Houston Methodist Division of Surgical Oncology & Gastrointestinal Surgery

Surgical Oncology in Abdominal & Malignant Hepatopancreatobiliary (HPB) Cancers 

At Houston Methodist, our Surgical Oncology team provides comprehensive, high-acuity care for patients with complex abdominal and malignant hepatopancreatobiliary (HPB) cancers, including pancreatic, hepatic, biliary and advanced gastrointestinal malignancies. We distinguish ourselves through high procedural volume, seamless multidisciplinary integration, and the consistent delivery of technically demanding oncologic surgery with precision and rigor.

We have been early and sustained adopters of robotic surgery as a standard approach for complex HPB procedures when clinically appropriate, while continuing to provide excellence in open surgery for advanced or anatomically complex disease.

Our team is actively expanding robotic approaches for pancreaticoduodenectomy (Whipple), distal pancreatectomy, and major and minor hepatectomy. These innovations are associated with lower complication rates and improved return to intended oncologic therapy (RIOT), reducing the risk that patients will be unable to complete multimodality cancer treatment. 

Our surgical management extends across gastrointestinal malignancies, including partial, subtotal and total gastrectomy for gastric cancer and select benign conditions, as well as esophagogastrectomy for bulky gastroesophageal tumors. We anchor care planning in real-time, multidisciplinary tumor boards, aligning surgical, medical and radiation oncology to ensure cohesive treatment strategies. Through this hub-and-spoke model, we bring specialized surgical expertise to patients across the Houston Methodist system.

Our research efforts focus on HPB malignancies and include clinical trials, translational collaborations supported by tissue banking, and a pancreatic cancer prehabilitation study led by Atiya Dhala, MD, and Nestor F. Esnaola, MD, MPH, MBA, FACS, investigating how functional optimization affects treatment tolerance and tumor biology. We also leverage advanced surgical platforms to support emerging research in technology-enabled, data-driven oncology.

As an academic surgical oncology program, we provide robust training for general surgery residents, including six to eight months of dedicated oncology experience and growing participation in NIH T32–funded research pathways. By combining mentorship, active clinical trials and hands-on experience, we prepare trainees for careers in advanced abdominal and HPB surgical oncology.

Surgical Oncology in Melanoma & Sarcoma

Our Melanoma and Sarcoma team at Houston Methodist provides comprehensive care for patients with melanoma and rare soft tissue and bone sarcomas. These malignancies present distinct clinical and research challenges due to their biological diversity, low incidence and frequent need for complex, multidisciplinary treatment strategies.

Because sarcomas are rare — accounting for approximately 1% of all cancers — our team participates in collaborative research networks that aggregate outcomes across institutions. This includes our involvement in the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Through these partnerships, we contribute patient data to shared initiatives, enabling meaningful investigation of surgical approaches, disease behavior and long-term outcomes that would be difficult to study at a single center. 

We anchor clinical care in high-level multidisciplinary collaboration. Surgical planning is integrated through tumor boards that convene medical oncology, radiation oncology, pathology and reconstructive surgery. Many of our melanoma and sarcoma procedures require complex reconstruction following tumor resection, often involving microvascular techniques, muscle flaps or tissue transposition performed in close collaboration with plastic and reconstructive surgeons.

As a high-volume academic center, we provide residents with extensive exposure to melanoma and sarcoma surgery, including lymphadenectomy, radical resections, post-neoadjuvant surgery and coordinated reconstructive care. Our approach emphasizes comprehensive cancer management and prepares trainees to meet the clinical and intellectual demands of surgical oncology practice. 

Endocrine Surgery, Thyroid, Parathyroid & Adrenal Diseases & Cancers

Our Endocrine Surgery program at Houston Methodist offers comprehensive care for patients with benign and malignant thyroid, parathyroid and adrenal disorders. We are recognized nationally for our breadth of clinical expertise, high procedural volume and leadership in innovative surgical approaches for complex endocrine conditions.

We lead one of the highest–volume adrenal surgery programs in the nation across all operative approaches and are internationally recognized as a premier center for advanced robotic adrenal surgery. Our team has pioneered multiple innovative techniques, including the world’s first documented single-port robotic retroperitoneoscopic adrenalectomy, setting new standards in minimally invasive adrenal surgery.

Robotic approaches are offered routinely when safe and appropriate, allowing us to manage highly complex adrenal pathology through cutting-edge, minimally invasive techniques. At the same time, we maintain exceptional expertise in open adrenal surgery, ensuring comprehensive, multidisciplinary care for patients with advanced, locally invasive or oncologically challenging disease.

In thyroid and parathyroid surgery, we integrate advanced technologies including radiofrequency ablation and emerging ablative platforms, expanding treatment options beyond conventional surgery for appropriately selected patients. We are also one of the few centers in the country performing thyroid embolization for substernal thyroid goiters, offering an advanced and highly specialized adjunct in complex cases. Our team routinely employs intraoperative nerve monitoring and localization strategies, while system-wide molecular reflex testing for indeterminate thyroid nodules informs precision surgical decision-making in collaboration with specialized endocrine pathologists.

We support clinical care with strong multidisciplinary collaboration and an active academic mission. As a high-volume referral center, we provide residents with extensive exposure to complex endocrine surgery, as well as opportunities for scholarly engagement and leadership in innovation, education and outcomes-driven research.

