Reprinted from Karmanos Hope Magazine, Fall 2007.

Ever since she was a child, Patricia Kraus has lived in the shadow of cancer.

Patricia’s mother died at age 46 from colon cancer, as did her grandmother at age 32 and great-grandmother at age 28. Last June, Patricia’s sister died of colon cancer at age 44. All had Lynch syndrome, a rare genetic disorder that predisposes people with the inherited defect to develop colorectal and other forms of cancer.

“Knowing that cancer was hereditary in my family, it was something I anticipated for myself,” says Kraus, 44. “I’m the first woman on my mom’s side in generations to see her grandchild born.”

But thanks in part to a life-saving, minimally invasive procedure performed last December by Madhu Prasad, M.D., co-chief, Surgical Oncology at the Karmanos Cancer Center, Kraus can look forward to many days of play with her infant granddaughter and grandson. Using a technique called assisted laparoscopy, Dr. Prasad performed a total abdominal colectomy, removing five feet of Kraus’ colon. Because the procedure was performed through a two-inch incision, Kraus’ post-surgical discomfort was minimized and recovery time reduced. Within a week, she was home and living with renewed hope.

“Because of the extent of the surgery, I initially thought I’d be laid up for at least three months and unable to pick up my grandchildren,” Kraus says. “But after the surgery I didn’t feel a lot of pain and was shocked by how quickly I healed. The doctors at Karmanos saved my life. Now I know I have a future.”

Small incisions – Big results
A small incision is the hallmark of a minimally invasive operation. Depending on the size of the tumor, an incision can be as small as two inches as opposed to 10 or 12 in a traditional surgery. Smaller incisions mean patients have less pain, smaller scars, a shorter hospital stay and possibly a better surgical outcome, says Chris Steffes, M.D., associate professor of surgery at Karmanos and member of its Gastrointestinal and Sarcoma Oncology multidisciplinary teams.

“When undergoing a minimally invasive procedure, patients are able to tolerate the surgery better and have an opportunity of receiving other treatments sooner, if necessary, says Dr. Steffes. “An open, invasive operation reduces the strength of the patient as the recovery from surgery is more prolonged. We hope that by performing operations with smaller incisions the patient’s overall strength will stay intact.”

Dr. Steffes notes that certain characteristics determine whether a patient is a good candidate for minimally invasive surgery.

“If the tumor is in its early stages and not attached to too many surrounding organs, then surgery could be approached minimally,” Dr. Steffes says. “Because it’s much less stressful on the patient, we can also investigate a tumor earlier by inserting a scope through the small incision. This type of procedure could be applied to just about any type of tumor, but we only consider it if it’s in the best interest of the patient.”

A Matter of Inches
When she was diagnosed with Lynch syndrome, Kraus’ tumor blocked nearly 100 percent of her colon and she was losing a pound a day. Within two weeks of her diagnosis, Dr. Prasad performed the minimally invasive laparoscopic procedure.
“Traditionally for this type of operation, a 10 to 12-inch incision is made down the middle of the abdomen,” says Dr. Prasad. “You have to divide a lot of normal tissue to get at the site of the disease. But by using a minimally invasive technique, there is less collateral damage to tissues and you reduce complications and promote healing. For Patricia’s surgery, we made a small, two inch incision below her belly button. She had minimal pain and was home within a week with no complications.”

Karmanos surgeons are collaborating with world-renowned surgeon Dr. C. Palanivelu of Gem Hospital in Coimbatore, India to develop new techniques to make operations more precise and less invasive than ever before. The Center is also partnering with Wayne State University to develop the Center for Surgery and Advanced Technology, which will accelerate the application of new technologies to the clinical setting.

“Cancer patients need specialized cancer surgeons,” Dr. Prasad says. “At Karmanos, we do a lot of complex surgery as well as routine cancer surgery. We also work hand-in-hand with specialists in other disciplines in a way you won’t find in another institution. Our experience and access to creative new technologies to apply specifically to cancer patients sets us apart.”

In August, Kraus had a complete hysterectomy performed at Karmanos by robotic surgery. Kraus elected to have the surgery performed as a preventative measure due to her family history. Now she’s agreed to participate in a research protocol at Karmanos as part of her aftercare and monitoring program.

“I’m here with my family today because of Dr. Prasad and everyone at Karmanos,” Kraus says. “They saved my life, and the research they’re doing will help save the lives of my children and grandchildren. That’s very reassuring to me when I consider the future.”