Colorectal Surgery Success

For common or complex colorectal surgery, choose a specialist

Innovations in Digestive Health | Fall 2019

David Deitz, MD

Studies have shown a positive relationship between surgeon experience and clinical outcomes for a number of surgical procedures¹.  University Hospitals is fortunate to have a team of specialized, highly experienced surgeons as part of the Division of Colorectal Surgery at University Hospitals. They treat a wide range of common and complex colorectal conditions using advanced surgical techniques. 

MULTIDISCIPLINARY TEAM

Successful treatment of colorectal cancer and inflammatory bowel disease (IBD) requires complex decision-making and a multidisciplinary approach. The Division of Colorectal Surgery collaborates across disciplines to determine the best approach for every patient.

Collaboration is especially important when treating colorectal cancer. The University Hospitals Colorectal Cancer Team holds weekly multidisciplinary group meetings to help ensure each patient receives the best treatment possible for his or her disease.

Colorectal surgeons, medical and radiation oncologists, pathologists, radiologists and gastroenterologists review each case in detail and craft individualized treatment plans that consider the unique aspects of the patient’s disease, comorbidities and social situation.

David Dietz, MD, Chief of the Division of Colorectal Surgery; Professor of Surgery, Case Western Reserve University School of Medicine, is nothing if not committed to high quality outcomes in surgery. He is the UH Vice President of System Surgery Quality and Experience and the Vice Chair of Clinical Operations and Quality, Department of Surgery, for UH Cleveland Medical Center. He also has led an effort during the past five years to address variability in rectal cancer care in the United States.

Dr. Dietz and other medical leaders worked with the American College of Surgeons (ACS) to develop the National Accreditation Program for Rectal Cancer (NAPRC), which evolved out of a collaboration between The OSTRiCh Consortium (Optimizing the Surgical Treatment of Rectal Cancer) and the Commission on Cancer, a quality program of the ACS. Dr. Dietz and the University Hospitals Multidisciplinary Rectal Cancer Team are in the process of applying for NAPRC accreditation this year.

INNOVATIVE APPROACHES TO COMPLEX DISEASE

The Division of Colorectal Surgery has expertise in surgical approaches ranging from the most complex open surgery for conditions such as locally advanced tumors, recurrent Crohn’s disease, enterocutaneous fistulas, and postoperative anastomotic complications, to the latest minimally invasive approaches for ulcerative colitis and diverticulitis, among other diseases. A few of those minimally invasive approaches include robotic surgery, transanal minimally invasive surgery (TAMIS), transanal total mesorectal excision (TaTME), and single-port/incision laparoscopic surgery (SILS).

Meagan Costedio, MD, Colon and Rectal Surgery, offers SILS to many patients with ulcerative colitis, Crohn’s disease or cancer. “Single-incision or single-port laparoscopic surgery is the most minimal minimally invasive surgery out there,” Dr. Costedio says. “It is not widely available to patients because few surgeons have developed the technical expertise necessary to provide this approach.”

Dr. Costedio also teams with Sharon Stein, MD, to offer patients TaTME, a new minimally invasive approach for the surgical treatment of rectal cancer. This technique allows the lowest rectal cancers to be approached laparoscopically. “TaTME is an exciting new innovation we can use even for ulcerative colitis patients requiring pelvic pouch surgery,” says Dr. Stein.

In addition to offering the widest range of advanced surgical procedures in the region, UH colorectal surgeons continue to develop programs for the treatment of complex patients. About 2 to 5 percent of colorectal cancer patients have well-defined inherited familial colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC)².  To provide these patients and their families with the personalized medicine approach they need, colorectal surgeon Emily Steinhagen, MD, is developing a specific program for patients with these inherited disorders.

NEW TECHNIQUES IMPROVE QUALITY OF LIFE

The American Cancer Society expects colon and rectal cancers to affect nearly 150,000 people in 2019 alone. Meanwhile, about 3 million adults reported being diagnosed with IBD, either Crohn’s disease or ulcerative colitis, in 2015, according to the Centers for Disease Control and Prevention. Adults with IBD are more likely to have associated health conditions such as malnutrition, immune suppression, cancer, arthritis, and eye and liver disease. University Hospitals Digestive Health Institute surgeons and physicians ensure patients receive the right combination of medication, nutritional support and, when necessary, surgery.

While UH surgeons are experts in pelvic pouch surgery and other procedures that maintain a normal route for defecation, in some cases a permanent ileostomy may be the only apparent option. Standard ileostomies require patients to use an external bag to collect and eliminate waste, which significantly hampers quality of life. UH is one of only a handful of centers in the world that offer an alternative.

The continent ileostomy procedure, or Kock pouch (K-pouch), creates an internal pouch that connects to a small opening in the abdominal wall (stoma) and maintains continence by an autologous valve mechanism. The patients intubates and drains the K-pouch an average of five times a day, and thus avoids the burden of wearing an external appliance or bag.

“UH is one of the leading centers in the world for continent ileostomy surgery,” says Dr. Dietz. “The procedure allows patients to simply cover their stoma with a bandage, increasing freedom and greatly improving quality of life.”

THE RIGHT TEAM FOR COMPLEX COLORECTAL SURGERIES

In addition to providing surgical care for patients with common colorectal disorders and diseases, the Division of Colorectal Surgery is one of the few departments in the United States with extensive experience in the most complex reoperative surgeries. UH colorectal surgeons treat conditions such as enterocutaneous fistula, anastomotic leaks, strictures, and locally advanced or recurrent rectal cancer.

“These patients often require a multidisciplinary approach that involves abdominal wall reconstruction, plastic surgery, and gynecological and/or urological surgery. We have expertise in all those areas through the UH Center for Reoperative Surgery,” says Ronald Charles, MD. In addition to undergoing fellowship training in colorectal surgery, Dr. Charles has also studied at one of the world’s foremost centers for the treatment of recurrent rectal cancer in Australia. He brings that experience back to UH to patients’ benefit.

EXPERT CARE CLOSE TO HOME

The UH colorectal team understands that convenience and family are an important consideration when seeking and undergoing treatment for medical problems. In addition to UH’s expert team of colorectal surgeons, Donya Woconish, CNP, and Vicki Rumpler, CNP, provide outpatient appointments for anorectal disorders such as hemorrhoids, constipation, pelvic floor disorders and anal fissures, as well as for other benign diseases and postoperative follow-up visits.

“All our providers see patients at UH facilities throughout the region,” says Rumpler. “While more complex problems are best served at UH Cleveland Medical Center, most patients can be evaluated and treated closer to home at one of our facilities in Mentor, Beachwood, Fairlawn or Westlake. We believe in the motto: right patient, right provider, right location.”

In an emergency, patients may not have a choice of specialist. When they do, the Division of Colorectal Surgery provides hyperspecialized service for optimum clinical outcomes.

To refer a patient to the Division of Colorectal Surgery, call 216-553-1976.

¹Relationship between surgeon volume and outcomes: a systematic review of systematic reviews, Systematic Reviews.

²Inherited Colorectal Cancer Syndromes, The Cancer Journal.