This Clinician's View is written by Daniel Galante, DO, Program Director of the AdventHealth Colon and Rectal Surgery Fellowship.
Colorectal cancer is the third most common cancer worldwide and the second leading cause of cancer related deaths in the U.S. for men and women combined. In the under 50 population, it is now the number one cause of cancer death for men and the second leading cause of cancer death in women. As the medical community works to better understand the reasons for these startling statistics and how to prevent them, it is also critical to ensure we have fellowship-trained colorectal surgeons who can provide the most advanced and effective treatments for both colorectal cancers and benign disease.
At AdventHealth, we believe that we hold a dual responsibility to make the highest level of care available to our patients and to train the next generation of sub-specialized surgeons. That is why we have been committed to graduate medical education for nearly five decades. Our Colon & Rectal Surgery Fellowship Program launched in 2009 and has since grown to become one of the largest such programs in the U.S. and one of five Accreditation Council for Graduate Medical Education (ACGME)-accredited colorectal surgery fellowships in Florida.
Surgical Volume Matters
When it comes to surgery, skills are refined through repetition. At AdventHealth, our colorectal surgery fellows are required to train on a significant number of different procedures. In fact, the sheer volume of colorectal procedures they complete in their year of fellowship training is greater than what they performed during their entire five-year general surgery residency training. For example, minimum case numbers for a general surgery resident are 15 stomach/abdominal and 20 anorectal procedures, while our colorectal surgery fellows perform 150-200 minimally invasive colorectal resections and an average of 100 anorectal procedures.
Improving Outcomes for Patients with Colorectal Disease
Beyond surgical volumes, when it comes to specialized care for both cancer and benign disease, there is tremendous value in seeing a surgeon who has not only learned the nuance of the disease process and surgery itself, but also the most effective pre- and post-operative care.
As colorectal surgeons, we treat diseases of the colon, rectum and anus, and care for patients both inside and outside the operating room. Because of this, we see a full range of colorectal conditions, including hemorrhoids, fissures, fistulas and other benign anorectal disease that general surgeons without specialized colorectal fellowship training may not.
Several published studies have documented how better patient outcomes are achieved with fellowship-trained colorectal surgeons. One study published in the Journal of Gastrointestinal Surgery compared outcomes between general surgeons and colorectal surgeons. It found that for patients undergoing colectomy/proctectomy, when the operation was performed by a colorectal surgeon, even after accounting for hospital and surgeon volume, the following outcomes were achieved:
- In-hospital mortality decreased.
- Patients experienced a shorter inpatient stay.
- There was a decreased chance of colostomy.
- Patients were more likely to have undergone minimally invasive surgery.
Separately, a retrospective review published in the World Journal of Colorectal Surgery compared overall survival and lymph node sampling in colon cancer resections amongst colorectal fellowship trained surgeons vs. non-colorectal specialty trained surgeons and found:
- Survival probability was greater for patients who underwent resection by colorectal surgeons than those for patients who underwent resection by non-colorectal surgeons.
- Lymph node sampling in elective resections by colorectal surgeons was significantly higher.
Increased Exposure to Robotics and Advanced Colorectal Surgery Techniques
One of the keys to improving patient care and outcomes is always looking for better ways to do things. A hallmark of AdventHealth’s colorectal training program is our emphasis on new technology with opportunities for fellows to gain hands-on training in these advanced techniques and methods. This includes:
- Transanal minimally invasive surgery (TAMIS) — AdventHealth’s own Matthew Albert, MD, FACS, FASCRS, and his medical team invented this revolutionary technique that allows high quality local excision of benign rectal neoplasms and early-stage rectal cancers without using a specialized scope (TEMS device), minimizing operative costs.
- Transanal total mesolectal excision (taTME) — This innovative approach allows colorectal surgeons to remove lower rectal tumors with a smaller incision, and AdventHealth serves as one of just a few North American training centers for the procedure.
- Robotic-assisted colorectal surgery — We are one of the busiest robotic surgery centers in the country. Our team also pioneered robotic transanal surgery and teaches this procedure to leading surgeons and institutions around the world.
These and other evolving techniques have become a standard practice in our fellowship training program.
Encouraging Diverse Surgical Approaches
Because there is often more than one way to approach treatment, another critical element of effective colorectal surgical training is exposure to a wide variety of views. Colorectal surgery fellows at AdventHealth gain access to multiple different surgical techniques through our faculty of 14, who come from diverse training backgrounds. In addition to Dr. Albert and myself, our team includes:
- Mark Soilman, MD, FACS, FASCRS, Associate Program Director and Chief of Colorectal Surgery
- Justin Kelly, MD, FRCS
- George Nassif, DO, FACS, FASCRS
- Teresa H. deBeche-Adams, MD, FACS, FASCRS
- Christopher Aquina, MD
- Radhika Smith, MD, FACS
- Yaphet Tilahun, MD, FACS
- Norbert Garcia-Henriquez, MD, FACS, FASCRS
- Jeremy Drake, MD, FACS
- Navin Changoor, MD, FACS
- Rahila Essani, MD, FACS, FASCRS
- Ashley Althoff, DO
Additionally, teaching within our program takes place at various AdventHealth locations throughout Central Florida, exposing our fellows to a broad and diverse patient base. This allows them to leave with a large body of knowledge and a full armamentarium to care for their patients.
As a physician, I always want the best possible outcome for my patients and strive to continually learn, grow and improve. I can confidently say that this philosophy is shared by all my colleagues within the AdventHealth Colon and Rectal Surgery Fellowship Program. We remain committed to teaching, training, researching and investing in the future physician leaders who will continue tackling the challenge of colorectal cancers and benign conditions.
