Dr. Jesse Guardado's Colorectal Practice Thriving in the Wake of COVID

It's been almost two years since Jesse Guardado, MD, joined Surgical Institute of South Dakota as the only fellowship-trained colorectal surgeon on the Avera Campus in Sioux Falls. Dr. Guardado inherited a full and busy practice from his predecessor. And in early 2020, that practice was growing quickly with a variety of both cancer and non-cancer colorectal surgeries.

"Right before COVID hit, I was in full swing," says Dr. Guardado "Unfortunately, that took a big hit from March to June 2020."

Fortunately, it did not take the practice long to recover. As soon as he got the "green light" to begin performing elective surgeries again, Dr. Guardado's schedule was once again full. As his practice has grown, so has his comfort level with robotics, in which he was already well-trained. 

"I had good exposure to robotics in my training but, of the 400 to 500 colon resections I did, 35 of them were robotic. The rest were laparoscopic," says Guardado. "So when I came here, I was still doing certain things laparoscopically. This year, I have moved almost exclusively to robotics."

Guardado has now performed more than 200 robotic colorectal surgeries locally. As his confidence has grown, he says he sees fewer situations that might once have prompted him to revert to an open procedure. His patients have had good outcomes and reasonable hospital stays and the incidence of surgical wound infections is well below the national average. 

With his practice once again on solid footing, Dr. Guardado has turned his attention to helping SI in collaboration with Avera McKennan achieve accreditation through the National Accreditation Program for Rectal Cancer (NAPRC). 

The five-year-old program was developed through a collaboration between the The OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer) and the Commission on Cancer to promote a multidisciplinary approach to rectal cancer. The program is similar to those already in place for pancreatic, breast, and esophageal cancers. 

"Rectal cancer outcomes in the US have lagged behind those of Europe," says Dr. Guardado. "We started seeing that the best US outcomes seem to be in larger academic centers where they already have this kind of thing in place."

SI already had a multidisciplinary conference in place but without national accreditation. Under Guardarado's guidance, they began the extensive NAPRC application process and submitted the application last winter. 

Among other things, accreditation requires rectal cancer surgeons and certain other specialists to agree to meet on a regular schedule. There are also requirements around the timing and type of care, types of imaging studies, outcomes, and documentation as well as a yearly site review. Accredited programs are included in a national registry. As of last fall, only 16 other programs in the country had earned NAPRC accreditation.

"It is about meeting a certain standard," says Dr. Guardado."Compared to the national landscape, Sioux Falls is small. So the fact that we are going for this is a big deal."

Guardado is hopeful that the first site review can take place in early 2022 and that full accreditation will come after that. In the meantime, he says the extensive application process is already paying off.

"Everything we have put in place so far to achieve NAPRC accreditation has helped to streamline the care of rectal cancer patients in Sioux Falls," he says.