A doctor from Lanzarote, among the only specialists in the country in early digestive cancer surgery

Diego Álvarez de Sotomayor specializes in endoscopic submucosal dissection, a pioneering technique in Spain for the surgical treatment of colon cancer.

February 17 2024 (16:30 WET)
Updated in February 19 2024 (11:22 WET)
The digestive doctor Diego Álvarez de Sotomayor. Photo: Provided.
The digestive doctor Diego Álvarez de Sotomayor. Photo: Provided.

One in 25 people develop colon cancer during their lifetime in Western countries. This reality means that in the last 30 years, methods to stop the accelerated growth of malignant cells and guarantee the lives of patients have been modernized. The doctor from Lanzarote, Diego Álvarez de Sotomayor, is a specialist in the digestive system and works in the Digestive Endoscopy Unit of the Tortosa Verge de la Cinta Hospital in southern Tarragona, developing pioneering work in Spain: endoscopic submucosal dissection, one of these innovative techniques.

The Lanzarote native's involvement with this specialization was not a pre-planned choice, but a combination of "opportunities or interests" that led him to end up training in the field. Between 2013 and 2017, he trained as a specialist in the digestive system at the La Fe Hospital in Valencia. After finishing his specialization, the lack of a permanent job in Spain pushed him to leave the country and look for opportunities in the United Kingdom. It was then that he began his career as a doctor at St. Marks Hospital in London, where he trained as a specialist in performing digestive endoscopies and, specifically, in oncological endoscopies.

Currently, based at the hospital in Tarragona, his work consists of the detection and treatment of early tumors of the digestive tract. "In the digestive tract, formations sometimes occur that are commonly called polyps (or accumulation of cells), which are the precursor lesions that can then lead to cancers," the digestive specialist begins. Not all polyps end up being cancerous, but the time it takes for a polyp (or accumulation of cells) to become cancerous is very long, between ten and 20 years.

To diagnose this type of disease, national colon cancer screening campaigns are carried out in Spain. In most autonomous communities, they are aimed at patients between 50 and 69 years old and a first round is done, which consists of an analysis of occult blood in stool and a second round of colonoscopies.

These colon cancer screening programs and the increase in colonoscopies have meant that more and more cancerous lesions are detected, which are large in size, in very early stages or stages.

When it comes to small polyps, in most cases they are removed by endoscopy, where the polyps are extracted in pieces. For Álvarez, this technique "is not ideal" because by chopping up the cells "it makes it difficult" for the pathologist who is in charge of analyzing the sample.

A second method used in Spain is open surgery, where diseases in more advanced stages are dealt with and which requires more economic and personnel investment. As a third option, although it is not yet the most used, is added endoscopic submucosal dissection, carried out by only about two dozen specialists throughout the country.

Endoscopic submucosal dissection

During his stay at St. Mark's Hospital in London, Diego Álvarez trained with the Japanese specialist Noriko Suzuki, a world expert in the technique and who instructed him in the preparation of endoscopic submucosal dissection. A method widely used in Japan to treat larger tumors at early ages.

His involvement with this pioneering specialization in Spain was not a vocational choice. "It was nothing planned in advance, nor orchestrated from years ago," he confesses. It was his time at the London hospital and his work with Dr. Suzuki that made this technique something "attractive" for the Lanzarote native. "You develop, you gain skills and you feel more skilled and you like it more," he highlights.

"This technique emerged throughout the 90s. Initially, it started from the idea of treating early stomach tumors, but over the years it has been gaining acceptance and is used for early tumors of the large intestine, colon, rectum and even the small intestine," explains Dr. Álvarez. Thus, for the Lanzarote health professional, the economic efficiency of endoscopic submucosal dissection reduces the cost of the operating room, operating room material and days of stay in the hospital.

Compared to other methods, it is a "minimally invasive" surgery in which a natural orifice is used, from which the endoscope is introduced and with the help of an electro scalpel the tumor is resected or separated "completely" from the wall of the intestine in one piece. In addition, the recovery of the operated patient is faster than usual.

This polyp that is extracted is then analyzed by a pathology expert, who with the help of a microscope delves into the characteristics of the tumor. "The patient does not really perceive the difference with respect to a normal colonoscopy and goes home the same day.

"If done well, the technique is safe, effective and above all less expensive," defends the digestive doctor.

However, not all patients who have tumors in the digestive system are ideal to be operated on through this method. Specifically, this technique is only intended for people who are in stage one of cancer, that is, at the earliest level. "If we find that when we do the dissection, the pathologist analyzes the piece and sees that there is a cancer with a significant risk of recurrence or metastasis, then the patient usually goes through a committee and typically a rescue surgery is decided and carried out," he attests.

The digestive specialist Diego Álvarez de Sotomayor. Photo: Cedida.
The digestive specialist Diego Álvarez de Sotomayor. Photo: Cedida.

 

Lack of specialist doctors in the field

For Diego Álvarez, in Spain, as in the rest of Western countries, the problem is not detection, which is carried out early in many cases. The digestive specialist alludes to the fact that the barrier is the lack of competent people in the technique. "It is a very laborious technique and has a very steep learning curve, its learning is not a matter of a week and can extend between two and five years as a minimum," he explains.

In his case, the Lanzarote doctor began his training in 2017 and is still continuing it in 2024. As part of this education, Álvarez traveled to Japan, in a training financed by his hospital center. On this occasion, he trained for five weeks in the last months of 2023.

The Lanzarote digestive doctor Diego Álvarez during his trip to Japan. Photo: Cedida.
The Lanzarote digestive doctor Diego Álvarez during his trip to Japan. Photo: Cedida.

 

Throughout his specialization, most of his education has been funded by his own work. "The problem is that in our country, while it is true that during the university stage and part of the specialty we enjoy more resources, when you are already a specialist you usually have to take care of this type of training and you subsidize it from your own pocket," Álvarez shows.

On his trip to Japan, he was in four reference hospitals and was able to be tutored by four world experts in the technique. "The truth is that it is lucky, as I say, there is the concentration of experts because they have so many cases and they are so many years ahead of us," he highlights. In the Asian country they have an advanced technique in the technique of endoscopic submucosal dissection. In addition, several virtual and artificial simulators are available to facilitate practice.

"There must be enough competent specialists in the technique to be able to learn. In Spain today there is still a shortage of qualified doctors to teach it, which makes learning difficult," reveals the digestive specialist.

"What ends up happening is that these patients, as they cannot be treated by endoscopic submucosal dissection, end up being operated on," explains Álvarez. For him, the growth of this technique is important, "especially because this type of lesions are detected mostly in fragile patients, with advanced ages and with many concomitant diseases and that, therefore, become bad candidates for conventional surgery."

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