A Conversation on Colon Cancer and Minimally Invasive Surgery

Colon cancer is one of the deadliest cancers; more than 150,000 new cases are diagnosed in the U.S. each year and an estimated 52,900 will die from the disease in 2025, according to statistics from the American Cancer Society (ACS).

“Colon cancer is the third-leading cause of cancer-related deaths in men and the fourth leading cause in women, but it’s the second most common cause of cancer deaths when numbers for men and women are combined,” the ACS states.

Resource editors spoke about colon cancer, also known as colorectal cancer, with Jordan Moseson, D.O., a board-certified surgeon at Baptist Health who specializes in minimally invasive colorectal and general surgery, including robotic surgery. Dr. Moseson also has special expertise in performing colonoscopies and sacral neuromodulation (electrical stimulation therapy) for bowel incontinence. 

Jordan Moseson, D.O., a surgeon at Baptist Health who specializes in minimally invasive colorectal and general surgery, including robotic surgery

RESOURCE: Are there any specific diagnostic trends you are seeing among patients in your practice that are concerning or unusual or that people should know about?

Dr. Moseson: We’re seeing a rise in colorectal cancer diagnosis in patients under the age of 50 and often these cancers are more aggressive and diagnosed at later stages. This is one reason why the recommendation is now to start screening at the age of 45 for people who are considered average risk for developing colorectal cancer.

RESOURCE: How do you determine if a patient is a good candidate for minimally invasive colorectal surgery, and what are the typical benefits of this approach compared to traditional surgery?

Dr. Moseson: There are many factors to consider when deciding what the best surgical approach should, including patient-specific factors such as cardiovascular and pulmonary health, overall nutritional and functional status, and what medications a patient is taking. We work in concert with our patients’ medical doctors to help determine who is a candidate for minimally invasive surgery and who would be better served with an open procedure. Generally speaking, minimally invasive surgery is safe and is my preferred approach for most colorectal cancer patients. Minimally invasive techniques often allow for smaller incisions and less postoperative pain with quicker recovery and less time in the hospital after surgery.

RESOURCE: Can you explain how robotic surgery enhances precision in colorectal procedures? Are there specific conditions or cases where you would recommend it over other techniques?

Dr. Moseson: Robotic surgery is an extension of laparoscopic surgery, which is a minimally invasive technique that uses a scope with a camera to visualize the operative field and longer, small diameter (5-12mm) instruments to perform the operation. Robotic surgery enhances precision by providing a more stable view of the operative field in 3D that is completely controlled by the surgeon. Similarly, the surgeon can control all the instruments and retractors, which helps to minimize trauma to tissues and surrounding structures. The instruments themselves are “wristed” which allows for more articulation and are easier to work with compared to standard non-wristed laparoscopic instruments – particularly in the narrow confines of the pelvis or by the gastro-esophageal junction. These instruments also allow for easier suturing within the abdominal cavity, which can enhance the surgeon’s ability to perform certain techniques such as reconnecting or anastomosing portions of the patient’s colon and small intestine.

RESOURCE: Could you explain how sacral neuromodulation works for bowel incontinence, and what kind of outcomes do most patients see after undergoing this therapy?

Dr. Moseson: Sacral neuromodulation is a technique that utilizes a small electrical generator to stimulate the pelvic nerves which control the anal sphincter muscles. This therapy was initially designed for people having urinary incontinence and it was noted that patients who also had bowel incontinence were seeing an improvement in those symptoms as well, so now it is used for either or both conditions. We have seen excellent results with this technique in our practice. Success is defined as a 50% or greater reduction in incontinent episodes, but many of our patients see an even greater reduction in their symptoms. These results are also more durable than other surgical techniques for bowel incontinence, meaning they show sustained results over time.

RESOURCE: What does recovery look like for patients who’ve had minimally invasive colorectal surgery? Are there any special precautions they should take during healing?

Dr. Moseson: Usually, a patient will spend two to four days in the hospital after minimally invasive colorectal surgery. We combine our surgical technique with an Enhanced Recovery After Surgery (ERAS) protocol. This focuses on getting them up and walking sooner and advancing their diet after surgery, which often allows patients to be discharged sooner. Once at home, patients typically will have some restrictions in terms of physical activity and heavy lifting for the first couple of weeks. I usually see post-op patients in the office at two weeks after surgery and based on how they are doing we can then adjust those restrictions. Patients are usually completely healed in about six weeks. 

