Minimizing minimally invasive surgery

June 9, 2016 Drew Schembre, MD, FASGE, FACG

From the advent of reliable anesthetics in the mid-19th century until only a few years ago, conventional open surgery involving a long incision had been virtually the only tool for curative treatment of cancerous and pre-cancerous tissues of the GI tract.  While open surgery has been highly effective, it comes with the price of permanently altering GI anatomy and often function.  

Minimally invasive surgeries have lessened the impact of open surgery. But significant disability can still result from laparoscopic or robotic surgery to remove all or part of the esophagus (esophagectomy), stomach (gastrectomy) and colon (colon resection).

Advances with endoscopic surgery

Over the last decade, we have refined treatment for GI cancer even further with endoscopic therapies aimed at removing only the most superficial layer of tissue while preserving the wall of the GI tract. Endoscopy has increasingly replaced segmental resection (removing part of an organ) for pre-cancerous conditions and even early, established cancers that are confined to the most superficial, or mucosal, layer.

In the esophagus, endoscopic mucosal resection (EMR) has virtually replaced esophagectomy for precancerous conditions like Barrett’s esophagus with dysplasia and intra-mucosal cancers where the cancer hasn’t spread to the lymph nodes. In addition to EMR, esophageal cancers also are treated with minimally invasive ablative therapies where extreme heat (radiofrequency ablation) or extreme cold (cryoablation) are used to destroy cancer cells.

More techniques to avoid gastrectomy

In Asia, where stomach cancers are very common, a more advanced technique called endoscopic submucosal dissection (ESD) has been widely used to treat early gastric cancers and avoid gastrectomy.  This procedure is used to remove tumors that have spread to tissue beneath the mucosal layer, but not to muscle.

While stomach cancers remain relatively rare in the U.S., many endoscopists, including gastroenterologists and surgeons at Swedish, are learning the techniques to treat gastric and other early cancers.

Moving past partial colectomy

In the 1960s, one-third of abdominal surgeries were performed to remove precancerous colon polyps.  Since the advent of colonoscopy, most colon polyps can be removed without surgery, and this procedure has been credited for much of the dramatic decrease in deaths from 
colon cancer.

However, partial colectomy, or removal of part of the colon, remains common in most parts of the country for many large, non-cancerous polyps.  At Swedish, we believe that even very large non-cancerous polyps can be removed safely, completely and non-surgically via a technique known as endoscopic complex polypectomy.

Trend away from surgery will continue

We believe these trends in minimally invasive treatment will continue as more and more complex digestive problems shift from surgical solutions to endoscopic ones.  Through the collaboration of advanced endoscopists and minimally invasive surgeons, we strive to maintain very high cure rates while reducing the disability and burden of invasive treatment for serious digestive diseases.

If you or a loved one has gastroenterological health issues, the Digestive Health Network at Swedish offers a broad range of treatments for many conditions. Call 1-855-411-6944 to schedule a consultation.

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