G.I. Cancer

Defining success How to improve results ‘Team’ approach Newer challenges

G.I. Cancer

How can results of surgery be improved ?

Short term results - Morbidity & mortality

Long term results - QOL & survival

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

ERAS

Fast track recovery program Early discharge Reduce cost Reduce ambiguity Improve outcome Improve outcome

ERAS in Pancreaticoduodenectomy

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

G.I. Cancer

Definite benefit of preoperative CTRT

Rectal cancer Esophageal cancer Colorectal liver metastasis

After 5FU/Oxaliplatin

PVE

4 weeks 9 weeks

Laparoscopic Surgery in GI Cancer

Technical feasibility

Patient benefit / harm

Laparoscopic Surgery in GI Cancer

Definite benefit

Colorectal cancer Esophageal cancer ‘Minor’ hepatectomy Distal pancreatectomy

Laparoscopic Surgery in GI Cancer

Staging Laparoscopy

Lesions <1cm missed on CT/MRI

Robotics in GI Cancer

Benefit ???

G.I. Cancer

How much information is enough ?

USG,CT,CECT,MRI,PET,PET CT,Angiography,Endoscopy,EUS,Biopsy

0

10

20

30

40

5 10 20 40Items of Information Avai lable to Handicappers

Perc

enta

ge o

f Cor

rect

Pre

dict

ions

Confidence Does Increase

Accuracy Does Not Increase

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

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