A permanent ostomy bag and a long recovery are often associated with colorectal cancer surgery, but according to a surgeon at Baylor College of Medicine, advances in the field mean that these concerns could be a thing of the past.
Dr. Atif Iqbal, chief of colorectal surgery in the Michael E. DeBakey Department of Surgery at Baylor, dispels some common myths and explains how Baylor’s multidisciplinary approach to treating these cancers improves patient outcomes.
Myth: You will have a permanent colostomy bag following colorectal cancer surgery.
Fact: While some surgeons treat colorectal cancer, specifically rectal cancer, using a procedure that results in a permanent colostomy bag, restorative colorectal surgeons are more specialized. They are able to reconnect the intestines with the anus using specialized techniques as opposed to making a permanent colostomy bag.
“Data suggests that patients of surgeons who perform more surgeries that result in a permanent colostomy bag have a longer length of stay in the hospital, a higher chance of the tumor coming back and a higher chance of death,” said Iqbal, who also is a member of the NCI-designated Dan L Duncan Comprehensive Cancer Center at Baylor.
According to Iqbal, who operates at Baylor St. Luke’s Medical Center, there also is data to suggest that a patient with colorectal cancer who is operated on by a colorectal specialist has a lower risk of mortality and return of cancer.
Myth: Recovery from colorectal cancer surgery requires a long stay in the hospital.
Fact: Recovery has changed quite a bit thanks to enhanced recovery after surgery (ERAS) protocols, which rely on evidence-based medicine to direct patient care and recovery after surgery. While patients used to stay in the hospital for seven to 12 days after major abdominal surgery, the length of stay has now been significantly reduced, usually to between one and three days.
“The enhanced recovery after surgery protocol starts even before the patient arrives at the hospital. In fact, it starts a couple of weeks before surgery and goes through their postoperative recovery,” Iqbal said.
Previously, patients were told not to eat or drink starting at midnight on the day of surgery, even if their case was later in the day. Because this can cause dehydration and low-sugar levels before they go into the operating room, patients are now told to continue their liquid diet up to three hours before the surgery. In addition, patients can have a liquid diet immediately following their surgery and can go to a regular diet the next morning. Most patients also are able to avoid tubes in their nose/mouth or drains after surgery.
Another change in the recovery is that patients do not have to wait for their bowels to start functioning before they are able to eat or before they are able to be discharged from the hospital.
“We have found that the quicker we feed them, the better the patients do because a portion of the nutrition for the bowel comes from the food within the bowel, so if you’re not feeding the gut, you’re essentially starving the gut itself,” Iqbal said.
Myth: Postoperative pain control will require narcotics.
Fact: The opioid addiction crisis across the country can make many people hesitant to use narcotics to control their pain, but Iqbal said that many surgeons are now giving a combination of different non-narcotic mediations to provide pain control in both the postoperative inpatient and outpatient setting.
“Most of our patients are not needing any narcotics after surgery anymore, while they continue to have adequate pain control,” Iqbal said.