Answering Research Questions

In this video, Robert Goldstone, MD, surgeon in the Division of Gastrointestinal and Oncologic Surgery at Massachusetts General Hospital and the Mass General Cancer Center, discusses how he tackles research questions that are not easily answered—preferring to review retrospective databases in order to generalize data for the entire community.

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Transcript

So with the research that I perform here, I like to answer questions that cannot be answered easily or that we do not have the answers to already. And for that, I typically do either retrospective database review to answer questions for which we have, versus using large national databases, which is also retrospective review but has a large sample size to answer questions that we can't really perform randomized controlled trials for.

And it's interesting to look at the data from our tertiary referral center such as Massachusetts General Hospital, where we have the highest level of care and say, "Okay, is this data actually generalizable to the entire community?" And so that's where the national or statewide databases really come into play, and you can compare questions that may have been answered at only tertiary referral centers from small sample sizes to large databases that really are generalizable because it's throughout the entire community.

So with this, I'll look at the management of cancer and outcomes for octogenarians in the colon and rectal cancer, compared to those of the normal standard age, and we can look at the results here but it's also important to look at those on a national level to show or see whether it's actually generalizable data.

For this, I like to answer questions such as, "What is the optimal approach to transverse colon cancer?" We've had transverse colon cancer prevalent for a very, very long time and there's never been a defined standard of care in the sense that some people believe in doing an extended left or right colectomy, whereas others say a segmental transverse colectomy is the optimal approach. Comparing these at small centers is not really ideal unless I use the national cancer database to look into this and actually showed there's zero difference in survival between the two approaches despite the higher lymph node yield and the extended left or right colectomies compared to the transverse colectomies. Despite this, it is probably that the higher lymph node yield is insignificant lymph nodes as they're not related to the lymphatic drainage of the tumor in the segment that you are resecting and thus it's really only important to get the necessary vasculature as well as lymphatic drainage for the tumor.

So with this research, I always like to pursue questions that remain and that could be used for answers to optimize patient care as well as operative approach for these patients. I believe this is advancing our field by looking at these questions that remain and always looking for answers, so despite there being gold standards in textbooks or things that were commonly stated or performed, it's always best to reevaluate especially as time and medicine changes to see what is the optimal approach for care, especially as times continue to change.

For instance, the rate of cancer and inflammatory bowel disease used to be reported as high as 20% or 30% within 20 years of disease. That rate is decreasing and a lot of people feel that it's not just environmental factors, but could be improved surveillance with higher-end endoscopy with better visualization versus the appropriate medicines that are decreasing the inflammation and prolonging the disease duration but reducing the degree of inflammation in those patients that have it. And so I find that by addressing questions that do not have significant current research to answer or data to answer those questions, can actually change the impact or surgical course or outcomes for these patients.

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