Enhanced Surgery Recovery Program
About 60% of patients will undergo some type of surgery to treat their cancer. In some cases, surgery is the only treatment required. It may also be combined with chemotherapy or radiation as part of an overall treatment plan.
There are several types of cancer surgery:
Curative surgery simply involves removal of a cancerous tumor. It works best on localized cancers that haven't yet spread to other parts of the body, and is often followed by radiation therapy or chemotherapy to make sure all cancerous cells have been removed.
Preventive surgery is used to keep cancer from occurring. Many colon cancers can be prevented by removing precancerous polyps before they become malignant. Women at high risk for breast cancer due to family history or genetic mutations may decide to have their breasts removed to prevent cancer from occurring. Preventive surgery is also known as prophylactic surgery.
Reconstructive surgery returns the body to normal or near-normal appearance or function following cancer treatment. The most common is breast reconstruction surgery after a mastectomy (breast removal). Facial reconstruction and testicular implants are other examples of reconstructive surgery.
Staging surgery determines the extent of cancer. Staging surgery can sometimes be done without an incision by using an endoscope to view the suspicious area and take a tissue sample. For abdominal tumors, a laparoscope is used to view the area, a procedure that involves a small incision in the abdominal cavity done under general anesthesia.
Supportive surgery is used to help with other cancer treatments. For example, some chemotherapy devices require a port (connecting device) to be inserted under the skin.
Palliative surgery is used to improve a patient’s quality of life by easing pain or other symptoms caused by advanced or untreatable cancer. Palliative surgery is not a cure or anti-cancer treatment.
Minimally invasive surgery employs advanced techniques to remove tumors through tiny incisions. Minimally invasive procedures can also be performed by robotic arms controlled by surgeons. Read more about minimally invasive surgery.
Enhanced Surgery Recovery Program
Research from a worldwide clinical study has found that it takes patients more time to recover from preparing for surgery than from the procedure itself.
For decades, standard practice has required patients to stop eating and drinking up to 12 hours before surgery and to undergo bowel preparation. This results in dehydration and hunger before surgery even begins. Much of a patient's recovery time is spent getting over the side effects of completely stopping the digestive process.
The enhanced surgery recovery program at MD Anderson completely eliminates the need for bowel preparation. Food is allowed until midnight the day before the procedure, and clear liquids can be taken up to two hours before surgery.
After surgery, patients are encouraged to get on their feet that same day, and urinary catheters are removed as soon as possible.
Patients in the program have enjoyed shorter hospital stays, decreased pain, and a quicker return to normal. Ask your care team if enhanced surgical recovery is right for you.
Since becoming a doctor, one of the most important things I’ve learned is that the more we can lower patients’ anxiety levels, the better off they are. Educating patients about what to expect improves both how they do during cancer treatment and how they feel about it. It’s like giving people a passport to their own healing.
That’s why I’m so pleased to be involved in MD Anderson initiatives that ensure our patients receive the best possible care. My role lets me keep enjoying the remarkable relationships I’ve developed by treating individuals, while also putting entire systems in place that help all of our patients.
Enhanced Recovery Program gets cancer patients feeling better faster
As a physician, my goal is to do the right thing for the right patient at the right time, every time. And every other doctor at MD Anderson shares this goal.
It starts with putting extremely talented people together with really good safety and quality practices. Many of these practices are included in our Enhanced Recovery Program (ERP), a set of 21 guidelines initially used before, during and after surgical procedures. Now these same practices have crossed over to medicine and are being used to aid in the recovery of non-surgical patients, as well.
But Enhanced Recovery is more of a philosophy of care than a narrow program. It includes strategies such as minimizing the use of narcotics, aggressive physical therapy, and allowing patients to drink clear fluids up to two hours before a procedure. The idea is to get people feeling better faster, so they can get back to their lives that much sooner. Our motto is: “Back to home, back to family, back to work, back to life and back to self.”
Enhanced Recovery is one of the most valuable advances in 30 years
Enhanced Recovery is arguably one of the most valuable advances that medicine has seen in 30 years. And patients who’ve had surgery using both kinds of recovery plans universally report having a better experience with Enhanced Recovery. Some recover so quickly, they literally spring out of bed after surgery. Many express surprise afterwards at how functional they were, how little pain they had and how quickly they got back to their lives.
We used to tell patients to expect about six weeks of disability after surgery. Now, we’re measuring recovery in days instead of weeks. Some patients ask to go back to work, start driving again or even resume chemotherapy less than two weeks after a procedure. And about 40% of my patients don’t need any narcotics to control their pain: a combination of other agents — including over-the-counter anti-inflammatories like ibuprofen — work just fine.
The future of Enhanced Recovery
At its core, Enhanced Recovery is about examining every step in the cancer care journey, taking out the waste and leaving in the essentials. The data offer compelling evidence that the way we treat patients now is more effective. Notably, Enhanced Recovery has been shown to improve patient results, reduce harm, lower costs for everyone and even to lengthen survival.
The more data we have, the better we’ll be at identifying what’s still not quite right or could be just a little better. Big data and analytics are what will help us make the next big strides in recovery from cancer treatment.
Surgery, chemotherapy and radiation therapy have all seen advances in the areas of technology and research. Future success lies in the better sequencing and coordination of those treatments. But regardless of what type of treatment is involved, when we educate patients about what’s going to happen, when and why, we make them partners in their own healing. The impact is substantial.
We can’t ever promise patients a cure, but we can always promise them a plan. Taking away uncertainty — and by extension, anxiety — is perhaps the greatest gift we can give.
Thomas Aloia, M.D., is a liver surgeon and the chief quality officer at MD Anderson.
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