Drs. Bleday and Meyerhardt speak with Dr. Kevin Elias about "Enhanced Recovery After Surgery" methods and studies taking place right now in reducing stress on the patient's body pre-surgery. Even eating, hydrating, and carbohydrates are involved in prepping for common surgeries CRC doctors will want to learn more about. Click here to read Kevin's full bio.
To view the full references for this episode see below. To read about the particular ERAS study/abstract mentioned in episode, click here.
Decreasing the Surgical Stress Response and an Initial Experience from the Enhanced Recovery After Surgery Colorectal Surgery Program at an Academic Institution. Powell AC, Stopfkuchen-Evans M, Urman RD, Bleday R. Int Anesthesiol Clin. 2017 Fall;55(4):163-178. doi: 10.1097/AIA.0000000000000162. No abstract available. PMID: 28901989
Institution-wide Implementation Strategies, Finance, and Administration for Enhanced Recovery After Surgery Programs. Najjar PA, Whang EE, Urman RD, McGrath CT, Beloff JR, Bleday R. Int Anesthesiol Clin. 2017 Fall;55(4):90-100. doi: 10.1097/AIA.0000000000000158. No abstract available. PMID: 28901984
The Development of Enhanced Recovery After Surgery Across Surgical Specialties. Senturk JC, Kristo G, Gold J, Bleday R, Whang E. J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):863-870. doi: 10.1089/lap.2017.0317. Epub 2017 Aug 10. PMID: 28795911
Second, the podcast is joined by Dr. Rodrigo O. Perez from Brazil who worked on the Watch and Wait approach with Dr. Angelita Habr-Gama. He is an expert on the topic, and shares some of his experiences working with one of the innovators in colorectal cancer treatment.
According to their team's study and paper in Dis Colon Rectum in 2013, "No immediate surgery (Watch and Wait) has been considered in select patients with complete clinical response after neoadjuvant chemoradiation to avoid postoperative morbidity and functional disorders after radical surgery."
Below are some references to the topics discussed in this month's episode. Enjoy!
Brazilian protocol, originally proposed by Habr-Gama in 2006:
(Habr-Gama et al., 2010) – follow-up study looking at short term data
(Habr-Gama et al., 2013) – same group, looking at longer-term outcomes
MSKCC protocol (Smith et al., 2012)
van der Valk’s presentation at ASCO in 2017 re: update from the International Watch & Wait database
A recent retrospective study in Dis Colon Rectum that appeared in March 2017 (from Kong and others in Australia) that tracked outcomes with those patients end up needing a salvage operation following “watch and wait”
A recent review by Habr-Gama and others:
Two good review/perspective piece on the topic of watch and wait in this disease:
Torok et al., 2016
Glynne-Jones and Hughes, 2016
Episode Library: References and Guests
Episode #1: Postoperative Chemotherapy for Rectal Cancer (October 2016)
In the first ever episode of the podcast, the Dana-Farber/Brigham and Women's presents a discussion between Dr. Ronald Bleday and his colleague, Dr. Marios Giannakis. They discuss a rectal cancer case involving the use of chemotherapy after surgery and radiation.
Ep. 1 References:
- Bujko K, Glimelius B, Valentini V, Michalski W, Spalek M. Postoperative chemotherapy in patients with rectal cancer receiving preoperative radio(chemo)therapy: A meta-analysis of randomized trials comparing surgery ± a fluoropyrimidine and surgery + a fluoropyrimidine ± oxaliplatin. Eur J Surg Oncol. 2015 Jun;41(6):713-23.
- Maas M, Nelemans PJ, Valentini V, Crane CH, Capirci C, Rödel C, Nash GM, Kuo LJ, Glynne-Jones R, García-Aguilar J, Suárez J, Calvo FA, Pucciarelli S, Biondo S,Theodoropoulos G, Lambregts DM, Beets-Tan RG, Beets GL. Adjuvant chemotherapy in rectal cancer: defining subgroups who may benefit after neoadjuvant chemoradiation and resection: a pooled analysis of 3,313 patients. Int J Cancer. 2015 Jul 1;137(1):212-20.
Episode #2: Rectal Cancer Imaging (October 2016)Dr. Michael Rosenthal shares a case with the team, and discussed the optimal imaging methods for rectal cancer staging and decision making.
Ep. 2 References:
- Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging--a meta-analysis. Radiology 2004;232:773-83.
- Hartman RI, Chang CY, Wo JY, et al. Optimizing adjuvant treatment decisions for stage t2 rectal cancer based on mesorectal node size: a decision analysis. Academic radiology 2013;20:79-89.
Episode #3: Colorectal Cancer and Inflammatory Bowel Disease (November 2016)
This episode's guests are Dr. Joshua Korzenik and Dr. Harvey Mamon. Both doctors join Dr. Ronald Bleday for a discussion about a patient with colitis who developed an upper rectal cancer. Abstract and more info on this article can be found by clicking here.
Ep. 3 References:
- White EC1, Murphy JD, Chang DT, Koong AC: Low Toxicity in Inflammatory Bowel Disease Patients Treated With Abdominal and Pelvic Radiation Therapy. Am J Clin Oncol. 2015 Dec; 38 (6): 564-9.
Episode #4: Frailty during Colorectal Cancer Care (December 2016)
Episode #5: Colorectal Cancer Genetics, Microsatellite Instability, and Checkpoint Inhibitors (January 2017)
Ron and Jeff discuss their care of a recent colorectal cancer patient with Lynch Syndrome. The episode explores the case's complications, immunotherapy, genetics, and steps in the treatment process when handling this type of case.
In this episode, our hosts talk over a case with two specialists in immunotherapy from the Dana-Farber: Dr. Osama Rahma and Dr. Matthew Yurgelun. After reviewing the patient and case details, our guests outline the unique set of challenges during treatment due to the patient testing positive for Lynch Syndrome. It is an engaging discussion.
The How We Treat Colon & Rectal Cancer podcast's next two episodes will feature discussions about clinical trials focused on colorectal cancer treatment. In part one, Dr. Deborah Schrag joins us to provide an inside look at the PROSPECT trial currently taking place.
PROSPECT is the acronym for Preoperative Radiation Or Selective Preoperative Radiation and Evaluation before Chemotherapy and Total Mesorectal Excision (TME). From the on-going trial, Dr. Schrag and her team hope to decipher and compare the results of standard chemo and radiation treatment using a regimen of drugs named FOLFOX (the drugs 5-fluorouracil (5-FU), oxaliplatin and leucovorin). To learn more about this trial, listeners can click here.
Episode #7: Clinical and Surgical Trials [Pt. 2] (March 2017)
In the second part of our discussion on colorectal cancer trials, Dr. James Fleshman joins Ron to discuss the ACOSOG Z6051 Randomized Clinical Trial. This surgical trial aims to decipher the differences of open versus laparoscopic surgery in the treatment of colorectal cancer. To read more about Dr. Fleshman's findings and reports click here.
Dr. Fleshman is the Helen and Stanley Joseph Seeger Professor and Chairman, Department of Surgery at Baylor University Medical Center in Dallas. His professional focus is the treatment of patients with colorectal diseases. He has developed an international reputation in the laparoscopic treatment of colorectal cancer and the development of randomized controlled trials to evaluate the use of laparoscopic techniques in the treatment of colorectal cancer. Click here to read a full bio.
In this episode, Jeff and Ron also answer a listener question and discuss the future of patient trials in this field.