Patient Suffers From Recurrent Colon Cancer Following Allegedly Incomplete Colectomy

This case involves a female patient who went in for a colectomy to remove a malignant tumor in her descending colon. Following the procedure, the patient was given chemotherapy treatment but the patient continued to have recurrent colon cancer with metasistis. It was alleged that the doctor who conducted the colectomy did not remove the entire cancerous part of the colon causing the recurrent colon cancer. An expert in colon and rectal surgery was sought to opine on this case.

Question(s) For Expert Witness

1. How often do you perform colectomies for distal descending colon cancers?

2. What care is taken and what modalities are used to ensure all of the cancerous colon is removed?

Expert Witness Response E-055121

I am board certified in general and colon and rectal surgery and have been practicing for 25 years. I am very active in medical staff peer review committees in 2 hospitals and regularly am involved in evaluating surgical cases. I review cases for the state medical board as well as for private attorneys and do both plaintiff and defense work - about 50/50. I review approximately 5 cases per year and have testified in court 3 times.

I do colectomies on a weekly basis, over 100/year and descending colon cancer makes up approximately 15-20% as it is a less common site for colon cancer than the right colon, sigmoid colon, and rectum. I do both open and minimally invasive surgery. I always evaluate the specimen off the field during surgery to ensure the area of interest is removed and often times, that includes a palpable or visible tumor but also might include the area of india ink tattoo placed at the time of colonoscopy and biopsy of the specimen. Some lesions I treat have responded to neoadjuvant therapy and disappeared and all that is left grossly is the tattooed area with the india ink at the site. I have heard of cases where the wrong segment was removed and the lesion was left behind. I have been involved with cases where the endoscopist has misidentified the segment of colon containing the lesion as one anatomic location (i.e. the sigmoid colon) and the lesion was found in the descending colon before resection. Lesions in the rectum and distal sigmoid are often inaccurately described and require intra-operative proctosigmoidoscopy to guide the resection.