Today we’re talking with Dr. Benny Chong of Paragon colorectal care Paragon colorectal care is a division of Paragon surgical in Concord, North Carolina. Dr. Chong completed his fellowship training in colon and rectal surgery at the Orlando Health Colon and Rectal Clinic in Orlando, Florida. He has a special interest in treating rectal cancer and anal rectal disorders. Dr. Chong is board certified and is experienced in both traditional and robotic surgical techniques. Over the past 50 years Paragon Surgical Specialists has earned a reputation of excellence by combining technical proficiency, advanced surgical techniques and compassionate care. Each day they strive to set the standard for general thoracic, laparoscopic, vascular, and cancer surgery in the region. So, hi, Dr. Chong. Thanks for joining us today.
Dr. Chong 01:07
So today we’re going to talk about minimally invasive surgical techniques in colon and rectal surgery.
Dr. Chong 01:14
I was wondering if you could tell us a little bit about some of the the options you have for colon and rectal surgery.
Dr. Chong 01:21
So in terms of minimally invasive surgery, um, there are two approaches that I can do. One is laparoscopy and the other one is robotic surgery. Really, with the robotic type of approach, the visualization, it’s much better, there are tissue planes that you can see much better with the magnification. And also with the robot, you can get down into the pelvis and do pelvic surgery much safer.
So how do you determine what type of surgery is best for the patient is that depending on where you need to go in the abdomen or the lower GI tract?
Dr. Chong 01:58
Yes, for the most part, that is. With the robot, again, with the pelvic surgery, it’s much better utilized, because again, we can see the pelvic plains and you can actually go into a much narrower space like the pelvis. And also because it has wristed movements. And instead of a laparoscopic approach where the instruments are straight, it’s a much better tool to dissect within such a narrow space. And then also, in terms of a robotic approach for colon surgery, it allows me to do more of the stuff inside the body as opposed to making incisions and doing part of the surgery outside of the body. And that has, you know, from a patient standpoint, benefits in cosmesis and, as well, quicker return to bowel function.
Can you talk a little bit about what that is like? So a patient goes to the O.R. just like they would traditionally. But I think some people have, they don’t have a concept of what happens when they get in there. You know, what is… Who’s actually operating the machine and things like that? What can you explain a little bit more about that?
Dr. Chong 03:17
Yeah, so in terms of robotic surgery, so the operating surgeon, so myself, is still the one in charge of everything. So we’re at the bedside, and we put in all the instruments that are required. And then we actually have full control of the robot. So we’re still in the room operating and we actually direct the instruments that the robot has with our hands. And we also have a physician’s assistant at the bedside to help us in terms of retracting, or suctioning or whatever is needed, right at the patient’s bedside.
So about how long does that take normally? I know they’re different surgeries, so it may Some may be more complex than others. But is this a faster type of surgery?
Dr. Chong 04:02
In terms of a time between laparoscopic and robotic? For myself, at least, it’s very similar, perhaps a little bit faster with a laparoscopic approach. And again, the reason for that is because, partly, with the laparoscopic approach, a portion of the procedures is outside of the body. So again, you don’t have that added benefit of cosmesis or quick return to bowel function.
So in terms of open surgery, is that really even done anymore? Is there any case where you need to do a traditional open surgery.
Dr. Chong 04:37
So there will always be a role for open surgery. And partly, you know, if you, if someone has a very large and bulky tumor where the incision to remove that bulky tumor, is the size of an open incision anyways, and there’s really not much added benefit to doing a minimally invasive approach. Then also a lot of times safer when it’s open, such as in patients who’ve had multiple belly surgeries and there’s a lot of scar tissue involved, you can’t safely do a minimally invasive approach.
So in terms of aftercare, they’ve had surgery, either robotic or laparoscopic, I know you said that their return to bowel function is quicker, but what about just a normal lifestyle?
Dr. Chong 05:27
In terms of normal lifestyle? There’s not really much difference between laparoscopic and robotic. Long term wise.
What are some of the common conditions that you are addressing with this type of surgery?
Dr. Chong 05:43
I do a lot of surgeries for diverticulitis, and for colon cancer and rectal cancer in general.
So in reference to colon cancer, I mean, obviously, that’s a very common cancer in the United States. Can you tell us a little bit about the recent statistics?
Dr. Chong 06:04
There are more than 1 million current survivors of colorectal cancer. And what’s important for the public to know is that this is preventable cancer. If you undergo a screening colonoscopy early and we can catch polyps early, then you can actually prevent progression into colon cancer.
So the American Cancer Society said that when caught early, there’s a 90% chance of a five year survival rate, but explain that… Is that someone that you know, maybe had polyps or it was farther along? Because I mean, I’ve even known of some people lived much longer than five years.
Dr. Chong 06:46
Yeah, so actually the five-year survival rate of 90%. That comes from data from stage one colon cancer, and that’s quoted at, you know, overall outcome from a stage one colon cancer 90% survival in five years. So obviously, if someone is caught even earlier than that, then their percentage would be even greater.
So is colon cancer surgery a large part of your practice you’re seeing a lot of that?
Dr. Chong 07:14
It definitely is and actually it’s more getting more and more common in a younger generation. So we’re pushing for screening colonoscopies and younger patients as well.
Why do you think that’s happening with younger patients?
Dr. Chong 07:29
There are a lot of different studies out there. So there’s nothing conclusive, but one of the things that I’m seeing in some of the readings that I’ve done is with a more sedentary lifestyle in the younger patients nowadays, and also, you know, decrease bowel movements secondary to that, it increases mucosal contact time between the stool and the bacteria in his stool and the colon. So that may have some role in developing of colorectal cancer.
So if you are recommending an earlier screening, you know, when they’re younger, I know, typically, they say your first screening at 50. But what are you, what are you recommending in some particular patients who may have a higher risk factor?
Dr. Chong 08:17
So definitely, in patients with high risk factors, such as family history of colon cancers, and colon polyps, their screening age is much younger than that, and it’s actually 10 years younger than the earliest age of diagnosis in family members. However, if you’re my patient coming into my clinic with complaints of, you know, hemorrhoidal bleeding, my first recommendation to you would be a screening colonoscopy, because my thought is, unless someone can go and say for 100% certainty that there was no cancers or polyps causing bleeding, then I have to play devil’s advocate.
Wow, it’s kind of scary to think about that. So you’re saying that I mean, in the younger population, one of the things that they can do is be more active?
Dr. Chong 09:03
Yeah, definitely don’t brush off bleeding noted in the stool and don’t just automatically think it’s from hemorrhoids. I just want to caution the general public that, you know, blood in the stool is not something to be taken lightly unless you’ve had recent investigation.
So what other things can everyone do to help reduce their chances of getting colon cancer,
Dr. Chong 09:30
Definitely increased physical activity. That’s shown to help. Modifying your diet to decrease the amount of red meats that you eat, low in fat, and also definitely cut back on tobacco use because nicotine is shown to increase polyp production and also again, polyps eventually will turn into cancer. Decrease alcohol use, and also if you have a strong family history of any sort of colon and rectal problems, then get investigated earlier rather than later.
So definitely talk to your physician about your risk factors, talk about when you should be screened for colon cancer and then if they are screened and there is evidence of some sort of polyp or something those are removed at that time?
Dr. Chong 10:18
Yeah, under when you undergo a colonoscopy, if there are any sort of abnormalities such as polyps or masses, those are usually either biopsied or removed at the time of colonoscopy.
Very good. That’s good information. Well, thank you so much for all of that.
Dr. Chong 10:33