At the Forefront of Colorectal Surgery
“NewYork-Presbyterian/Weill Cornell Medical Center was one of the early centers of excellence for minimally invasive surgery and innovative procedures,” says Alessio Pigazzi, MD, PhD, one of the nation’s leading colorectal surgeons and Chief of Colorectal Surgery in the Department of Surgery at Weill Cornell. “Over the last two decades, I‘ve seen laparoscopic and robotic surgery go from niche procedures to becoming the standard of care for both benign and malignant diseases.”
Rare Expertise in Cytoreductive Surgery and HIPEC
Dr. Pigazzi’s clinical expertise focuses on the treatment of complex colon, rectal, and anal conditions and cancers, including laparoscopic, robotic, and open surgical techniques. He is among a small cadre of surgeons skilled in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), which involves heated chemotherapy applied directly within the abdominal cavity following removal of cancerous tumors.
“HIPEC is indicated for patients who have cancer that has spread to the lining of the abdominal cavity and the surface of the internal organs. The procedure calls for performing extensive surgery to remove all the visible cancer deposits first, and then administering heated chemotherapy at the end of the operation,” says Dr. Pigazzi, who has treated hundreds of patients with peritoneal surface malignancies. “I've seen this evolve from a quasi-experimental procedure to what is now a widely accepted modality for patients who have very few effective treatment options. These are conventional chemotherapeutic agents that are given in a slightly different environment, straight into the abdomen as opposed to the bloodstream and given in higher doses.”
“There is a lot of research behind HIPEC and also a lot of controversy behind it, with believers and non-believers,” continues Dr. Pigazzi. “But the surgical aspect of cytoreduction has been confirmed in the last two decades by research and many trials that have shown a real benefit in select patients with significant improvement in survival. Not every patient qualifies for this type of surgery, but those who have cancer of the appendix, colon, sometimes stomach and small intestine, and ovaries are the most common categories.”
Dr. Pigazzi’s research in cancer is also focused on minimally invasive techniques to improve recovery after cancer surgery, postoperative chemotherapy, and the relationship between diet and colorectal cancer development.
Robotic Surgery: Experience Counts
In 2004, Dr. Pigazzi performed the world’s first robot-assisted tumor removal for rectal cancer, a procedure that has revolutionized the treatment of this condition. He is also skilled in robot-assisted surgery for pelvic injuries caused by fistulas.
In 2017, he published the results of a seminal trial in JAMA on the effect of robotic-assisted versus conventional laparoscopic surgery on the risk of conversion to open laparotomy for resection of rectal cancer. “The ROLLAR trial validated the role of robotic surgery in experienced hands,” says Dr. Pigazzi. “Just going to someone who says they do robotics does not equate with good outcomes. That’s true of any procedure.”
Dr. Pigazzi notes that robotic systems continue to evolve, and the current iteration of technology is substantially improved over earlier models. “There are more instruments and features on these systems that give us great leeway in terms of what we can do,” he says. “These are difficult procedures and the learning curve it takes to become an expert is quite long. The Weill Cornell team has abundantly surpassed this learning curve and can, with a high degree of confidence, provide the best possible outcome for patients who need these types of surgeries.”
“Though we do employ laparoscopic and robotic surgery for at least 75 to 80 percent of operative surgeries, we still do open procedures for the more complex operations, such as recurring cancer, intestinal fistula, and complex infections.” — Alessio Pigazzi, MD
While Dr. Pigazzi embraced laparoscopic surgery early on in his career, he emphasizes a need for the full range of surgical procedures. “Though we do employ laparoscopic and robotic surgery for at least 75 to 80 percent of operative surgeries, we still do open procedures for the more complex operations, such as recurring cancer, intestinal fistula, and complex infections,” he says. “We also perform many revision surgeries for surgical complications and ostomies. I would love to treat more patients who have been told that they have an ostomy that cannot be closed and hopefully give them a chance at closing them.”
Expanding Colorectal Care Virtually
Dr. Pigazzi is expanding the geographic reach of colorectal services through the establishment of a virtual multidisciplinary colorectal clinic. “We have brought together the best physicians, surgeons, and ancillary staff across our network, which involves several hospitals from Manhattan to Brooklyn and Queens,” notes Dr. Pigazzi. “Patients can access us from the comfort of their homes and at least have an initial visit and meet all of our specialists at once on a Zoom call. We expect it to be very helpful, especially for cancer patients, in accessing our system and services.”
“The outstanding team here at Weill Cornell shares my commitment to excellence in clinical activities, research, and education,” adds Dr. Pigazzi, “and I look forward to building on this solid foundation to provide the best possible care to all patients.”
Dr. Pigazzi’s appointment as Chief in 2020 marked a return to NewYork-Presbyterian and Weill Cornell Medicine, where he completed his surgical residency nearly 20 years ago. He became interested in minimally invasive surgery during his residency at Weill Cornell at which time his predecessor, Jeffrey M. Milsom, MD, was Chief of Colorectal Surgery. Dr. Pigazzi previously served as Chief of the Divisions of Colorectal Surgery and Surgical Oncology at the University of California, Irvine.
“Returning to NewYork-Presbyterian and Weill Cornell Medicine to lead this distinguished colorectal surgery program is extremely fulfilling,” says Dr. Pigazzi. “This is a highly innovative colorectal center, and we have a great team with a full complement of expertise to treat the most complex conditions in our field. I would like to combine that with a very vigorous research and educational effort and activities to keep advancing our field to new levels and new heights.”
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