Improving Surgical Outcomes for Patients with Colorectal Cancer

Rocco Ricciardi, MD, MPH, is chief of Colon and Rectal Surgery at Massachusetts General Hospital. In this video, he explores ways in which his research is improving surgical outcomes for patients with colorectal cancer.

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Transcript

Our lab in our research group is very interested in looking at image-guided surgery. We have a group that's worked on two different branches of this research—one is computer-assisted imagery where we use computer reconstructed images to look at surgical techniques, and also florescence-guided surgery, meaning using antibodies targeted towards cancer cells and identifying them intraoperatively so that we can see real-time pathology.

I think there's a real benefit in many different areas of colorectal cancer care. Colorectal cancer is one of the most common types of cancers in the world and it is the second leading cause of cancer deaths. Our goal is to try to improve safety by reducing the number of patients who have surgical resection or surgical cure and not leaving behind any abnormal cancer cells and also leaving behind normal tissue. So, our goal is to try to identify processes or techniques where we actually spare healthy tissue and take out all of the diseased tissue or the cancerous tissue at the time of surgery.

One of the more difficult problems we have during surgery for colorectal cancer is that we have difficulty identifying margins where the cancer actually ends and where the healthy tissue begins, and this type of research will help us better identify those margins so we can identify those boundaries more carefully and efficiently without having to wait for a frozen section or pathology report. You can imagine obtaining real-time results while just doing the operation and that would, of course, reduce the number of patients who have an abnormal margin or a positive margin that has cancer in it that might lead to patients coming back with local recurrence or recurrent cancer.

One of the things that I find most valuable about performing research at Mass General is the number of collaborative groups, research labs, that are also interested in working with our group—whether it's in pathology or radiology or GI—all of these groups are excited to participate and collaborate. We have formal meetings on a regular basis, on a weekly basis, to go through research projects and identify patients for those protocols. We also invite labs from the other research groups to join us.

For example, the anesthesia group will join us on Tuesday and go through their research protocols and discuss ways that we can collaborate or synergize our research and move them forward at a much more rapid pace. So we work within the Mass General Cancer Center to perform clinical trials that are not available in many organizations or institutions. Our group will work within the Cancer Center to identify patients who might be good candidates for special trials within cancer oncology or survivorship. We have many trials looking at organoids with the Cancer Center growing cancer tissue into its form to determine its three-dimensional structure and its response to various chemotherapies, and we work very closely with the genetics group to look at genetic abnormalities within our patients with colorectal cancer.

I think our research will help our patients by reducing the amount of unnecessary tissue that needs to be removed during surgery and thereby reducing the disability associated with removing additional tissue. It will also improve our surgery by providing real-time pathology so that surgeons know exactly what they're doing and exactly what types of tissue they're removing at the time of the operation.

Ultimately, I feel like our research will bring the field forward by improving the proportion of patients who are cured of cancer with surgery and treated appropriately without removing unnecessary tissues or tissues that are healthy and do not need to be removed. You can imagine that these types of operations can remove large amounts of tissue that sometimes are still healthy or do not have any disease in them but need to be removed in order to obtain negative margins or to make sure that we removed all the diseased tissue. By using these types of technologies we can spare tissues that are not diseased.

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