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C LEVELAND CLINIC'S DIGESTIVE Disease Institute (DDI) has long been a recognized leader in diagnosis, treatment and surgical innovation. Through new endo- scopic technologies, advanced options for gastroparesis, fecal transplantation, and efforts to standardize rectal cancer treatment nationwide, the DDI continues to demonstrate its commitment to cutting- edge patient care. Nowhere is that commitment more apparent than in DDI's Department of Colorectal Surgery, one of the leading programs performing colon and rectal cancer surgery nationally. Rectal cancer is not common; it affects only about 40,000 Americans annually. Because the patient population is so small, and because the surgery to treat rectal cancer is so complex, case volume and surgical experience result in better outcomes. In fact, volume and experience are consistently linked with the best outcomes. " We (the colorecta l surgeons at Cleveland Clinic) handle about 250 rectal cancer cases each year — one of the high- est-volume centers in the nation — and have a very clear understanding of even the most complex rectal cancer cases," says Feza H. Remzi, MD, Chairman of the Department of Colorectal Surgery. "We embody a collective spirit of experi- ence and excellence, which enables us to put patients first and give them the best outcomes." David Dietz, MD, Vice Chairman of the Department of Colorectal Surgery, agrees. "As a department, we do nearly twice as many colorectal surgeries as any of the other national academic medical centers. This experience, first and foremost, is what sets us apart." But experience and volume are not the only differentiators. Surgical technique and treatment approach also play impor- tant roles in rectal cancer outcomes. Technique is of paramount impor- tance in rectal cancer surgery, an idea that has been popularized over the past decade. At Cleveland Clinic, surgeons have been perfecting the art of total mesorectal excision — the gold-standard operation for rectal cancer removal for the past 40 years. This approach has resulted in a five-year rectal cancer survival rate of around 80 percent at Cleveland Clinic and a recurrence rate of roughly 9 percent, according to Dr. Remzi. "People tend to blame a poor outcome on the recurrence of rectal cancer when, in fact, it is often the result of poor surgical technique," he says. "If rectal cancer comes back within two or three Rectal Cancer Surgery: Pushing the Envelope at Cleveland Clinic By Alex Strauss (L–R) David Dietz, MD, is Vice Chairman, and Feza H. Remzi, MD, is Chairman of the Department of Colorectal Surgery at Cleveland Clinic, where more than 5,000 colorectal procedures are performed each year. SURGERY SPOTLIGHT PHOTOS COURTESY OF CLEVELAND CLINIC 2 2 | Cleveland/Akron/Canton MD NEWS ■ M D N E W S . CO M ■ N OV E M B E R / D E C E M B E R 2 0 1 4