gastrocon 2016 - gi cancer
TRANSCRIPT
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G.I. Cancer
Defining success How to improve results ‘Team’ approach Newer challenges
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G.I. Cancer
How can results of surgery be improved ?
Short term results - Morbidity & mortality
Long term results - QOL & survival
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G.I. Cancer
How can short term results of surgery be improved ?
Proper assessment Perioperative nutritional support Intra operative measures - blood loss restricted fluids normothermia ERAS protocols ‘High volume’ centers
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ERAS
Fast track recovery program Early discharge Reduce cost Reduce ambiguity Improve outcome Improve outcome
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ERAS in Pancreaticoduodenectomy
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G.I. Cancer
How can long term results of surgery be improved ?
Accurate staging ‘Tailored’ surgery Minimal post operative complications Judicious use of chemotherapy/radiation ‘High volume’ centers
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G.I. Cancer
Definite benefit of preoperative CTRT
Rectal cancer Esophageal cancer Colorectal liver metastasis
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After 5FU/Oxaliplatin
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PVE
4 weeks 9 weeks
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Laparoscopic Surgery in GI Cancer
Technical feasibility
Patient benefit / harm
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Laparoscopic Surgery in GI Cancer
Definite benefit
Colorectal cancer Esophageal cancer ‘Minor’ hepatectomy Distal pancreatectomy
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Laparoscopic Surgery in GI Cancer
Staging Laparoscopy
Lesions <1cm missed on CT/MRI
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Robotics in GI Cancer
Benefit ???
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G.I. Cancer
How much information is enough ?
USG,CT,CECT,MRI,PET,PET CT,Angiography,Endoscopy,EUS,Biopsy
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0
10
20
30
40
5 10 20 40Items of Information Avai lable to Handicappers
Perc
enta
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f Cor
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Pre
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ions
Confidence Does Increase
Accuracy Does Not Increase
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Impact of the ageing population on the demand for colorectal procedures
30 fold increase in need for colorectal procedures
Increase surgical workforce Treatment algorithms Dis. Colon Rectum 2009;52:583-91
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G.I. Cancer
How to choose your surgeon ?
Number of investigations ordered Emphasis on preoperative assessment & build up Intra operative transfusions Post operative complications awareness Sensitivity to QOL issues Patient centered communication