Dr. Camilla Wong and Dr. Tyler Chesney

A team of surgical oncologists at St. Michael’s Hospital performed a total gastrectomy, distal pancreatectomy and splenectomy on a patient, marking the first time these complex cancer operations were performed at the hospital.

This procedure advances the type of care older adults with complex cancer can receive at St. Michael’s.

“Being able to take on these types of cases for patients means that the people in our community – the people that are served by St. Michael’s – will have access to the care they need to treat their advanced cancers,” said Dr. Tyler Chesney, a colorectal and gastrointestinal surgical oncologist who led the procedure, which required careful preparation of the patient’s perioperative care and coordination of multiple surgical teams.

The patient, who was over 70 years old, required a complex multivisceral resection to treat advanced gastric cancer. A multivisceral resection is the removal of the tumor and at least one other adjacent organ.

After reviewing the patient, Dr. Chesney and the team determined the patient’s stomach cancer was invading the vessels that carry blood into the spleen and pancreas. They decided to perform the total gastrectomy, distal pancreatectomy and splenectomy – a type of multivisceral resection.

“I am the first surgical oncologist in the Division of General Surgery here who is trained in planning out surgeries that require resection of more than one structure at a time to remove more advanced cancers,” Dr. Chesney said. “Normally, a patient with an advanced tumour who required this type of procedure would have been referred out of St. Michael’s. This total gastrectomy, distal pancreatectomy and splenectomy allows us, as a hospital, to expand the care we are able to provide for our patients.”

After joining St. Michael’s in July 2020, Dr. Chesney has helped to build a unique program called the “Older Adults Surgery and Oncology Program” (OSOP) in which geriatricians and an interdisciplinary team play a significant role in perioperative shared care of patients who are 70 years of age or older and are undergoing surgery for gastrointestinal, colon or rectal cancer.

The Older Adults Surgery and Oncology Program team.

After a patient is identified as meeting the criteria of the program, Dr. Camilla Wong, the geriatric lead for the program and a Geriatrician at St. Michael’s, performs a comprehensive preoperative geriatric assessment. She evaluates the patient’s medical comorbidities, screens for cognitive impairment and determines how the patient manages their day-to-day living and what type of psychosocial supports the patient may have. The assessment helps to optimize the patient’s health pre-surgery to decrease the potential for any poor post-surgery outcomes. After surgery, Dr. Wong will follow the patient with the surgical team throughout their hospital stay.

In this situation, the OSOP team identified previously developed pressure ulcers on the patient and arranged for home care to mend the wounds so the patient would be prepared for and comfortable during the operation.

“We can prevent a lot of the complications that may occur in older adults after surgery if we get involved early as opposed to waiting until post-operation. This program is important for patient care because it takes a very proactive approach,” said Dr. Wong. “It’s a whole team effort. We do everything we can to make sure the older adults regain as much function as possible.”

The Older Adults Surgery and Oncology Program involves support from a variety of disciplines and roles across the hospital. The team includes a transition facility coordinator, dietitian, social worker, physiotherapist, physicians and anesthesiologists. 

“Last month’s operation really speaks to the willingness of different individuals in the hospital to work together and collaborate to allow us to expand what is possible in terms of the procedures and care we can provide for certain types of patients, such as those with complex cancers or older adults undergoing cancer surgery,” said Dr. Chesney.

By: Jessica Cabral