Understanding gastroenterology trends in preoperative care can allow gastroenterologists to better prepare patients for surgery and recovery.
Richard Hodin, MD, is chief of Boston-based Massachusetts General Hospital's Division of General and Gastrointestinal and the Division of Gastrointestinal and Oncologic Surgery. He spoke with Becker's ASC Review about the trends in preoperative gastrointestinal treatment that all gastroenterologists should know.
Dr. Richard Hodin: Neoadjuvant Rx prior to GI cancer surgery is key. Years ago, we routinely took patients straight to surgery when they had a diagnosis of cancer. Then, after surgery, some would get chemotherapy and/or radiotherapy.
This paradigm shifted a number of years ago for rectal cancer, and now is being adapted for many other GI cancers, including esophageal, pancreatic and stomach. We now understand that chemotherapy and radiation before surgery can be of great benefit — increasing the likelihood of getting clean margins in some cases.
In certain patients, the neoadjuvant treatment can turn an unresectable cancer into a resectable one. The nature of the surgery can be fundamentally changed for the better, in some cases, avoiding the need for a permanent colostomy in some rectal cancer patients.
This neoadjuvant approach highlights the need for a multidisciplinary team to be involved early on in the care of patients with GI cancer diagnoses. This extra time prior to surgery also is giving rise to "pre-hab" programs focused on exercise, nutrition, etc. that help the patient be better prepared for the surgery and postoperative recovery.