Breast Surgery, Breast Cancer & Reconstruction

Our Breast Surgery team at Houston Methodist delivers comprehensive, multidisciplinary care for patients with benign and malignant breast disease, combining oncologic surgery with advanced reconstructive techniques. We prioritize personalized, evidence-based decision-making across the full spectrum of breast cancer, from early screen-detected lesions to locally advanced and complex tumors.

A hallmark of our program is the close operative integration between breast surgical oncology and plastic and reconstructive surgery. This collaboration allows us to offer a full range of surgical options, including breast-conserving surgery with oncoplastic reconstruction, mastectomy with immediate reconstruction, and complex chest wall resections requiring coordinated closure and reconstruction. Oncoplastic techniques enable tumor excision with negative margins while preserving or restoring breast contour and symmetry, often using simultaneous tissue rearrangement or contralateral balancing procedures. 

For patients undergoing mastectomy, we increasingly employ nipple-sparing approaches when oncologically appropriate, paired with reconstructive strategies that prioritize both form and function. Our team incorporates nerve preservation and neurosensitization techniques to support sensory restoration of the breast and nipple-areolar complex, addressing long-term quality-of-life considerations alongside cancer control.

We have also advanced tumor localization for nonpalpable breast cancers, which is now most of the screen-detected disease. Our adoption of wireless localization technologies enhances intraoperative precision, improves margin confidence and streamlines operative workflow, complementing coordination with breast imaging and pathology teams.

Clinical care is distinguished by real-time multidisciplinary collaboration. Fellowship-trained breast radiologists and dedicated breast pathologists participate directly in operative planning and intraoperative assessment, creating a tumor board environment for every case. This coordinated approach contributes to consistently low margin re-excision rates, well below national benchmarks, reflecting our commitment to quality-driven outcomes.

As a high-volume academic referral center, we provide residents with exposure to the full breadth of breast surgery, including complex oncologic resections, reconstruction-adjacent procedures and multidisciplinary cancer management. By participating in multiple national clinical trials, our team ensures that both patients and trainees benefit from evolving, data-driven standards of care.

We are a highly collegial team of clinicians spanning the full spectrum of surgical oncology and breast and endocrine surgery. We partner both within and across disciplines, emphasizing clinical excellence via personalized treatment, evidence-based practices and holistic care that considers the patient’s full clinical, social and economic context.

Houston Methodist’s strong culture and I CARE values — integrity, compassion, accountability, respect and excellence — underpin our ethos, from recruitment through retirement. These values are on full display during our tumor boards, which are used not just for routine review but for in-depth, cross-disciplinary patient-specific discussions. In our clinical work, we are supported by nurses and nurse practitioners, patient navigators, dietitians, social workers, financial counselors and chaplains, all contributing to our holistic care model.

Well-known and regarded both locally and nationally, our surgeons hold prominent leadership roles in national organizations such as the American Board of Surgery, among others, and serve on National Institutes of Health (NIH) study sections and professional society committees. Our faculty also consult on national board exams for surgical oncologists. Interdisciplinary collaboration and multidisciplinary tumor boards allow us to share experiences and opportunities to advance our field. Faculty members are deeply involved in education, mentoring residents and undergraduate students.

Many of our surgeons are also members of two prominent Houston Methodist centers of excellence — the Lynda K. and David M. Underwood Center for Digestive Health and the Dr. Mary and Ron Neal Cancer Center — fostering collaboration and promoting cross-disciplinary and cross-division education, clinical innovation and research. 

Our Faculty ➝   Our Physicians ➝ 

As leading physician-scientists, we focus our research and clinical efforts on cancer prevention, community outreach and engagement, cancer health disparities, and population science research in accordance with National Cancer Institute cancer center guidelines.

Our surgical oncology faculty are deeply involved in translational research, notably NIH-funded research partnerships with Baylor College of Medicine and MD Anderson Cancer Center.

Nestor Esnaola, MD, is leading a $1.6M Cancer Prevention and Research Institute of Texas (CPRIT)- funded outreach initiative for breast, colorectal, cervical and HCV cancer screening.

Our clinical trials are focused on uncovering new pre-operative approaches to optimizing long-term outcomes. Recent clinical trials include neoadjuvant therapy for melanoma, combined chemo-immunotherapy for pancreatic cancer and DEBRA trial for breast cancer.

The depth of our clinical expertise is directly integrated into our academic involvement. Experts in our division are passionate about training the next generation of leaders in the field of oncology and surgery.

Residents participating in our General Surgery Residency program spend eight-week rotations in our division, gaining exposure to high-volume, complex oncologic procedures. Academic collaborations include Baylor College of Medicine and MD Anderson Cancer Center. We regularly host high school students and undergraduate summer fellows.

Our physicians are involved with the Houston Methodist Neal Cancer Center GI Oncology Symposium, featuring expert presentations on advancements in immunotherapy, molecular diagnostics, targeted therapies and new surgical techniques for gastrointestinal cancers.

We are also involved with the Houston Methodist Neal Cancer Center Annual Symposium for solid and hematologic malignancies, bringing together scientists and physicians from basic, clinical and epidemiological research. Educational topics span innovative translational science to clinical updates, with strategies for implementation in current clinical practice.

For ongoing training and CME opportunities, we provide regular surgery and oncology grand rounds. We also hold multidisciplinary tumor boards to discuss the latest advancements.

Our division remains deeply involved in the community through outreach programs including CPRIT-funded cancer screening initiatives and educational events in partnership with Legacy Community Health. Outreach includes hosting educational events and breast surgeons participating in educational cancer outreach events.