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New Protocols for Colorectal Cancer surgery Prove Beneficial


By Kathy Hubbard


There’s a funny scene in Neil Simon’s Brighton Beach Memoirs where the protagonist, who’s a teenage boy, says that if you say a disease out loud you might come down with it. So, throughout he whispers words like “cancer.” If that was only a true way to prevent a disease, life would be so good.

Over the years, I’ve written about colorectal cancer five times including two first-person accounts of colonoscopies. In each column I have advocated for early detection and will continue to do so. However, today we’re going to talk out loud about this disease which is the third most common cancer in men and women.

Do we all know what colorectal cancer is? The American Cancer Society explains, “Colorectal cancer is a cancer that starts in the colon or the rectum. These cancers can also be named colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.”

Most colorectal cancers start as growths, called polyps, on the inner lining of the colon or rectum. Not all polyps will become cancer. If cancer forms in a polyp, it can grow into the wall of the colon/rectum and from there can grow into blood vessels or lymph vessels and from there to other parts of the body.

Warning signs (although often there aren’t any) can include changes in bowel habits, blood in the stool, diarrhea, constipation, stools that are narrower than usual, frequent gas pains, bloating, fullness or cramps, weight loss for no reason, feeling very tired and vomiting.

Surgery is the most common treatment for all stages of colorectal cancer. If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. If the cancer is larger, the surgeon will remove the cancer and a small amount of healthy tissue around it and remove lymph nodes to examine for cancer cells.

As you can imagine, surgery on your digestive tract can affect other organs and lead to a lengthy recovery period. Depending on the stage of the cancer, treatment following surgery may include radiation and chemotherapy.

The good news on this front is a program called Enhanced Recovery after Surgery (ERAS). Brought to Bonner General Health by surgeon Chase Williams and certified registered nurse anesthetist, Pam Schillar, this program is defined as a multimodal perioperative care pathway designed to achieve early recovery after an elective surgical procedure.

Oh sure, we know what that means, don’t we? Chief Nursing and Quality Officer, Tracy Autler, RN, MSN CPHQ (registered nurse, masters in nursing, certified professional in healthcare quality) explains:

“The pathway helps to maintain preoperative organ function and reduce the stress response during surgery. The goals are to improve patient outcomes, decrease the length of hospitalization, improve bowel function, decrease the use of opiate pain medication; minimize the use of tubes and drains and to improve patient satisfaction,” she said.

The American Association of Nurse Anesthetists says that the key element is educating the patient and their family prior to admission to the hospital. The Journal of American Medical Association calls it a team effort that includes surgeons, anesthetists, an ERAS coordinator (either a nurse or a physician) and the staff from units that care for surgical patients.

“We implemented ERAS in May of 2018,” Autler said. “During 2018 we had a total of 24 patients who had colorectal surgery and were treated with the ERAS pathways. The pathways are quite specific and begin pre-hospital and follows steps each day post-operative.

“What we saw was a decrease in our length of hospitalization from 5.2 days to 3.7 days with ERAS and a decrease in the use of opiate pain medications. We also saw patients’ bowel function and ability to tolerate solid food one to two days sooner than patients without ERAS.”

Each individual’s treatment may vary, but specifically the pathways consist of minimal fasting prior to surgery (which wasn’t the case in the past), actually consuming a carbohydrate beverage before anesthesia, utilizing analgesics and an appropriate use of opioids only when indicated and a return to the home and ability to resume daily activities and to eat a normal diet as quickly as possible.


Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at kathyleehubbard@yahoo.com.

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