Surgeon uses unique robotics procedure to treat colorectal cancer patient

BEECH GROVE, Ind. – Today, (May 29) at St. Francis Hospital-Beech Grove, Dipen Maun, M.D., used sophisticated robotic technology to perform a low anterior resection on a rectal cancer patient – a procedure that is the first of its kind in Indiana.

Maun, a surgeon with the St. Francis-affiliated Kendrick Regional Center for Colon and Rectal Care, performed a low anterior resection (LAR) to remove a cancerous tumor from the patient’s lower rectum. Traditionally, such operations required large incisions and lengthy recovery periods. More recently, the surgeries have been performed laparoscopically to minimize pain and accelerate recovery.

What made Maun’s approach unique is that he used the da Vinci™ Surgical System.

"The da Vinci robotic system offers many advantages for the patient," said Maun, who specializes in endoscopy and laparoscopic colorectal surgery. "These include decreased conversion rates from laparoscopic to open surgery, improved specimen completeness, fewer complications, and possibly shorter hospital stays and faster recovery times."

The system, developed by Intuitive Surgical, also provides the surgical team with improved options. Working at the da Vinci controls several feet from the operating table, the attending surgeon has an enhanced 3-D view of the field of operation, improved dexterity and greater precision.

The da Vinci system was developed more than a decade ago at the urging of the Department of Defense. Military surgeons were looking for ways they could perform procedures from remote locations, far from battlefields. While that ultimate goal has yet to be realized, the computerized robotic system has been welcomed by surgeons in public and private hospitals worldwide.

More information about the Kendrick Regional Center for Colon and Rectal Care, located on the St. Francis Hospital-Mooresville campus, is at www.kendrickcenter.com/meet.html.
To learn more about the St. Francis Colorectal Cancer Center of Excellence go to www.stfrancishospitals.org/Cancer/DesktopDefault.aspx?tabid=38.

Microsurgery offers incisionless treatment of colorectal cancers, polyps

MOORESVILLE, Ind. – A novel, less-risky procedure to surgically remove early cancers is now being used by surgeons at St. Francis Hospital-Mooresville. The surgery removes low rectal to low sigmoid colon polyps and early cancers of the rectum and low sigmoid colon.
It’s called transanal endoscopic miscrosurgery (TEM), a technique developed in Germany two decades ago that recently was introduced in the United States. Colon and rectal surgeons undergo specialized training to perform the surgery, and hospitals must have advanced equipment to offer TEM.
St. Francis is one of only three hospitals in central Indiana to offer the procedure.
Because of their location, even some early cancers and polyps have required more extensive surgery and possibly a colostomy or temporary ileostomy. Both of those procedures often involve creating an opening whereby bodily wastes pass into an external pouch stuck to the skin.
With TEM, the polyps and cancers are removed with less-invasive laparoscopic procedures, avoiding longer and more risky surgery, as well as their accompanying pain and complications.
"TEM has proven to offer the same outcomes and survival benefit that major colon and rectal surgery does for select patients with rectal and low sigmoid tumors and polyps," said Bridget Sanders, M.D., a surgeon at Kendrick Regional Center for Colon and Rectal Care at St. Francis Hospital-Mooresville. "Most patients can go home the same day or early the next after TEM, where standard surgery usually requires up to a 10-day stay."
Dr. Sanders and Dipen Maun, M.D., also with the center, are two of only six surgeons in central Indiana performing this surgery.
While TEM today is intended for patients with early cancers, some patients with more advanced rectal cancer can be enrolled in national oncology trials that use the less-invasive TEM procedure, Dr. Sanders said.

Colon cancer survival rates at St. Francis surpass national figures

INDIANAPOLIS – Patients treated for colon cancer at St. Francis Hospital & Health Centers have markedly higher survival rates than national and statewide averages, according to the American Joint Committee on Cancer.

The overall five-year survival for all colon cancer patients treated at St. Francis Cancer Care Services was 52.1 percent. This compares to 49 percent statewide and 50 percent nationally.

Colon and rectal cancers are the most common malignancies in the United States and result in the third highest number of cancer deaths, according to the American Cancer Society. Of the estimated 154,000 colorectal cases diagnosed each year, 73 percent are colon-related.

