Colorectal Surgery

Colon and rectal surgeons treat benign and malignant conditions, perform routine screening examinations and surgically treat problems when necessary.

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Introduction

Many people do not realize that colon and rectal surgery is a subspecialty of its own. It has actually been a recognized specialty of the American Board of Medical Specialties since 1959, and has been present in one form of another since 1899.

A colon and rectal surgeon must complete a full general surgery residency followed by a one year fellowship specifically in colon and rectal surgery. To be board certified in colon and rectal surgery, a physician also must be board certified in general surgery, then take an additional written and oral exam after fellowship. Both the general surgery and colon and rectal surgery certifications must be maintained with periodic exams. An added step beyond board certification is fellowship in the national society: to be a fellow of the American College of Surgeons (FACS), or of the American Society of Colon and Rectal Surgeons (FASCRS) a surgeon must have practiced for several years and met additional standards set by those societies, and be recommended by his or her peers.

Colon and rectal surgeons care for a wide spectrum of diseases across a range of ages. Not only do they care for diseases of the colon and rectum, but also the small intestine and anus, and the areas which surround them. Thus diseases such as Crohn’s disease, colon and rectal cancer, hemorrhoids, anal fissures, fistula in ano, ulcerative colitis, diverticulitis and many, many others are in their area of expertise. Most colon and rectal surgeons also practice colonoscopy in addition to surgical and non-surgical treatment of colorectal problems.

ColonMany general surgeons also take care of patients with colon and rectal diseases. There are several reasons for this: these diseases are so common that there are not enough board certified colon and rectal surgeons across the country to care for all the patients; most general surgeons do a very good job of managing these patients; many of the problems are relatively straightforward and benign and do not require the additional expertise of a colorectal surgeon. As patients are becoming increasingly more educated and savvy, however, they are seeking out subspecialists for their care. It is becoming clear that, for the treatment of colorectal cancer, subspecialty training and experience play a significant role in improving long term survival.

People with problems of the colon, rectum or anus are often embarrassed to discuss their problems with friends, family, and even their physicians.  This is understandable but unfortunate.  Many people live in misery for many months and even years when often a simple, painless medication or minor procedure can solve their problem.  More importantly, it can be difficult for a lay person to distinguish between symptoms caused by benign or malignant diseases.  For this reason you owe it to yourself to seek care as soon as possible if you experience rectal bleeding, pain, or a change in bowel habits (constipation, diarrhea, change in size or frequency of bowel movements).

 

Should a colorectal surgeon treat your colon or rectal cancer?

As patients become more educated and take more of an active role in choosing their physicians and surgeons, many are seeking out subspecialists such as colon and rectal surgeons for serious problems such as colorectal cancer. Does this make sense? Is there evidence to support this? In short, do colorectal surgeons take care of colorectal cancer better than non specialty trained surgeons? There is increasing evidence that patients with colon cancer or rectal cancer have improved outcomes if operated on by a subspecialty trained colon and rectal surgeon. This means better long term survival, fewer complications, and lower rates of permanent colostomies. There are numerous studies from the U.S. and around the world that are beginning to show this trend. A few of these references are listed below:


1: Read TE, Myerson RJ, Fleshman JW, Fry RD, Birnbaum EH, Walz BJ, Kodner IJ.  
  Surgeon specialty is associated with outcome in rectal cancer treatment.
Dis Colon Rectum. 2002 Jul;45(7):904-14.
PMID: 12130879 [PubMed - indexed for MEDLINE]

2: McArdle CS, Hole DJ.  
  Influence of volume and specialization on survival following surgery for colorectal cancer.
Br J Surg. 2004 May;91(5):610-7.
PMID: 15122614 [PubMed - indexed for MEDLINE]

3: Martling A, Cedermark B, Johansson H, Rutqvist LE, Holm T.  
  The surgeon as a prognostic factor after the introduction of total mesorectal excision in the treatment of rectal cancer.
Br J Surg. 2002 Aug;89(8):1008-13.
PMID: 12153626 [PubMed - indexed for MEDLINE]

4: Meagher AP.  
  Colorectal cancer: is the surgeon a prognostic factor? A systematic review.
Med J Aust. 1999 Sep 20;171(6):308-10.
PMID: 10560448 [PubMed - indexed for MEDLINE]

5: Dorrance HR, Docherty GM, O'Dwyer PJ.
  Effect of surgeon specialty interest on patient outcome after potentially curative colorectal cancer surgery.
Dis Colon Rectum. 2000 Apr;43(4):492-8.
PMID: 10789744 [PubMed - indexed for MEDLINE]

 

If you have a question or would like more information on a gastrointestinal disease not covered here, please call us at 781-279-1123, or visit the National Digestive Diseases Information Clearinghouse.