Understanding gastroenterological surgery trends in preoperative, intraoperative and postoperative care is critical for the long-term success of GIs and GI practices.
Richard Hodin, MD, is chief of Massachusetts General Hospital's Division of General and Gastrointestinal and the Division of Gastrointestinal and Oncologic Surgery. He spoke with Becker's ASC Review on trends in GI surgery that gastroenterologists should know.
This interview was edited for brevity and clarity.
Question: What are trends in GI surgeries that gastroenterologists should know?
Dr. Richard Hodin:
Preoperative care trends:
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 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 and, 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.
Intraoperative care trends:
Laparoscopic approaches are now utilized in a wide array of GI surgical procedures. More recently, robotic technology has been applied to some areas of surgery, especially when there are hard-to-reach sites.
The advantages of the robotic approach are still not well-defined, and we have learned the hard way that some new approaches like this can be associated with increased complications, especially early on.
Something to keep an eye on in the future is the application of artificial intelligence to both teach young trainees how to do procedures but, even more importantly, to make surgery safer.
Postoperative care trends:
Home hospital programs are being developed that allow for patients to return more quickly to their comfortable home environment by utilizing resources from the hospital that can provide advanced care in the home setting.
Some of this care can be provided through telemedicine approaches, and some require actual home visits. The result is better, more comfortable care for the patient while saving the high costs associated with hospital stays.
We are now understanding that the traditional outcome measures that we have used for years, such as standard surgical complications and survival curves, are not enough. The true patient experience is much more complex.