Senior Staff Surgeon, Henry Ford Hospital, Detroit, Michigan August, 1994 to July, 2013

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5 Senior Staff Surgeon, Henry Ford Hospital, Detroit, Michigan August, 1994 to July, 2013 Service Chief, Surgery Credentials Committee Member Medical Executive Committee Member Service Chiefs Counsel Member OR Executive Committee Member Co chair, Surgical QA Committee Infection Control Committee Member Henry Ford West Bloomfield Hospital, West Bloomfield, Michigan Clinical Assistant Professor of Surgery Wayne State University School of Medicine, Detroit, Michigan

6 SURGICAL EDUCATION General Surgery Residency Program Colon and Rectal Surgery Fellowship Program CLINICAL INITIATIVES Inflammatory Bowel Disease Center founding member Colon and Rectal Surgery Quality Assessment Minimally Invasive Surgery Initiative ACADEMICS 10 Publications in peer-reviewed national/international publications 7 Presentations in national/international meetings HONORS Best Doctors in America Hour Detroit magazine s Top Docs

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11 Current Surgical Management of Colon & Rectal Cancer Southeastern Colorectal Cancer Roundtable Kickoff EVMS Brock Institute for Community & Global Health March 15, 2016 Chong S Lee, MD, FACS, FASCRS Colon and Rectal Surgery Bon Secours Surgical Specialists

12 Types of Malignancies of Colon & Rectal Cancer 1. Adenocarcinoma 2. Carcinoid tumor 3. GIST (Gastrointestinal stromal tumor) 4. Lymphoma 5. Sarcoma

13 Colon & Rectal Adenocarcinoma (American Cancer Society) 1. Third most common cancer diagnosed in both genders. 2. Lifetime risks (4.7% - Male, 4.4% Female) estimated new cases: colon, rectal estimated deaths: Death rate (deaths/100,000 people) have been decreasing steadily.

14 The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute

15 Prevention and Early Detection of Colon and Rectal Cancer 1. Lifestyle modification/changes 2. Vitamin supplements, Calcium, ASA/NSAIDs 3. Screening gfobt (Guaiac-based fecal occult blood test) FIT (fecal immunochemical test), Stool DNA Colonoscopy CT colonography, Barium enema

16 Ideally most if not all colon & rectal cancer should be preventable with screening. For the patient with the unfortunate diagnosis of colon & rectal cancer: All is not lost. Surgery remains the mainstay therapy and can be accomplished with acceptable risks for the patient. If indicated addition of adjuvant chemotherapy with or without radiation can significantly improve overall survival.

17 Preoperative Evaluation 1. History and Physical 2. Colonoscopy report (Pathology report if available) 3. Blood tests (including CEA level) 4. Radiographic studies CT scan, CXR Endorectal ultrasound MRI PET/CT scan

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22 Colon Cancer Surgeries Right colectomy Transverse colectomy Left colectomy Sigmoid colectomy Total abdominal colectomy

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28 Potential Complications of Colectomy Hemorrhage Deep venous thrombosis, Pulmonary embolism Anesthesia complications. Damage to adjacent structures Wound complications.

29 Postoperative Management following Colectomy Review the final Pathology report. No adjuvant chemotherapy generally recommended for Stage I and Stage II disease. Adjuvant chemotherapy can be recommended for certain Stage II disease. Adjuvant chemotherapy recommended for all Stage III disease if possible. Generally palliative therapy for Stage IV disease.

30 Rectal Cancer Surgeries Preoperative neoadjuvant therapy for Stage II and Stage III disease. Abdominoperineal resection Low anterior resection Complete proctectomy with coloanal anastomosis (with ileostomy) Total proctocolectomy with ileal pouch anal anastomosis (with ileostomy) Transanal excision, TEM, TAMIS Pelvic exenteration

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35 Potential Complications of Rectal Cancer Surgery Hemorrhage Deep venous thrombosis, Pulmonary embolism Anesthesia complications Damage to adjacent structures Wound complications Sexual and/or urinary dysfunction Ostomy complications

36 Postoperative Management following Rectal Cancer Surgery Review the final Pathology report. No neoadjuvant therapy recommended for Stage I disease. Preoperative neoadjuvant therapy and postoperative chemotherapy recommended for Stage II and Stage III disease. Treatment for Stage IV and recurrent disease need to be individualized for each patient (Generally palliative therapy).

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38 Summary and Conclusion Prevention of colon & rectal cancer is most effective with dedicated screening programs and is most responsible for decreasing death rate. For those patients unfortunately diagnosed with colon & rectal cancer, early detection combined with expedient treatment, both with surgery and adjuvant therapy, will improve overall survival. Current perioperative management will allow patients to undergo successful surgery with acceptable operative risks. Although the advent of newer minimally invasive technology has the potential to possibly reduce operative risks/complications, survival benefit has not been seen.

39 MOST IMPORTANTLY, THE CARE FOR THE COLON & RECTAL CANCER PATIENT MUST BE A TOTAL TEAM EFFORT.