MDNews - Cleveland-Akron-Canton

years, it is usually an indication that the patient did not have the proper surgery." The complete array of surgical treat- ments, including single-site laparoscopic surgery, robotic colectomy, and trans- anal resection to save a patient from needing a stoma, is offered at Cleveland Clinic's DDI. Says Dr. Remzi, "Over the past decade, we have led the world in laparoscopic colorectal surgery. The future is to push the envelope – smaller incisions, fewer ports, different extraction sites." Equally important for patients, accord- ing to Dr. Dietz, is the fact that Cleveland Clinic's colorectal surgeons are specially trained to perform these procedures. "Most of us have subspecialty interest within the sphere of rectal cancer," he explains. "Some are focused on developing minimally invasive techniques. Others, such as myself, are interested in locally advanced or recurrent disease. So patients get the benefit of very focused expertise." Each patient also benefits from a highly individualized treatment plan formulated by a multidisciplinary team. All rectal cancer cases are discussed at weekly team meetings that involve not only colorectal surgeons but also liver surgeons, gastroenterologists, radia- tion oncologists, medical oncologists, pathologists, radiologists, hereditary cancer specialists and others. The team works with patients and their families to develop treatment plans tailored to their individual needs. "Patients may only see one physician, but they benefit from the collective knowledge of upwards of 30 people," says Dr. Dietz. "The multidisciplinary approach may even extend into the operating room where multiple surgeons, urologists, reconstructive specialists, orthopedists, or others are often involved in complex rectal cancer cases." This, he feels, offers patients the great- est chance of cure and the best possible quality of life. In an effort to improve care nation- wide, Drs. Remzi and Dietz and their Cleveland Clinic colleagues have been working to standardize rectal cancer care through the Consortium for Optimizing the Surgical Treatment of Rectal Cancer (OSTRiCh). Established in 2011 under the vision of Dr. Remzi and in collaboration with the American Society of Colon and Rectal Surgeons, the American College of Surgeons (ACS), and other surgery, radiolog y, patholog y and oncolog y societies, OSTRiCH was instrumental in establishing a nationwide Centers of Excellence designation for rectal cancer. The designation was approved by ACS in May. Now OSTRiCh and ACS are work- ing together to design what Dr. Dietz calls the "nuts and bolts" of a rectal cancer program similar to that established for breast cancer care. INNOVATIONS AND EXPERIENCE IN COLORECTAL SURGERY AT CLEVELAND CLINIC + Since 1983, surgeons at Cleveland Clinic have performed more than 4,200 J-pouch procedures, the most in the world. + In 2007, Cleveland Clinic surgeons performed one of their first colorectal pro- cedures utilizing the umbilicus (belly button) as the sole access point to the abdomen. + In 2013, approximately 50 percent of colon cancer operations at Cleveland Clinic were performed minimally invasively. + Cleveland Clinic surgeons avoid a permanent colostomy in about 80 percent of cases and achieve some of the lowest recurrence rates in the world. + Colorectal surgeons perform more than 5,000 procedures annually in the Digestive Disease Institute (DDI), including an average of 500 minimally invasive intestinal procedures. + In 2009, Cleveland Clinic colorectal surgeons performed the world's first single-incision procedure to remove the entire colon of a 13-year-old patient with a rare genetic condition that leads to colon cancer. The procedure, called a procto-colectomy, will significantly reduce the patient's risk of colon cancer. + Since 2012, Cleveland Clinic surgeons have performed 54 total robotic rectal cancer surgeries. + DDI's team has extensive experience with ileal pouch surgery, performing more than 500 cases to date. "For an institution to be accredited, standards must be in place that are all related to the process of care, including the multidisciplinary approach," says Dr. Dietz. "The idea is that if you put the evidence- based process in place and follow it, you will see improved outcomes." For more information about rectal cancer surgery at Cleveland Clinic, visit clevelandclinic.org/digestive. To learn more about OSTRiCh, contact Dr. David Dietz at dietzd2@ccf.org. To refer a patient, call 855-REFER-123. ■ 2 0 1 4 N OV E M B E R / D E C E M B E R ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 2 3

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