Each year, St. Francis’ Cancer Care Committee chooses one tumor site for annual review to monitor cancer treatment. It gathers and analyzes its data from the hospital’s Tumor Registry.

In 2006 it focused on 103 cases of colon cancer. Cases examined represented a nearly even distribution between males and females with a majority of patients ranging in age from 60 to 90.

The main treatment for colon cancer is surgery, curative in most cases. At St. Francis, surgery was performed on 89 percent of patients. However, surgery often needs to be accompanied with additional therapies for patients with more locally extensive disease or if the cancer has spread to the lymph nodes.

Nearly all colon cancer patients whose cancer has spread to their lymph nodes receive chemotherapy at St. Francis, hospital officials reported. Statewide and nationally, patients undergo chemotherapy only 73 percent of the time.

“Certainly these results are encouraging, but our goal is prevention and early diagnosis,” said Peter G. Garrett, M.D., medical director of oncology services and chairman of the Cancer Care Committee at St. Francis.

“Screening for colon cancer is highly effective, and one of the key objectives of our Colorectal Cancer Center of Excellence is to increase awareness of risk factors associated with colon cancer,” Garrett added. “Colonoscopy should be part of routine care for everyone who is 50 and older, or earlier for those with a significant family history.”

The Colorectal Cancer Center of Excellence team, headed by medical director Michael Morelli, M.D., includes more than 25 physician specialists including gastroenterologists, colorectal surgeons, general surgeons, radiation oncologists, medical oncologists, pathologists, family practice physicians and radiologists. The team evaluates the latest treatment options, and makes recommendations for the education, screening, diagnosis, staging and surveillance of patients with colorectal cancer.

St. Francis Hospital long has been recognized for its strong cancer care programs rating highly with regard to standardized outcomes measures and has achieved many “firsts” in Indiana. Of the 34 Commission on Cancer programs in Indiana, St. Francis ranks in the top 3 percent in treating stage III colorectal disease.

And in the area of new technology, St. Francis Hospital & Health Centers also is a leader in piloting selective internal radiation therapy for colon cancer that has spread to the liver. It is also first to offer megavoltage cone beam imaging, providing more precise targeting of several types of cancer tumors.

For more information about St. Francis Cancer Care Services, go to http://stfrancishospitals.org/cancer.

St. Francis has hospitals on Indianapolis’ south side, Beech Grove and Mooresville. St. Francis is part of a network of 13 hospital campuses in Indiana and Illinois owned and operated by the Sisters of St. Francis Health Services, Inc., one of the largest health-care systems in Indiana.

Colorectal surgeon honored with prestigious fellowship

INDIANAPOLIS – Bridget Sanders, M.D., has been named a Fellow of the American College of Surgeons (ACS).

Sanders practices with the Kendrick Regional Center for Colon and Rectal Care on the campuses of the St. Francis Mooresville and Indianapolis hospitals. She specializes in the treatment of pelvic floor disorders, as well as laparoscopic colon and rectal surgery.

A 1998 graduate of the Indiana University School of Medicine, Sanders completed her general surgery residency at IU and finished her fellowship in Colon and Rectal Surgery at the Cleveland Clinic in Florida.

Sanders attained board certification from the American Board of Surgery and was board-certified in colon and rectal surgery in 2006.

She is a member of the ACS, American Women Surgical Association, American Society of Colon and Rectal Surgery, Society of American Gastrointestinal Endoscopic Surgeons, the American Medical Association, the Indiana State Medical Association, Crohn’s and Colitis Foundation and SAGES.

Sanders was named a Fellow during the ACS’s 93rd annual Clinical Congress, held recently in New Orleans.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The organization has more than 72,000 members and is the largest organization of surgeons in the world.

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St. Francis offers free colorectal cancer risk assessments in March

INDIANAPOLIS – Kim Goelz was shocked when her doctor broke the news to her: she had stage III colon cancer and soon would be in for the fight for her life.

“I was stunned,” said the 35-year-old wife and mother of two. “I had no family history and no major health issues, and yet here I was diagnosed with colon cancer.”

Goelz is among more than 112,000 Americans diagnosed each year with colon cancer, according to the National Cancer Institute. She immediately sought medical help when she experienced symptoms and her family physician encouraged her to get a colonoscopy which detected the cancer.

