Division of Colorectal Surgery

Division of Colorectal Surgery
at St. Luke’s-Roosevelt Hospital Center

Division of Colorectal Surgery

Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center
Roosevelt Division
1000 Tenth Avenue at 58th Street
New York, NY 10019
and
425 W. 59th Street, Suite 9A
New York, NY 10019
(212) 523-8417

About the Division
Screening and Early Detection
Special Services and Programs

About the Division
The Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center offers specialty care for patients with colorectal cancer or the other colorectal diseases which may be precursors to colorectal cancer. Providing complete care for all conditions of the rectum, colon and anus, including both benign and malignant conditions, the division features four board-certified colorectal surgeons as well as a post-graduate fellowship training in colorectal surgery.

Routinely performed diagnostic studies include anoscopy, proctoscopy, sigmoidoscopy, colonoscopy, and biopsy. In collaboration, other diagnostic services include all forms of endoscopy, manometry and nerve conduction studies for anal incontinence (gastroenterology), ultrasonography, including endoscopic ultrasound (EUS) for primary tumors, anal sphincter injuries and intra-operative procedures for the detection of liver abnormalities. Virtual colonoscopy will soon be available as well. St. Luke’s-Roosevelt also features a state-of-the-art diagnostic lab for disorders of fecal incontinence and constipation.

Treatment programs in collaboration with radiation oncology and medical oncology include international leadership in intra-operative radiation therapy, multidisciplinary management of liver metastases, staging of rectal cancer, etc. Whenever possible, surgery is performed in an ambulatory setting, saving the patient both time and expense.

The Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center participates in the National Cancer Institute’s Phase III trial for laparoscopy and colorectal malignancy. In addition, the division is participating in several national studies on treatments of anal fissures and anal condyloma.

Screening and Early Detection
Diagnostic tests are available for people with a strong family history of colorectal cancer in particular and gastro-intestinal cancers in general. Fecal occult blood tests, endoscopy, colonic polypectomy and biopsies are available for people who are a risk by virtue of age alone (50 or older), by family history, or by the presence of potentially high-risk conditions, i.e., ulcerative colitis, familial polyposis, hereditary non-polyposis colon cancer, or Crohn’s Disease. All diagnostic tests are available at the ambulatory center in the Roosevelt site or at the 425 W. 59th Street site.

Special Services and Programs
Total Mesorectal Excision with Autonomic Nerve Preservation: TME with ANP
The physicians at the Division of Colorectal Surgery at St. Luke’s-Roosevelt are trained in this operative treatment of rectal cancer. The operation known as Total Mesorectal Excision (TME) with Autonomic Nerve Preservation (ANP) represents a fundamental departure from the conventional techniques of operating on rectal cancer.

The advent of TME with ANP combines the best advances in cancer cure rates with the best improvements in quality of life issues. While the cure rate for rectal cancer averages 45-50 percent following conventional surgery, it has risen to 75 percent or higher in patients undergoing TME. Whereas the recurrence rate for cancer in the pelvis is 30-40 percent worldwide, the rate of pelvic recurrence is only 5-8 percent after TME surgery. While 55 percent of American patients undergoing surgery for rectal cancer end up with a permanent colostomy, TME avoids a permanent colostomy in over 90 percent of patients. And while 50-95 percent of patients after conventional or radical pelvic surgery experience erectile impotence or serious urinary disturbances, the autonomic nerve preservation which we perform in association with TME has resulted in an 85 percent rate of function preservation.

These operations have resulted in a treatment for rectal cancer with a high rate of cure and, for the first time, a body image and functional outcome which allows patients to look forward to an optimistic future.

Pre-operative Ultrasound Staging
In rectal cancers, a pre-operative clinical estimation of the cancer stage is important from the outset of treatment. Transanal ultrasound techniques may be used to determine the depth of penetration into the bowel wall, or to detect any potentially involved lymph nodes. Findings may help to determine the value of pre-operative radiation or chemotherapy.

Assessment of Lymph Node Distribution
Some patients have metastases to lymph nodes along the major arteries and nerves which are located along the pelvic side wall. Routine removal of these lymph nodes can cause unnecessary urinary and sexual morbidity. Targeting those lymph nodes by intra-operative identification and biopsy (as opposed to their total removal) could improve survival and reduce morbidity. A special program assessing the involvement of these nodes is in progress at the present time.

Local Excisions for Patients with Early Rectal Cancer who are at Risk of Colostomy
A small but definite number of patients harbor early rectal cancers which are located so close to the anal opening that a major operation would risk a permanent colostomy. Often, these are early cancers which are removable via the anus without risk of colostomy. In patients who are eligible for this treatment, the removed cancer is studied by a pathologist, looking for depth of penetration, positive or negative margins, blood vessel invasion, or other adverse features. Based upon these findings, patients are told whether they can undergo frequent observation or radiation therapy or further surgery. In carefully selected patients, an excellent outlook is often available to patients who would otherwise have been treated by removal of the rectum and permanent colostomy.

Curative Approach to the Treatment of Patient with Five or Fewer Liver Metastases
Patients with multiple liver metastases are often candidates for systemic chemotherapy, unless all disease appears limited to the liver. In that case, the liver itself can be treated with chemotherapy via an artery, using a pump which may be implanted at the time of surgery.

Pelvic Operations for Unusual Conditions
Rare and unusual conditions often confound the treatment of patients, resulting in unnecessarily radical or morbid surgery. The approaches taken to many different tumors allows application of unusual surgical approaches to rare conditions resection disease with limited long term side effects. Such conditions may include sacrococcygeal tumor or cysts, pelvic sarcomas or benign soft tissue tumors, etc.