RESOURCE: Are there any emerging technologies or techniques in colorectal or general surgery you’re excited about? How might they impact patient care in the near future?

Dr. Moseson: I think that we’ll continue to see refinements to the robotic surgery platforms and certainly as we continue to gain experience with this technology our outcomes will continue to improve. I think what is most impactful to our field, however, is the increased awareness and education of both patients and physicians of colorectal cancer and the options that are available for screening, early detection and treatment. 

RESOURCE: As a surgeon specializing in colorectal health, how would you explain the critical role of colorectal cancer screenings in early detection and prevention?

Dr. Moseson: I believe that with proper screening, colorectal cancer is a preventable disease. The majority of colon cancers start as polyps, which are small, benign growths that form in the lining of the colon. These can be easily detected and removed during a colonoscopy which prevents them from ever transforming into cancer. Therefore, it is critical that patients and their physicians are aware of the various screening modalities and when to start the screening process. 

RESOURCE: With advancements in minimally invasive surgery and screening technologies, what is the impact of early detection on the treatment options available to your patients?

Dr. Moseson: As I mentioned above, early detection of polyps can prevent patients from ever having colorectal cancer. However, if the diagnosis of cancer is made, and it is found to be at an early stage (stage 1 or stage 2 at most), minimally invasive surgery is usually all that is required to achieve cure. More advanced stage cancers sometimes require chemotherapy and/or radiation either before or after surgery. 

RESOURCE: There’s often hesitance when it comes to scheduling a colonoscopy. What do you say to patients who feel uncomfortable with the idea of the procedure and are reluctant to undergo colorectal cancer screenings?

Dr. Moseson: I usually try to focus on the benefits of screening and explain that it’s much easier to have a colonoscopy than it is treatment for a colorectal cancer that is discovered once someone is having symptoms. The exam itself has minimal discomfort and with the type of anesthesia we use, the patient has no awareness during the procedure. If a patient still does not want to undergo a colonoscopy, there are other less invasive screening modalities that can be used, however they do not have the same level of sensitivity or specificity as a colonoscopy and if they come back positive, the patient still needs a colonoscopy to verify the results. 

RESOURCE: Given that colorectal cancer is a leading cause of cancer deaths, do you think current screening guidelines are adequate, or should they be adjusted based on newer research or patient demographics?

Dr. Moseson: I am happy to see that the American Cancer Society has lowered the starting age for screening to 45 and I believe that this recommendation is based on the scientific evidence that is currently available. I suspect that if current trends continue, these guidelines are likely to change and we may end up starting screening even earlier. It is important to understand that these guidelines are not hard and fast rules and that each patient should discuss his or her specific risk factors and concerns with their doctors so that the correct strategy can be employed with the best outcome for that patient. 

RESOURCE: Given that colorectal cancer is a leading cause of cancer deaths, do you think current screening guidelines are adequate, or should they be adjusted based on newer research or patient demographics?

Dr. Moseson: I am happy to see that the American Cancer Society has lowered the starting age for screening to 45 and I believe that this recommendation is based on the scientific evidence that is currently available. I suspect that if current trends continue, these guidelines are likely to change and we may end up starting screening even earlier. It is important to understand that these guidelines are not hard and fast rules and that each patient should discuss his or her specific risk factors and concerns with their doctors so that the correct strategy can be employed with the best outcome for that patient. 

RESOURCE: As we observe Colorectal Cancer Awareness Month in March, what message would you like to share with individuals who may be at higher risk for colorectal cancer?

Dr. Moseson: My biggest message would be to simply get screened and to remember that colorectal cancer can be prevented. There are many different options available and patients should talk to their doctor about which is best for them. 

Get Your Colon Cancer Screening

The right screening, done on time, can catch colorectal cancer early, even before symptoms appear. Don't put it off any longer. Talk to your doctor today and find out which screening option is right for you. Visit BaptistHealth.net/ColorectalTest.