American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Optimizing colorectal cancer treatment

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday First Edition

Advances in the treatment of stage IV colorectal cancer (CRC) over the last 40 years have led to remarkable improvements in survival. Today, surgeons continue to find ways to refine and optimize treatment using genetics and other approaches, said Tony R. Reid, MD, University of California San Diego, La Jolla, CA.

“As we’re doing better and as patients are living longer, how we look at the molecular genetics and how we subtype them is becoming more important,” Dr. Reid said during a Wednesday panel session.

Several speakers discussed the importance of genomic features of CRC that may affect response to treatment. Alexander A. Parikh, MD, MPH, FACS, associate professor of Surgery and director of the Vanderbilt Pancreas Center, Nashville, TN, discussed the growing study of the “ ’omics” of hepatic resection, which may help surgeons determine which patients are the best candidates for surgery.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is one procedure used for peritoneal metastatic disease because systemic chemotherapy is often ineffective. However, while this operation is shown to prolong survival in certain cases, Richard E. Royal, MD, FACS, The University of Texas MD Anderson Cancer Center, Houston, TX, underscored the need to define the population that benefits from HIPEC: “Selection criteria for surgery is vital, and we still have not defined these. We still need to determine what patients actually benefit from this operation.”

Other treatment approaches were presented across varying contexts. Karin M. Hardiman, MD, PhD, FACS, surgical director, Multidisciplinary Colorectal Cancer Clinic, Michigan Medicine Comprehensive Cancer Center, Ann Arbor, MI, discussed important considerations in synchronous resection, given that 20 percent of patients present with metastases, often with the primary tumor still in place. Pasithorn Amy Suwanabol, MD, University of Michigan, Ann Arbor, MI described treatments for complications from chemotherapy and radiation. Robert S. Krouse, MD, MS, FACS, chief, Surgical Services, Cpl. Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, provided another perspective through the role of palliative surgery, as well as nonsurgical approaches, emphasizing the need for surgeons to be aware of alternative options and opportunities for their patients.

Additional Information:
The Panel Session, Management of Stage IV Colorectal Cancer, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at FACS.org/clincon2017.

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