	Division of Colorectal Surgery

	Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center Roosevelt Division 1000 Tenth Avenue at 58th Street New York, NY 10019 and 425 W. 59th Street, Suite 9A New York, NY 10019 (212) 523-8417 About the Division Screening and Early Detection Special Services and Programs About the Division The Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center offers specialty care for patients with colorectal cancer or the other colorectal diseases which may be precursors to colorectal cancer. Providing complete care for all conditions of the rectum, colon and anus, including both benign and malignant conditions, the division features four board-certified colorectal surgeons as well as a post-graduate fellowship training in colorectal surgery. Routinely performed diagnostic studies include anoscopy, proctoscopy, sigmoidoscopy, colonoscopy, and biopsy. In collaboration, other diagnostic services include all forms of endoscopy, manometry and nerve conduction studies for anal incontinence (gastroenterology), ultrasonography, including endoscopic ultrasound (EUS) for primary tumors, anal sphincter injuries and intra-operative procedures for the detection of liver abnormalities. Virtual colonoscopy will soon be available as well. St. Luke’s-Roosevelt also features a state-of-the-art diagnostic lab for disorders of fecal incontinence and constipation. Treatment programs in collaboration with radiation oncology and medical oncology include international leadership in intra-operative radiation therapy, multidisciplinary management of liver metastases, staging of rectal cancer, etc. Whenever possible, surgery is performed in an ambulatory setting, saving the patient both time and expense. The Division of Colorectal Surgery at St. Luke’s-Roosevelt Hospital Center participates in the National Cancer Institute’s Phase III trial for laparoscopy and colorectal malignancy. In addition, the division is participating in several national studies on treatments of anal fissures and anal condyloma. Screening and Early Detection Diagnostic tests are available for people with a strong family history of colorectal cancer in particular and gastro-intestinal cancers in general. Fecal occult blood tests, endoscopy, colonic polypectomy and biopsies are available for people who are a risk by virtue of age alone (50 or older), by family history, or by the presence of potentially high-risk conditions, i.e., ulcerative colitis, familial polyposis, hereditary non-polyposis colon cancer, or Crohn’s Disease. All diagnostic tests are available at the ambulatory center in the Roosevelt site or at the 425 W. 59th Street site. Special Services and Programs Total Mesorectal Excision with Autonomic Nerve Preservation: TME with ANP The physicians at the Division of Colorectal Surgery at St. Luke’s-Roosevelt are trained in this operative treatment of rectal cancer. The operation known as Total Mesorectal Excision (TME) with Autonomic Nerve Preservation (ANP) represents a fundamental departure from the conventional techniques of operating on rectal cancer. The advent of TME with ANP combines the best advances in cancer cure rates with the best improvements in quality of life issues. While the cure rate for rectal cancer averages 45-50 percent following conventional surgery, it has risen to 75 percent or higher in patients undergoing TME. Whereas the recurrence rate for cancer in the pelvis is 30-40 percent worldwide, the rate of pelvic recurrence is only 5-8 percent after TME surgery. While 55 percent of American patients undergoing surgery for rectal cancer end up with a permanent colostomy, TME avoids a permanent colostomy in over 90 percent of patients. And while 50-95 percent of patients after conventional or radical pelvic surgery experience erectile impotence or serious urinary disturbances, the autonomic nerve preservation which we perform in association with TME has resulted in an 85 percent rate of function preservation. These operations have resulted in a treatment for rectal cancer with a high rate of cure and, for the first time, a body image and functional outcome which allows patients to look forward to an optimistic future. Pre-operative Ultrasound Staging In rectal cancers, a pre-operative clinical estimation of the cancer stage is important from the outset of treatment. Transanal ultrasound techniques may be used to determine the depth of penetration into the bowel wall, or to detect any potentially involved lymph nodes. Findings may help to determine the value of pre-operative radiation or chemotherapy. Assessment of Lymph Node Distribution Some patients have metastases to lymph nodes along the major arteries and nerves which are located along the pelvic side wall. Routine removal of these lymph nodes can cause unnecessary urinary and sexual morbidity. Targeting those lymph nodes by intra-operative identification and biopsy (as opposed to their total removal) could improve survival and reduce morbidity. A special program assessing the involvement of these nodes is in progress at the present time. Local Excisions for Patients with Early Rectal Cancer who are at Risk of Colostomy A small but definite number of patients harbor early rectal cancers which are located so close to the anal opening that a major operation would risk a permanent colostomy. Often, these are early cancers which are removable via the anus without risk of colostomy. In patients who are eligible for this treatment, the removed cancer is studied by a pathologist, looking for depth of penetration, positive or negative margins, blood vessel invasion, or other adverse features. Based upon these findings, patients are told whether they can undergo frequent observation or radiation therapy or further surgery. In carefully selected patients, an excellent outlook is often available to patients who would otherwise have been treated by removal of the rectum and permanent colostomy. Curative Approach to the Treatment of Patient with Five or Fewer Liver Metastases Patients with multiple liver metastases are often candidates for systemic chemotherapy, unless all disease appears limited to the liver. In that case, the liver itself can be treated with chemotherapy via an artery, using a pump which may be implanted at the time of surgery. Pelvic Operations for Unusual Conditions Rare and unusual conditions often confound the treatment of patients, resulting in unnecessarily radical or morbid surgery. The approaches taken to many different tumors allows application of unusual surgical approaches to rare conditions resection disease with limited long term side effects. Such conditions may include sacrococcygeal tumor or cysts, pelvic sarcomas or benign soft tissue tumors, etc.