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Patient Benefits From Laparoscopic Colectomy

Winter 2005 – Kent Hirschfelder thought undergoing his first colonoscopy at age 55 was simply a good thing to do. He wasn’t having any symptoms of colon cancer, and he didn’t have a family history of the disease. But both Hirschfelder and his wife, Deborah, are children of physicians, and they know the important role screenings play in diagnosing diseases early.

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Although Hirschfelder’s colonoscopy didn’t show any polyps or other growths inside his colon, it did reveal a suspicious indention. Further testing showed a growth on his appendix. There was the possibility the growth was benign, but the only way to find out was to undergo a colectomy, a surgery in which all or part of the colon is removed.

 “I previously had my gallbladder removed laparoscopically,” Hirschfelder says. “That procedure caused so little discomfort, I wanted the colectomy to be done through minimally invasive surgery as well.”

That decision led Hirschfelder to the Siteman Cancer Center and James Fleshman Jr., MD, professor of surgery and chief of the section of colon and rectal surgery at Washington University School of Medicine. Fleshman and colleagues at Siteman were the first in the area to perform laparoscopic colectomy for cancer. They also teach laparoscopic techniques to physicians in training and practicing surgeons throughout the country.

During Hirschfelder’s surgery, Fleshman found a 2-centimeter mass. “It could have been full-blown cancer or a slow-growing type of tumor called a carcinoid that, at that size, could have become cancerous,” Fleshman says. “Because of the position of the mass, we removed the right colon.”

The mass was found to be a polyp called a mucinous cystadenoma that forms in the appendix. “Fortunately, the appendix had not perforated,” Fleshman says. “If it had, pseudomyxoma peritonei likely would have occurred. This syndrome causes widespread mucus and mucin production in the abdomen. It has a poor prognosis because it can lead to infection, intestinal obstruction, peritonitis and cancer. In other words, Mr. Hirschfelder had an early form of a real problem, and colonoscopy saved his life.”

Fleshman adds, “Because mucinous cystadenoma is a form of colon polyp that has malignant potential, Mr. Hirschfelder will need to have the rest of his colon screened on a regular basis.”

Hirschfelder’s satisfaction with the timely discovery of his polyp was amplified by the short recuperation time from the laparoscopic surgery. “Right after surgery I had a morphine pump that I didn’t need to use at all,” he says. “In fact, by the afternoon of the surgery, I was on the phone conducting business from my hospital bed. I recuperated a few days at home, and then I was able to start going into the office for a few hours a day.”

Hirschfelder, an investment banker whose company, Hospitality Brokerage Group, specializes in restaurant brokerage and consulting, has two daughters, both attorneys, and three grandchildren. Because of his experience and his wife’s family history of colon cancer, the couple stresses the importance of screenings to their children as well as their friends.

“I’ve lost some friends who didn’t get checkups,” Hirschfelder says. “Because of that, I’m trying to spread my story so that as many people as possible get the word about how important routine screenings are. I call myself the poster child for routine colonoscopy.”