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who had preoperative chemotherapy to patients who had chemotherapy and radiation therapy before surgery. “By and large, the improvement isn’t going to be found in doing the actual operation,” Katz says. “We’re asking, ‘can we make outcomes even better by looking RESEARCH IN THE LAB AND THE OPERATING ROOM at what happens before and after surgery. Can we use chemotherapy before the surgery, or a combination of chemotherapy and radiation before the surgery, for example, to help our patients?’” Some studies look at the success of surgery used in combination with newer therapies, like immunotherapy, a type of therapy in which the immune system is built up to fight the cancer cells. Others look at the effects of things like diet or exercise on surgery. Katz led one such trial. Patients in the study exercised moderately up to 30 minutes a day, five days a week and strength trained two days a week. Their fitness levels were then tested up to seven months after surgery to see if their overall fitness and quality of life improved. The combination of safer, more effective surgical techniques coupled with improving care before and after surgery is having positive results, illustrated in how MD Anderson’s pancreatic cancer patients’ outcomes compare to those nationally. At MD Anderson, the mortality rate within 90 days of surgery is essentially 0% of patients and the length of hospital stay is six days. Compare that with the national averages, in which surgery-related death is about 8% and the post-surgical hospital stay is more than 10 days. Overall, MD Anderson patients with pancreatic cancer have a median survival rate of more than 43 months – more than twice as long as the medical survival for patients in the US, which is less than 20 months. Katz says: “It’s all about finding the right procedure for the right patient at the right time.” Lab-based research still plays an important role in surgery Lab-based research still plays an important role in the research done by surgeons. Surgeons are increasingly offering novel complex surgeries and doing so with strong 10 MD Anderson Cancer Center biological evidence gained through translational research will only improve our patient outcomes. Summer Hanson, M.D., assistant professor and director of translational research in Plastic Surgery, has been studying how stem cells taken from different kinds of fat can be used to help patients heal better. “It turns out there’s a lot more to fat than we originally thought,” Hanson says. While we typically think of all fat as bad or unhealthy, researchers have found that certain fat cells in the body are healthier than others. Now, Hanson and her team are studying these fat cells to determine if they can help patients’ wounds heal more quickly and improve skin quality. “It’s not enough just to remove the cancer,” Hanson says. “We have to make sure we’re giving our patients the best possible quality of life.” Pedro Ramirez, M.D., conducted a study that helped show that minimally invasive radical hysterectomies — a standard of care for treating early stage cervical cancer — are actually less effective than the traditional type of treatment: an open hysterectomy. Division of Surgery | Surgical Outcomes FY18 11 About 5% of people who develop colorectal cancer have an inherited gene that caused them to develop the disease. That number goes up to 16% when applied to colorectal cancer patients younger than age 50. For these patients and others with a genetic risk of developing gastrointestinal cancers, the standard treatments aren’t enough. They may need different types of surgeries and other treatments to lower the risk of recurrence. They may need other preventative surgeries, like hysterectomies. They may need genetic counseling. Coordinating all that can be difficult, especially for someone coping with the shock of a cancer diagnosis. Personalized care At MD Anderson, we bring together all those services through our Familial High-risk Gastrointestinal Cancer Clinic. Under the guidance of medical director and colorectal cancer surgeon, Nancy You, M.D., an associate professor of Surgical Oncology, the center links patients with an increased genetic risk of developing cancer like Lynch syndrome and Familial Adenomatous Polyposis to the specific services they need, whether it’s genetic counseling, genetic testing, radiation oncology, general oncology or a prophylactic surgery. It’s a part of a growing trend in what’s called precision medicine – the idea that when it comes to treatment one size doesn’t fit all. Instead, our care teams consider the variability in patients’ genes, environment and lifestyle in order to determine the treatment that’s best for them. Even the surgeries themselves are tailored to each specific patient. “If we’re taking out part of the colon, we help ensure that the patient doesn’t have a recurrence, since we know the risk of this is higher with a genetic condition,” You says. PREVENTING CANCER IN HIGH-RISK PATIENTS Responding to increasing colorectal cancer rates Colorectal cancer rates are rising in younger patients. According to an MD Anderson study, by 2030 it’s estimated that colon and rectal cancers are expected to increase by 90% and 124.2% in patients ages 20 to 34. For those ages 35 to 49, the predicted increase will be 27.7% for colon cancer and 46% for rectal cancer. MD Anderson has become a leader in treating young colorectal
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