Early detection is the key to successfully treating and surviving colon cancer – and that’s why the St. Francis Colorectal Cancer Center of Excellence is offering free risk assessments to the public.

Screenings will be at Greenwood Park Mall Food Court 11 a.m. to 5 p.m., Saturday, March 1; and 8:30 a.m. to noon, Monday March 3; and 10 a.m. to 3 p.m., Saturday, March 8 at Meijer at Heartland Crossing in Camby.

The free assessments coincide with the observance of National Colorectal Cancer Awareness Month.

“Screening for colon cancer is highly effective, and one of the key objectives of our center is to increase awareness of the risks of colorectal cancers,” said medical director Michael Morelli, M.D. “Colonoscopy should be part of routine care for everyone who is 50 and older, or earlier for those with a significant family history.”

Goelz was treated with a combination of therapies by St. Francis physicians and she is determined to be among the 70 percent who survive colon cancer. And she’s grateful she didn’t ignore the early warning sign.

“It scares me to think what would have happened if I had waited,” she said. “I had no pain or other symptoms.”

For more information about the free risk assessments, call 317-782-4422.

The Colorectal Cancer Center of Excellence team includes more than 25 physician specialists including gastroenterologists, colorectal surgeons, general surgeons, radiation oncologists, medical oncologists, pathologists, family practice physicians and radiologists. They are committed to the prevention, early detection and treatment of colorectal cancer, with a focus on providing the highest quality and individualized care for each patient.

For more information about St. Francis Cancer Care Services, go to http://stfrancishospitals.org/cancer.

Nurse navigators help cancer patients maneuver through treatment

INDIANAPOLIS – When first diagnosed with cancer, a person often feels set adrift in a murky sea of uncertainty and fear – and alone in their struggle.

But an innovative program at St. Francis Hospital & Health Centers helps patients from the time of diagnosis throughout their treatment regimen. It’s the nurse navigator program and it’s designed for patients and their families with colorectal and head and neck cancers.

This nurse specialist assists patients in coordinating diagnostic appointments and physician visits, along with helping to manage symptoms, providing education, increasing awareness of clinical trial availability and very importantly, easing patient anxiety.

"We augment what’s being done on the clinical side by helping guide patients through every step of the treatment and beyond," said Karen Norris, R.N., nurse navigator at St. Francis’ Colorectal Cancer Center of Excellence. "It’s not enough for the technology to be good – you have to provide the human touch to the people you serve."

Norris, who took on her role as a nurse navigator in mid-2007, is an integral player on a team of more than 25 physician specialists including gastroenterologists, colorectal surgeons, general surgeons, radiation oncologists, medical oncologists, pathologists, family practice physicians and radiologists who comprise the Center.

"It truly is a collaborative effort and our physicians and other specialists do a wonderful job in communicating and coming together to decide what’s best for patients," Norris said.

Nurse Practitioner Janice Leak’s role as St. Francis’ other nurse navigator – she was the first in 2006 – has positioned her as a key link between physicians and patients receiving care for head and neck cancers. The patients Leak works with often go through different treatment phases, often a combination of surgery, radiation and chemotherapy, and that means they will be seen by different physicians and technicians for tests and procedures.

Leak currently works with about 48 patients having head and neck-related cancers; Norris has a caseload of more than 70 patients at St. Francis hospitals in Indianapolis, Beech Grove and Mooresville.

"Cancer treatment can seem very complex and segmented to patients," Leak said. "That’s where a nurse navigator can be a common thread to help weave the patient through the process and so that they feel supported throughout the process."

Cheryl Snooks is one patient who has experienced that process. The business project manager was diagnosed with an oral-related cancer in 2006 at St. Francis and was immediately paired with Leak.

"As you go from diagnosis to treatment, your questions and concerns change," Snooks said. "It was helpful to have Janice there with the answers and to have a positive experience."

As part of the Center’s commitment to provide the newest technology and highest quality of care, Norris explained that all patients are screened for enrollment in clinical trials. These research studies are among nearly 100 now under way and overseen by the St. Francis Cancer Research Foundation.

The attention doesn’t end with treatment. Norris and Leak both follow up with their patients long after their therapies.
St. Francis also has plans to expand its nurse navigator program into lung cancer.

More information about Cancer Care Services at St. Francis is at http://stfrancishospitals.org/cancer.