical Center as a surgical oncologist and residency training officer. During that time – 1984-89 – he also served as Consultant to the U.S. Surgeon General. He returned to active duty to serve as Chief of Surgery for the 159th MASH unit in Iraq during the Persian Gulf War. In 1991, he and his wife, Dr. Elizabeth Harden, a medical oncologist, moved to Hampton Roads, where they have both practiced ever since.
Dr. Hoefer has devoted his practice to caring for patients with breast, colorectal, hepatobiliary, pancreatic and melanoma cancers. “It’s a very exciting time to be in oncology,” he says. “There are new modalities and techniques for treating a number of cancers, even those aggressive cancers that carry the more formidable prognoses.”
Dr. Hoefer and his colleagues in the Sentara Cancer Network are addressing one of the most formidable of all – pancreatic cancer. “In 2009, we wanted to improve the quality of pancreatic cancer treatment, so with the help of Dr. Roger Perry at EVMS and many others, we developed a pancreatic cancer consortium within the Network,” he says. “We developed a web-based bi-weekly conference, where the five of us who perform the majority of pancreatic surgeries in the area – Doctors James Schneider, Roger Perry, Eric Feliberti and Jason Wilson and myself – present our cases. Our colleagues in pathology, gastroenterology, medical oncology, radiation oncology, and radiology join us as well; so every subspecialty reviews and discusses each case in real time, making recommendations and functioning as a cohesive team.”
The members of the consortium look very carefully at outcomes and quality metrics: during the past two and a half years, their postoperative mortality for surgery is less than the national average of two percent. “That’s as good as you can get anywhere in the country,” Dr. Hoefer says. That statistic includes pancreatic ductal carcinoma as well as neuroendrocine, duodenal and bile duct tumors. Even with early diagnosis, it’s still among the most formidable prognoses, he acknowledges, because there aren’t many patients who don’t have positive nodes or negative margins.
Dr. Hoefer and his partner, Dr. Dennis Cruff, have also performed two Whipple procedures in the past year laparoscopically. “It’s being done at several centers around the country, but we’re the only ones who’ve performed it in Hampton Roads so far,” he explains. “Patients have to be very carefully selected, but we think it’s going to be equivalent to doing an open operation, with a much easier, greatly shortened recovery period for the patient.”
There is another promising modality available for patients with colon and rectal metastases, ovarian cancer and appendiceal cancers and pseudomyxoma – and in rare cases, those with mesothelioma and even gastric cancer, Dr. Hoefer notes: heated intraperitoneal chemotherapy, or HIPEC. HIPEC is administered after the gross tumor is removed from the abdominal cavity (cytoreduction), and can add as much as two hours to an operation. “We started our program in 2005 at Sentara Careplex,” he says. “We’ve done close to a hundred HIPEC procedures thus far, and the results have been very gratifying. We’ve had several colorectal cancer patients who are now five or six years out from surgery and doing well.”
For breast cancer patients, Dr. Hoefer and his colleagues offer another innovative treatment not being done elsewhere in Hampton Roads: intraoperative radiation. For early stage cancers, it’s administered during lumpectomy, and has shown promising results equivalent to whole breast radiation. He and Dr. Wilson, along with Dr. Song Kang, have contributed to abstracts being presented this Spring to the American Society of Breast Surgeons and the Society of Surgical Oncology.
Dr. Hoefer has a personal connection with breast cancer: his mother, after watching her mother and her sister suffer with breast cancer, and her step-daughter die of breast cancer, made a grant to Sentara to establish the center that bears her name: the Dorothy G. Hoefer Comprehensive Breast Cancer Center, which he serves as Co-Director with Dr. Kelly Allison. “It’s very humbling for me,” he says, “that they named the Center for her.”