Interview with Dr. Leigh Kelliher: perioperative care and cancer surgery

Editor’s note

As an emerging journal in the field of digestive diseases, Digestive Medicine Research (DMR) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success could not have been achieved without the contribution of our distinguished guest editors. Taking this opportunity, this year DMR launched a new series, “Interviews with Outstanding Guest Editors”, to highlight our active contributors. We hope to express our heartfelt gratitude for their tremendous effort and further uncover the stories behind the special series.

The special series “Perioperative Care of the Cancer Patient” (1) led by Dr. Leigh Kelliher and Dr. Chris Jones from Royal Surrey Hospital NHS Foundation Trust has attracted numerous readers since its release. The aim of this series was to present the further refinements in surgical and anaesthetic technique pertaining to perioperative care of the cancer patient. At this moment, we are honored to have an interview with Dr. Leigh Kelliher who would share his scientific career experience and insights on this special series.

Expert introduction

Dr. Leigh Kelliher (Figure 1) is a consultant anaesthetist working at the Royal Surrey County Hospital in the UK. His day-to-day clinical activity comprises the provision of perioperative care for patients undergoing major oncological surgery, particularly oesophago-gastric, hepato-pancreatico-biliary, urology and gynae-oncology procedures. His main interests are oncoanaesthesia, enhanced recovery after surgery (ERAS) and perioperative care, and he has published a number of scientific papers in these areas. He is also active in clinical research and has contributed to a variety of clinical trials in the field of perioperative care. He conducted one of the first randomized control trials looking at the impact of ERAS following open liver resection surgery and his MD thesis examined markers of the stress response following liver resection.

Figure 1 Dr. Leigh Kelliher.

Interview

DMR: As a reputable expert in anesthesia, what drove you into this field in the first place?

Dr. Kelliher: Working as a junior doctor in the NHS, I was always impressed by the ability of the anaesthetists I encountered to provide emergency, life-saving care in a calm and efficient way to the acutely unwell patients they were called to attend. Having the skills to look after such high acuity patients and make a real difference to their outcomes was attractive to me and as a result, I applied for specialist training in anaesthesia. It was only really once I began my training that I developed an appreciation for the value and challenge of providing high quality perioperative care for patients undergoing high risk surgery.

DMR: Would you like to give us a general picture of the publications on perioperative care of the cancer patient? Any topics or papers that impressed you most in the past two years?

Dr. Kelliher: From my perspective, in the UK, the ERAS movement has been revolutionary in the field of perioperative care. Over the last 20 years, the development and implementation of the ERAS approach has changed perioperative outcomes for patients across a raft of surgical specialties. The ERAS society has produced procedure/specialty specific consensus guidelines for many different scenarios and these provide an excellent framework for individual centres to adapt and develop their own pathways to the benefit of their patients. The guidance produced by ERAS is constantly reviewed and updated as new evidence and technologies emerge and should be essential reading for health care providers involved in the perioperative care of patients.

DMR: ERAS principles call for the appropriate use of anesthetics to speed up the patient’s recovery. What should be aware of when using anesthetics?

Dr. Kelliher: With particular reference to anaesthetic drugs/interventions, I think the key principles are to adopt a protocol that utilizes the short-acting anaesthetic agents with minimal side effects/hangover, multi-modal opioid-sparing anaslgesia that includes the use of regional anaesthesia where appropriate, and effective prevention/treatment of nausea and vomiting. The goal should be to deliver the patient postoperatively to a state where early resumption of oral diet and mobilization is as feasible as possible. It is vitally important for individual institutions to develop pathways that work in their setting, allowing for the skills and resources that are available to them. For example, the use of thoracic epidural analgesia may be excellent in a centre that is familiar with this technique and has the support structure to care for these patients in the perioperative period, but might be deleterious in a centre where this is not the case.

DMR: In your opinion, what are the perioperative risk assessment and anesthesia considerations for cancer patients during the COVID-19 pandemic?

Dr. Kelliher: The COVID-19 pandemic has presented a huge challenge to healthcare systems across the globe and has greatly impacted the field of perioperative care. Apart from taking all measures to reduce the risk of transmission of COVID-19 in hospital patients, for elective surgery it has been necessary to screen and isolate patients preoperatively to reduce their perioperative covid risk. Whilst undertaking surgery in an acute covid infection is clearly inadvisable, the optimal timing of surgery (particularly time critical surgery e.g., cancer) following the resolution of a COVID-19 infection is unclear as is the impact of ‘long COVID’.

DMR: What kind of projects are you recently working on? How is the topic of this special series associated with some of them?

Dr. Kelliher: Currently I’m authoring a chapter for the Oxford handbook of Perioperative Medicine which will include a review of the current evidence for the perioperative care of patients undergoing oesophago-gastric surgery.

DMR: If there is a chance to update this special series, what would you like to moderate, add or emphasize more?

Dr. Kelliher: As new evidence and technologies emerge, the field constantly changes. As such all the areas in this special series will require updating in due course. Particular areas of interest in perioperative care at the moment are the role of prehabilitation programmes, the use of perioperative steroid supplementation and the expansion in endoscopic/radiological interventions and the subsequent impact on patients’ perioperative needs.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Digestive Medicine Research for the series “Interviews with Outstanding Guest Editors”. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dmr.amegroups.com/article/view/10.21037/dmr-22-75/coif). The series “Interviews with Outstanding Guest Editors” was commissioned by the editorial office without any funding or sponsorship. AL and LMG report that they are full-time employees of AME Publishing Company. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Perioperative Care of the Cancer Patient. Available online: https://dmr.amegroups.com/post/view/perioperative-care-of-the-cancer-patient