NEWS OF THE CCCRS

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What's New?

What's New at the Center:

Although the California Center closed in 2010, Dr. Khoo is still busy performing colon and rectal surgery. From 2010-2014 he was at Geisinger in Danville PA where he was the Chief of the Colon and Rectal Surgery section.
He is now the Medical Director of Colon and Rectal Surgery at Southern Ocean Medical Center which is part of the Hackensack Meridian Health system.

In 2016 Meridian Health merged with Hackensack to form Hackensack Meridian Health. Their new website is Hackensack Meridian Health

His office was just moved into new suites in the New Cancer Center at Southern Ocean Medical Center on the 2nd floor Medical Arts Pavillion.

Dr. Khoo closed his California practice on August 31, 2010. He transferred care of his patients to
Bay Area Colon and Rectal Surgeons

Dr. Khoo has presented his laparoscopic surgery videos at national meetings. In 2007 at the American College of Surgeons in New Orleans he presented on the Colon and Rectal Surgery Video Session. That video is now published on Cine-Med and used to educate other surgeons. He presented another laparoscopic video In May 2009 at the annual meeting of the American Society of Colon & Rectal Surgeons in Hollywood, FL. Most recently another one of his videos was accepted for publication in the journal, the Diseases of the Colon and Rectum.
He presented a video on his surgery, SILS Transanal Endoscopic Microsurgery on October 24, 2011 at the American College of Surgeons Clinical Congress at Moscone Center, San Francisco, CA.
He lectured about Transanal Endoscopic Surgery on November 9, 2012 at the 2012 Annual Scientific Meeting of the Keystone Chapter American College of Surgeons, Harrisburg, PA.
Another movie was presented on Loop Ileostomy and Colon Lavage for Severe Clostridium difficile Colitis the Annual Meeting of the American Society of Colon & Rectal Surgeons, Phoenix, Arizona. April 27-May 1, 2013.

Change - a movie by Tyler Macey
Dr. Khoo was interviewed about colon cancer in the movie "Change" which includes many Sonoma residents like Tommy Smothers. For details click on Change - the Movie. That movie was accepted at the Washougal International Film Festival and was shown at the San Fernando Valley International Film Festival.

Laparoscopic colectomy - For almost 10 years prior to 2004, there was a moratorium on laparoscopic colectomy for colon cancer, because of concern that the procedure lead to cancer recurrence in the wound. In the early 1990s some studies reported that as many as 21% of patients developed cancer recurrences at the trocar sites. In 1994 surgeons were asked not to perform laparoscopic surgery for cancer unless the patients were part of a randomized controlled study. In June 2004, the results of this study were announced. Dr. Heidi Nelson, Chief of Colorectal Surgery Mayo Clinic, Rochester, MN, was the lead author. This landmark paper showed that laparoscopic colectomy was safe and does not increase the incidence of cancer recurrence in the wound. Before 2004 Dr. Khoo performed laparoscopic colectomy only for benign disease. He avoided laparoscopic surgery for patients with cancer. Since the publication of Dr. Nelson's 2004 study, Dr. Khoo has performed over 1,000 laparoscopic colectomies for cancer patients.

Most (>95%) of his abdominal surgeries are performed laparoscopically.

In 2007 he presented a movie of one of his laparoscopic cases at the American College of Surgeons Annual meeting in New Orleans. His laparoscopic movies have also been published in the journal Diseases of the Colon & Rectum.

In 2004 Dr. Khoo underwent intensive training at the Ethicon Endo-Surgery center in Cincinnati Ohio. He uses a special device, the Lap Disc, to facilitate laparoscopic surgery. Using the Lap Disc allows him to insert his hand into the abdomen during laparoscopic surgery. This modification of laparoscopic colectomy is called HALS (Hand-Assisted Laparoscopic Surgery). In the past, one disadvantage of laparoscopic surgery was that the surgeon was not able to feel the tissues this slowed the progress of the procedure. The Lap Disc allows Dr. Khoo to feel the tissues as they are being dissected. The advantage is that the surgery can now be done much faster and safer than before. Since an incision is already necessary to retrieve the colon specimen, why not make it to insert the hand early to facilitate the procedure?

Dr. Khoo helped in developing a computerized bowel anastomosis device called SurgAssist which is made by Power Medical Interventions. This device allows the creation of reliable and safe anastomosis. The company is now taken over by Covidien.

Dr. Khoo has visited Sharp Memorial in San Diego and the Legacy Health Care Hospitals in Portland Oregon to continue learning and perfecting his laparoscopic colon resection technique. He plans to visit other centers of laparoscopic surgery around the U.S. in his effort to build a center of excellence in laparoscopy here in Northern California.

The benefits of laparoscopic colectomy are noticeable. There is significantly less post-op pain. The bowel function returns faster and the length of stay has been reduced by about 3 or more days on average.

