Many traditional open surgeries for cancer treatment are now performed using a laparoscope for a minimally invasive approach.  Sunnybrook leads the way.

Mary Abbott returned home just two days after she had laparoscopic surgery to remove a cancerous tumour from her colon that was then resected.

Diagnosed in her mid-forties with colorectal cancer, she hoped that the surgical treatment would not involve a long recovery.  “The cancer diagnosis and the surgery are just the first part of your journey. It was important to me that you’re not knocked first from surgery; that I could regain feeling fit and healthy, and to get my energy back to prepare for the next challenge of my treatment: the chemotherapy,” says Mary.

Instead of traditional open surgery involving a large incision, Dr. Shady Ashamalla, a surgical oncologist specializing in minimally invasive procedures for gastrointestinal cancers at Sunnybrook’s Odette Cancer Centre, made only a few small incisions. Through ports placed through the incisions, and using a laparoscope (tiny video camera) to see, he operates within the abdomen, skillfully maneuvering long, thin surgical instruments to remove the tumour without perforating any areas of the body and then to reconnect the two ends of the healthy colon.

“We strive to reduce the surgical footprint in every procedure while ensuring we achieve the same oncological effect, or removal of all of the cancer – an approach that translates into better quality of life for patients,” says Dr. Ashamalla who completed advanced fellowships in both Minimally Invasive Surgery (MIS) and Surgical Oncology as part of his training.

A smaller surgical footprint allows for less complications including a shorter stay in the hospital and improved recovery time.  Recalls Mary, “I’ve had C-sections for both my children. Recovery from this surgery was way easier.”

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A study published in April 2015 in the New England Journal of Medicine reports that laparoscopic surgery is as safe and effective as open surgery for patients with rectal cancer that has not spread to nearby tissues (no metastases). The Colorectal Cancer Laparoscopic or Open Resection (COLOR) II is a large, randomized trial conducted in 30 centres in 8 countries that looked at outcomes (disease-free survival, the occurrence of distant metastases) of 1,103 patients with rectal cancer, from January 2004 to May 2010, with a 3-year follow-up.

These researchers had previously reported on short-term outcomes in Lancet Oncology in March 2013 with an interpretation that laparoscopic surgery in patients with rectal cancer resulted in similar surgical safety, resection margins, and completeness of resection compared to that of open surgery. There was less blood loss for patients who underwent laparoscopic surgery; hospital stay was shorter, though the procedure was longer (on average 4 hours versus 3 hours).

“My procedure was on a Wednesday. I went home that Friday. It felt pretty good moving around. Some of my friends visited shortly after I returned home and asked with concern if I should be in bed resting,” Mary recalls.

“My thinking is that if there’s a less invasive option that is as safe, and you’ve got a skilled surgeon: why would anyone not do laparoscopic surgery,” says Mary, who specifically sought out Dr. Ashamalla. “He had the expertise I was looking for, for my treatment – skilled in gastrointestinal matters, in gastrointestinal cancers and a leader in minimally invasive surgery.”

Dr. Ashamalla is also an assistant professor and surgeon educator in the Department of Surgery at University of Toronto.  In his educator role, his research is focused on introducing more interactive teaching techniques for surgical residents.  At the Sunnybrook Canadian Simulation Centre, Dr. Ashamalla continues to implement advanced simulation technologies such as three-dimensional virtual reality and box simulator training for laparoscopy, into surgical education residency programs.

With his unique training, he also continues to break new ground, for example, by performing multi-visceral laparoscopic surgery for locally advanced adherent colorectal cancers that require multiple organ removal. This is a novel approach that Sunnybrook is leading in development, implementation and dissemination.

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Two and a half weeks after her surgery, Mary was on her way to a hiking vacation.  As she boarded the flight to her destination, she asked a fellow passenger to help her place her bag in the overhead compartment. Mary remarked that she had recently undergone surgery, but because she was moving with ease, he looked at her oddly and asked, “Where?” Mary replied with confidence, “I wouldn’t lie about something like that!”