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Robotic-assisted Laparoscopic Colectomy

From Start to Finish: A Winning Team

Kathleen Donato colectomy patientKathleen Donato, 65, of Bellingham will never forget what it was like in the early days of her colon cancer diagnosis. Although she tried to act upbeat, it was as if a fog had descended over her world. “It’s like how I felt when my parents died,” she murmurs. “I was thinking of my husband, my sons, my grandchildren. My life was flashing before me. I thought I was too young to go and worried about everyone I would leave behind.”

She credits Patrick McEnaney, MD, Chair of Surgery at Milford Regional, with saving her life. Dr. McEnaney performed a robotic-assisted laparoscopic colectomy—minimally invasive surgery to remove a portion of the colon through small incisions made in the abdomen wall—this past March just a couple weeks after her diagnosis. Dr. McEnaney used the da Vinci Surgical System, a sophisticated robotic platform that expands the surgeon’s capabilities, to perform the procedure.

 “I owe my life to Dr. McEnaney and truly believe that,” Kathleen states.      

Her ordeal started over the holidays with constant stomachaches and unusual bowel changes. When her symptoms didn’t improve, Kathleen checked in with her longtime gastroenterologist Ali A. Amini, MD, of Milford Gastroenterology Associates. Because her mother died of colon cancer at age 68, Kathleen was considered higher risk for the disease. Initially, Dr. Amini recommended that she undergo a colonoscopy every five years until 2011, when he found two polyps and advised her to retest in two years.

Kathleen put off the test because she hated the colonoscopy preparations, was busy with her family and her travel agent job, and honestly didn’t believe she was at risk. “My mother smoked all her life,” Kathleen says. “When she died, I said that’s why she had colon cancer, because she smoked.”

According to Dr. McEnaney, colon cancer has a strong genetic component. While the general population should receive a screening colonoscopy at age 50, there are stricter guidelines for those with a first-degree relative who had colon cancer.  “They should have a colonoscopy at least ten years before the age of the relative who was diagnosed,” he advises. “For example, if your father had it at 50, you should get a colonoscopy at 40. The earlier we detect the cancer, the more likely it is we’re going to be able to cure it.”

While not everyone has symptoms in the earlier stages, Dr. McEnaney says that some patients feel fatigued, may have anemia (low blood cell counts) and feel washed out. “Sometimes the stools are loose or blackish in color,” he relates. “There can be abdominal pain as the cancer starts to grow, or if it starts to block off the opening of the intestine.”

When Kathleen reported her symptoms, Dr. Amini told her she couldn’t postpone a colonoscopy any longer. To her shock, Dr. Amini found four polyps and a cancerous mass. “That, of course, scared the heck out of me,” she recalls.

Reeling, Kathleen made an appointment with medical oncologist Mona Kaddis, MD, of Dana-Faber/Brigham and Women’s Cancer Center at Milford Regional. From there, she was referred to Dr. McEnaney for the surgery. “I went through the whole ‘should I stay in Milford or go to Boston’ thing,” she recounts. “Dr. Kaddis is a great doctor and part of Dana-Farber. Everybody I talked to said Dr. McEnaney was wonderful. I had known Dr. Amini for so long. That all eased my mind. I was nervous, but knew I was lucky to have such a wonderful team.”

With all three doctors working together on her care, the pieces quickly fell into place and her surgery was scheduled for a mere thirteen days after the colonoscopy. Dr. McEnaney acknowledges that when people receive a cancer diagnosis, it’s a shock to their system. He will repeat himself numerous times to make certain that patients understand his words. “I explain in as simple terms as I can what’s going on and what we need to do to fix the problem,” he says. “I try to answer as many questions as they have and take as much time as I need to answer them. I know they’re going to be upset and worried. I don’t just treat it as an operation. There is a person behind it that I need to take care of.”

 As part of the visit, Dr. McEnaney describes how he will perform the surgery and the situations that could arise. He does most colectomy surgeries robotically, which gives him more control and added wrist action during the procedure. Exceptions would be if a patient had scar tissue from previous abdominal operations, or if the location of the mass would require him to operate in too many different areas. In those cases, he finds “straight stick” laparoscopy to be more efficient. An especially large mass could require open surgery.

Kathleen had a tumor which Dr. McEnaney equates to the size of a grapefruit. Since the appendix was attached to the area where her mass was, he removed that also. Anyone undergoing a right colectomy automatically gets the appendix taken out, he says.

“We remove the portion of the colon that harbors the cancer and like to remove at least twelve lymph nodes,” he says. “We took out Kathleen’s right colon and over 20 lymph nodes. In general, the colon is about 5 feet in length, but can vary from person to person. We took out about a foot and a half, just over a third of her colon. She still has plenty of colon to live a normal life.”

If the lymph nodes are negative, meaning that they don’t have cancer in them, then chemotherapy is oftentimes not necessary. Those who need chemotherapy would typically start five weeks after the surgery. Dr. McEnaney follows up with Stage 0 or 1 patients for a year and Stage 2 or higher for five years. Kathleen, who had Stage 2 cancer, was released from the hospital after two days and did not require chemotherapy. According to Dr. McEnaney, patients who have minimally invasive surgery can generally expect a recovery of 3-4 weeks. After three weeks, Kathleen resumed working from home as a travel agent.

“Everybody was so wonderful from the minute I checked in,” she praises. “I had the feeling that I wasn’t just another patient, that I was the main concern. The whole team acted that way for me. I wouldn’t even think about going anywhere else now because of the wonderful care that I got. Why go to Boston? We are Boston here.” 

 


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