Is Smaller Better? Minimally Invasive Oncologic Surgery Options Discussed at NCCN Conference
Minimally-invasive oncologic surgery procedures can be beneficial, but physicians need to be prudent when recommending the option to their patient according to Thomas A. D’Amico, MD, of Duke Comprehensive Cancer Center. Dr. D’Amico detailed the benefits and controversies of minimally invasive alternatives as well as emerging techniques including natural orifice surgery at the NCCN 14th Annual Conference.
March 13, 2009
HOLLYWOOD, FL — Cutting-edge surgery with less cutting is appealing for many, but how do minimally invasive surgical offerings rate in terms of outcomes for people with cancer? At the National Comprehensive Cancer Network’s 14th Annual Conference, Thomas A. D’Amico, MD, of Duke Comprehensive Cancer Center discussed the pros and the cons of minimally invasive oncologic surgery alternatives.
Dr. D’Amico acknowledged the tremendous technological advances that have resulted in minimally invasive offerings, but emphasized three guidelines that physicians need to be aware of when presenting the option to patients; the minimally invasive option must be oncologically equivalent or superior to the open procedure, the procedure should offer quality of life outcome advantages, and cost effectiveness needs to be considered.
Five minimally invasive procedures for oncologic surgery including robotic prostatectomy, laparoscopic colectomy, laparoscopic adrenalectory, minimally invasive esophagectomy, and thoracoscopic lobectomy were presented by Dr. D’Amico. In each procedure, he provided a comparison of the minimally invasive option versus the traditional open approach to surgery noting operating time, cost, recovery rates, length of stay, and oncologic outcomes.
Overall, the benefits to the minimally invasive options were a shorter hospital stay, faster recovery, and less pain. However, except for the thoracoscopic lobectomy, there is no data from randomized controlled clinical trials on minimally invasive options to provide any insight into oncologic outcomes or survival rates.
“The lack of evidence-based data for the majority of minimally invasive surgical options is one of the current shortcomings in the field,” stated Dr. D’Amico.
Another cause of debate includes the training and credentialing of physicians who perform minimally invasive procedures. Dr. D’Amico stated that the learning curve for physicians being trained needs to be addressed. Lastly, Dr. D’Amico touched upon the controversy of using minimally invasive surgery as a marketing tool particularly in the field of robotics, which can lend itself to eye-catching publicity.
The future of minimally invasive surgery will likely see an expanded use of robotics as well as an increased interest in a new technique called natural orifice surgery. Dr. D’Amico explained that natural orifice surgery is when surgeons conduct surgery through the natural orifices in the body such as the mouth, nose, or rectum. Since there are no incisions made on the body, the benefits are a reduced risk of infection and a quicker recovery, stated Dr. D’Amico.
In conclusion, Dr. D’Amico stressed again that improved outcomes should drive the utilization of minimally invasive procedures and that oncologic principles must be preserved.
“There is continued progress of minimally invasive oncology surgery,” said Dr. D’Amico, “but also the need for further evolution to optimize morbidity and oncologic outcomes. The question we need to ask ourselves is not ‘what can be done’, but ‘what should be done’.”
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 25 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. For more information, visit NCCN.org.
The NCCN Member Institutions are:
- Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center
- City of Hope Comprehensive Cancer Center
- Dana-Farber/Brigham and Women's Cancer Center
Massachusetts General Hospital Cancer Center
- Duke Cancer Institute
- Fox Chase Cancer Center
- Huntsman Cancer Institute at the University of Utah
- Fred Hutchinson Cancer Research Center / Seattle Cancer Care Alliance
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
- Mayo Clinic Cancer Center
- Memorial Sloan Kettering Cancer Center
- Moffitt Cancer Center
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
- Roswell Park Cancer Institute
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
- Stanford Cancer Institute
- University of Alabama at Birmingham Comprehensive Cancer Center
- UC San Diego Moores Cancer Center
- UCSF Helen Diller Family Comprehensive Cancer Center
- University of Colorado Cancer Center
- University of Michigan Comprehensive Cancer Center
- The University of Texas MD Anderson Cancer Center
- Vanderbilt-Ingram Cancer Center
- Yale Cancer Center/Smilow Cancer Hospital