Lap Disc device

The operating time with laparoscopic approach is 1-2 hours longer than with open surgery but the patient may have less pain, recover from surgery sooner, and get back to work faster. Not all patients can have laparoscopic surgery - some (about 5%) have to be converted to open surgery during the procedure. Factors such as adhesions and scar tissue, the patient's build, abdominal wall thickness, extent of tumor invasion may affect the success of laparoscopic surgery.

The laparoscopic study summary can be found at Laparoscopic Colectomy Trial

What's New in Colon and Rectal Surgery:

THE PHYSICAL GENIUS - What do Wayne Gretzky, Yo-Yo Ma, and a brain surgeon named Charlie Wilson have in common? - article by Malcolm Gladwell from The New Yorker which explains excellence though concentrated effort and practice.

Should I Have a Virtual Colonoscopy? - article from Dr. Robert Khoo

High Volume Surgeons Get Better Results - article from Wall Street Journal

PPH or Stapled Hemorrhoidectomy
Hemorrhoid Surgery Without Pain - A new revolution in surgery

New Weapons Against Colon Cancer Article from BusinessWeek

Katie Couric and the NBC Today Show Battle on Colon Cancer Time Magazine Article

Fiber Facts - Does Fiber Decrease The Risk of Colon Cancer?
- advice from Time Magazine's Christine Gorman

New articles on Screening for Colon Cancer can be accessed in the Medical Information section.

Screening for Colon Cancer
Advice from the Center for Colon and Rectal Surgery

In 1998 President Clinton announced that it would be easier for Medicare patients to get Colon Cancer screening. For the first time, there was coverage for screening for Colon and Rectal Cancer which is the second commonest cause of cancer death in the U.S. This is a cancer "no one wants to talk about". Breast and prostate cancer have received a lot of attention. Breast cancer is common and lethal but tends to affect women. Prostate cancer is also common but obviously, only affects men. In contrast, both men and women are equally likely to develop Colon and Rectal Cancer, and this cancer is especially deadly. This accounts for the fact that it is second only to lung cancer as a cancer killer.

Before this new law, Medicare paid for tests only if the patient had symptoms of cancer. To improve the cure rates from Colon and Rectal Cancer, screening must be done before symptoms arise. Every year 130,000 people are diagnosed with colon cancer and half of these people will die of it. The cure rate increases to 90% if this cancer is diagnosed and treated early. Because these cancers grow from polyps, if these polyps can be found early and removed, Colon and Rectal Cancer can be prevented.

Our lifetime risk of getting Colon and Rectal Cancer is 5%. If you are at "high risk" your chance of developing this cancer increases 2 to 3 times this figure. High risk people are those who have had Colon and Rectal polyps or cancer, a strong family history of Colon and Rectal polyps or cancer, or ulcerative colitis. A strong family history means you have a primary relative (your mother or father, brothers, sister, children) with this disease. Therefore if your grandmother or uncle have this cancer, you are not considered "high risk" and you need only routine screening. Routine screening involves an exam of the last 1/3 of your colon with sigmoidoscopy, as this is where most (60%) of these cancers arise. Sigmoidoscopy is done with a flexible scope in the office and no sedation or medication is necessary.

Because the "high risk" individual's entire colon is at risk of developing cancer, sigmoidoscopy is not enough. Occult blood testing of the stool is also not enough as a cancer may not bleed constantly, so this test may miss the cancer. The entire colon of the "high risk" individual needs to be examined. That can be done with a barium enema X-ray or colonoscopy. Both these tests need to be done in the hospital or an outpatient clinic.

Barium X-ray is not sensitive as polyps and small cancers may be missed. If a polyp or lump is seen on the X-ray, then colonoscopy will be necessary. Colonoscopy is more sensitive as it will detect small lesions (polyps or cancer) of the colon. At the time of colonoscopy, if a lesion is found, it can be biopsied or completely removed. Another advantage of colonoscopy, is that it is done with sedation which makes it comfortable for you.

What about Virtual Colonoscopy. This test holds promise for the future. At present, you have to pay for this test yourself, as your insurance will not cover it. The Virtual Colonoscopy is a special x-ray, actually an ultra-fast CAT Scan of your abdomen. The colon pictures are generated using a powerful computer. The problem is that small polyps can be missed and if a polyp or "lump" is found, you will need a regular colonoscopy to try to biopsy or remove the lesion. A bowel preparation with laxatives is still needed. If you are not completely cleaned out, the retained stool can look like a polyp or mass, and a colonoscopy is then necessary to examine the finding.

At the Center for Colon and Rectal Surgery, screening for Colon and Rectal Cancer begins with an interview to determine if you at "low" or at "high" risk.

Low Risk (Routine) Screening:
Yearly digital rectal exam, Stool for occult blood, Flexible sigmoidoscopy

High Risk:
Colonoscopy - repeat every 5 to 10 years afterward depending on findings: number of polyps, size and type of polyps.