Healthcare is in a state of rapid change. Between changing funding priorities, shifting patient behavior, and the advent of artificial intelligence, many specialties face a future quite different from the present.
In addition, some specialties—oncology arguably chief among them—are facing the welcome instability of rapid scientific advancement. With the rise of adjuvant, neoadjuvant, immunological, and other therapies; new approaches to surgery; and shifting epidemiological patterns, many surgical oncologists and their teams are closely reconsidering how to best shepherd their patients through effective care.
The panel session, “The Great Rectal Cancer Debates,” today from 12:45 to 2:15 pm, in Room W-375a, will tackle this quandary. Two debates, each of which will be allotted half the session, will focus on the pros and cons of neoadjuvant care for T2 lesions and the selection of synchronous versus staged resection for patients with rectal cancer and liver metastases.
“In other words, we have advanced cancers with liver metastasis, and then we have early cancers, with T2 lesions. So, we have the two ends of the spectrum, and in both of those ends, there are major debates ongoing now,” said Steven D. Wexner, MD, FACS.
Dr. Wexner, who is Chair of the ACS National Accreditation Program for Rectal Cancer, will moderate the session.
Although the session will be in a debate format, the choices between the two options in each pairing are ultimately made on a case-by-case basis. Within the context of each clinical encounter, though, “They truly are debates,” Dr. Wexner noted, in that no single answer may be obvious.
The session, therefore, will focus on giving attendees insights into informed, evidence-based decision-making, via “the current state-of-the-art evidence as to what the patients are candidates for, and the results of each of those pathways.”
The debate on the use of neoadjuvant care in cases of T2 rectal lesions will include the presentation “First Things First” from colorectal surgeon Julio E. Garcia-Aguilar, MD, FACS, of Memorial Sloan Kettering Cancer Center in New York, New York. He will argue that adding neoadjuvant therapy in advance of surgery is more often the best choice.
His counterpart, Elisabeth C. McLemore, MD, FACS, a colorectal surgeon at Kaiser Permanente Los Angeles Medical Center in California, will argue that going straight to surgery in T2 disease is often best, with the presentation “Keep It Simple.”
The second debate will address metastatic disease. Sameer H. Patel, MD, FACS, who is an assistant professor in the Division of Surgical Oncology of the Department of Surgery at the University of Cincinnati College of Medicine in Ohio, will deliver the presentation “One Fell Swoop.” He will argue for synchronous resection of rectal cancer with liver metastases.
In the counterpoint, Robert E. Roses, MD, FACS, a professor of surgery at the Hospital of the University of Pennsylvania in Philadelphia, will argue for a staged approach to rectal masses with liver metastatic tumors, with the presentation “Slow and Steady.”
Dr. Wexner noted the broad range of surgeons and surgical trainees who may benefit from the session, including those in colorectal, general, and oncological disciplines. He also explained that, although the session is officially “The Great Rectal Cancer Debates,” the inclusion of the debate on liver resection means the information will be meaningful to hepato-pancreato-biliary surgeons as well.
To maximize benefit to all attendees, each debate will be capped with a 15-minute question and answer session.
Dr. Wexner connected the need for the session to the broader programming of the ACS, in that both address the enormous shifts in rectal cancer care.
“Part of the biggest change of rectal cancer is that we now have, through the ACS Commission on Cancer, the National Accreditation Program for Rectal Cancer,” he said. “So that's how much new stuff there is: it warranted an accreditation program.”
