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New talent, new programs and new surgical options: Colorectal Surgery

When asked what attracted them to Tufts Medical Center, colorectal surgeon James Yoo, MD cited not only its high-quality care but also its intimate environment and decidedly patient-centric focus.

“This makes it a unique institution in Boston,” says Dr. Yoo, who assumed the post of chief of the Division of Colon and Rectal Surgery in January (Melnitchouk joined the staff last July). “And that’s a big draw.”

A new Colorectal Cancer Center opens its doors

The fellowship-trained surgeon has hit the ground running, launching a Colorectal Cancer Program. Part of the Tufts Medical Center Cancer Center, the multidisciplinary program streamlines and coordinates access to care for patients with colon and rectal cancers. A weekly tumor board ensures that patients benefit from the combined expertise of all specialists involved in diagnosing and treating this type of cancer.

“It can be difficult for patients to navigate through the healthcare system because so many specialists are involved,” Dr. Yoo says. “Our goal is to simplify that so the patient can just concentrate on getting better.”

For added convenience, Dr. Yoo sees patients at MetroWest Medical Center – one of Tufts Medical Center’s affiliate hospitals – as well as in Boston.

Important new surgical approach now offered

The two colorectal surgeons also bring an important new surgical approach to the region – making Tufts Medical Center one of only a handful of institutions in the nation to offer it.

Dr. Yoo explains that in some patients undergoing colonoscopy, the gastroenterologist finds a polyp that can’t be completely removed via the endoscope because it is too big, tucked behind a fold, or in a part of the colon where the wall is thinner, posing a risk of damaging the colon. In these situations, the patient typically is referred for colon resection. 

By combining colonoscopy with laparoscopic surgery, however, the surgeons can manipulate the colon wall, making it easier to remove the polyp. Because it is a minimally invasive procedure, patients typically go home the next day – versus the three- to four-day hospital stay that a standard bowel resection would require.

“If you have 100 patients in this situation, the majority, roughly 80, will have benign polyps,” Dr. Yoo says. “It’s crazy to recommend standard surgery since patients end up being over-treated. This avoids that.”

Dr. Yoo started performing these procedures while at UCLA, publishing outcomes data and generating media attention. Consistent with the Tufts Medical Center philosophy that so appealed to him and he feels it’s a better option for the patient.

If there’s one message these surgeons want to communicate to the referring physician community, it’s about the importance of screening – and the vital role that primary care physicians play in helping patients manage their risk for colorectal cancer.

“Make sure that people who should be screened get screened,” Dr. Yoo urges. “And anything that signals potential early cancer – rectal bleeding, change in bowel habits, unresolved abdominal pain – warrants an evaluation.”

Dr. Yoo stresses that screening should start earlier than age 50 in patients with a family history of colorectal cancer, or genetic diseases such as familial adenomatous polyposis (FAP) and Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC). 

Dr. Yoo notes that the incidence of colorectal cancer is rising dramatically in younger patients, even under age 40. “We’re not sure why because the increase has not been due to known syndromes such as FAP or HNPCC, which continue to account for roughly 5 percent of cases,” he says. “This is a big focus for us in research and patient care,” he adds, noting that every patient who becomes part of the Tufts colorectal cancer program is screened for familial associations and, when appropriate, referred for genetic testing and counseling.

Quick access to appointments

“We hustle to make sure patients are seen within days,” Dr. Yoo says. Follow-up communication is fast, too – referring physicians will receive a call or email as soon as their patient is seen. 

“I am always available to talk to referring physicians in the community,” he adds. “If you just want to talk about a patient, I'm happy to provide an opinion.”

To refer a patient to Dr. Yoo, call 617-636-6190.