The treatment of colorectal cancer is undergoing a fundamental transformation, and few surgeons are better positioned to explore what that means for the future of the specialty than Julio Garcia-Aguilar, MD, PhD, FACS, who will deliver today’s Herand Abcarian Lecture: “The Changing Landscape of Colorectal Oncology: Refining and Redefining the Surgeon’s Role.” The lecture begins at 2:30 pm in Room 202B.
A renowned colorectal surgeon and surgical oncologist, Dr. Garcia-Aguilar is chief of the colorectal service at Memorial Sloan Kettering (MSK) Cancer Center in New York City and holds the Benno C. Schmidt Chair in Surgical Oncology. He also directs MSK’s Colorectal Cancer Research Center. His career has centered on advancing the treatment of rectal cancer, including minimally invasive surgery, biomarkers and treatment response, and strategies to preserve the rectum and improve patients’ quality of life.
Those areas of expertise have placed him at the forefront of a central question facing colorectal surgeons today: What should the surgeon’s role be when surgery is no longer necessarily the first or definitive treatment for cancer?
Dr. Garcia-Aguilar said the increasing effectiveness of therapies given before an operation has changed surgery’s traditional place in colorectal cancer treatment.
“Historically, surgery was the definitive treatment for colorectal cancer, supplemented by adjuvant therapies,” he said. “It is increasingly playing a secondary role to neoadjuvant therapies, which for many patients can be curative on their own.”
As the range and effectiveness of neoadjuvant treatments continue to grow, including chemotherapy, radiation therapy, immunotherapy, and targeted approaches, the surgeon’s traditional role is being challenged. Dr. Garcia-Aguilar describes the specialty as being at a crossroads, with two potential paths forward.
“Surgeons can serve as technicians, with limited participation in multidisciplinary selection of the initial treatment and limited responsibility for treatment sequencing,” he said. “Or surgeons can co-lead multidisciplinary disease management, with full participation in assessment of response to neoadjuvant therapy and all associated decision-making.”
For Dr. Garcia-Aguilar, the latter approach represents an opportunity for surgeons to remain central to cancer care not by doing more surgery, but by taking greater responsibility for the entire treatment journey.
“With surgeons as co-leaders, patients are likely to benefit,” he said.
Assuming that role will require surgeons to expand their knowledge well beyond the operating room, however. Effective co-leadership requires an understanding of molecular biology, genetics, immunology, pharmacology, radiation oncology, and quality-of-life outcomes.
That evolution may also require changes in how surgeons are trained and evaluated.
“The surgical oncology curriculum and competency assessment may need to expand in order to avoid relegating surgeons to the role of a technician,” Dr. Garcia-Aguilar said.
For colorectal surgeons and others involved in cancer care, the lecture will provide an opportunity to consider not only how surgery is changing, but what it means to be a surgeon in an era when the best treatment may not always involve an operation.
