A healing space
Innovation and compassion grace the halls of the H.H. Chao Comprehensive Digestive Disease Center
June 13, 2017
Things looked bleak when Debra Baker, 60, sat down at UC Irvine Medical Center with Dr. Alessio Pigazzi, professor of surgery, in January 2015. Baker, of Crestline, had been diagnosed with cancer of the appendix and had undergone surgery to remove the appendix, uterus and ovaries at another Orange County hospital. But the cancer spread, and surgeons referred her to UCI Health for additional treatment.
The doctor and patient squared off — the start of a candid and honest relationship that, Baker says, saved her life.
“He was straightforward,” Baker recalls. “He said, ‘This is serious. It’s not good.’” But Baker saw through the tough talk and had confidence that Pigazzi could perform the advanced treatments necessary to restore her health. And Pigazzi came through. “He was more than positive. He listened and I never got the feeling that I wasn’t being heard. I love that man.”
Today, Baker is two years out from a life-threatening disease that was treated with extensive surgery, an innovative form of chemotherapy called hyperthermic intraoperative peritoneal chemotherapy (HIPEC) and a six-week hospitalization. Pigazzi, a colon and rectal surgeon, performed the complex procedure and oversaw Baker’s recovery, assisted by Dr. Mehraneh D. Jafari, also a colorectal surgeon and part of the HIPEC team.
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Baker would not likely have received the complex HIPEC treatment, requiring specialized surgical and recovery teams, at other hospitals. Near the end of a 12-hour surgery to remove cancer from her abdominal cavity, doctors pumped heated chemotherapy into her abdomen and gently rocked her body to circulate the fluid and bathe her internal organs with the cancer-fighting solution. After about an hour, the fluid was pumped out. HIPEC is designed to reach and kill any undetected cancer cells and to reduce recurrence of disease.
“I had never heard of it,” Baker says. “But it made a lot of sense. The chemo touches all of the surfaces. I kind of look at it as putting bleach on mold. After you go through something like this, there are a lot of things you reflect on. I was so fortunate that I received HIPEC.”
Pigazzi has been using HIPEC for several years. “It’s increasingly recognized as an important treatment modality for selected patients,” he says.
A renovated facility
From rare and challenging cases like Baker’s to the most common digestive disorders like heartburn, the UCI Health digestive disease center is one of the top in the country. And now the center has a building matching its star status. The H.H. Chao Comprehensive Digestive Disease Center (CDDC) will re-open later this summer after undergoing extensive additions and renovations.
The new building opens to a three-story, sunlight-filled atrium designed to reduce noise and soothe patients. Exam and procedure rooms are spacious. Patients can have diagnostic, treatment, followup care and visits with other specialists in the same building, says Dr. Kenneth Chang, director of the CDDC and a leading specialist in gastroesophageal reflux disease (GERD), Barrett’s esophagus and endoscopic surgery to treat digestive diseases.
“A lot of centers are virtual centers; they coordinate your care, but you go to this building and that building. The CDDC is a one-stop center for practically anything in digestion diseases. You can see a gastroenterologist, surgeon, oncologist — everyone will be under one roof. There is nothing like it anywhere on the West Coast.”
Ongoing research, including many novel clinical trials, and technological innovations also set the CDDC apart, Chang says. From mini microscopes that are inserted via the throat to look at the digestive tract to instruments that freeze away unwanted tissue (called cryotherapy), the center’s staff utilizes the latest tools and strategies to improve patient care.
“We’re always developing new treatments that are not yet standard of care, and our patients have access to them,” Chang says.
HIPEC, for example, is also used for advanced colorectal cancers, adding to the growing arsenal to fight the disease. At the CDDC, colorectal cancer patients receive multiple types of therapies (surgery, chemotherapy, radiation) to improve the odds of success. Patients undergo minimally invasive surgery in most cases.
“We are able to offer more minimally invasive procedures to more patients,” Pigazzi says. “These procedures result in better quality of life and faster initiation of other therapies.”
Doctors are even exploring whether some patients with rectal cancer can avoid surgery. UCI Health is part of an 18-center national study, called Organ Preservation in Rectal Adenocarcinoma (OPRA), that uses chemotherapy and radiation only — no surgery — for early-stage rectal cancer. The CDDC is the only program in the county offering the OPRA trial.
“The objective is to see if patients with rectal cancer can be treated without ever having surgery,” says Dr. Joseph Carmichael, a UCI Health colorectal surgeon. “If we develop protocols where people don’t have to undergo surgery it will be so much better for patients.”
Cancer treatment and prevention
The CDDC is also a leading center on the treatment of pancreatic cancer and is one of the few centers in the region to perform the Whipple procedure for removing pancreatic cancer found in the “head” of the organ. This surgery is a complex operation that is only offered at high-level hospitals.
Patients with tumors in the “body” or “tail” of the pancreas are often candidates for minimally invasive surgery. Dr. David Imagawa and his pancreas surgical team perform more minimally invasive pancreatic cancer procedures than any other medical center on the West Coast.
Chang also performs gene sequencing for patients with pancreatic cancer, which means these patients get the most effective treatment for their individual genetic makeup. He is a pioneer in devising ways to diagnose precancerous pancreatic cysts and determining which patients are at higher risk for developing pancreatic cancer.
Cancer prevention is a major goal of the CDDC staff, Chang says. The center is a leader in treating GERD as well as Barrett’s esophagus, a precancerous condition of the esophagus that can develop among people who have had severe GERD for many years. Without treatment, Barrett’s esophagus can lead to esophageal cancer.
Another prevention project spearheaded by UCI Health physicians is to make the county “colon cancer-free” by encouraging colorectal cancer screening. In UCI Health offices around Orange County, patients are asked to take a short survey on a mobile device that assesses their risk of developing colon cancer and shows how simple changes and appropriate cancer screening can reduce the risk.
Inflammatory bowel disease program
The CDDC is also home to the region’s only comprehensive program for inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis. These chronic and often-complex conditions are best treated in a multidisciplinary setting and by physicians who are experienced in a wide range of IBD manifestations, says program director Dr. Nimisha Parekh.
The CDDC is one of the few facilities in Southern California to use magnetic resonance (MR) enterography as a first-line tool to diagnose IBD. This type of scan can reveal inflammation and thickening in the small bowel walls and other changes that define IBD. Patients who require surgery can often undergo minimally invasive and robot-assisted procedures that preserve the small bowel, hasten recovery and reduce complications. Since IBD is often diagnosed in younger adults, the CDDC provides a comprehensive care plan that includes a focus on patients’ psychosocial needs and supportive services to enhance quality of life, Parekh says.
Obesity treatment and prevention is another objective of the CDDC staff, Chang says. Obesity is implicated in many types of cancers, such as colorectal cancer. Physicians offer state-of-the-art procedures and programs for weight loss, including a new nonsurgical procedure called endoscopic sleeve gastroplasty.
During this procedure, a flexible tube called an endoscope is inserted through the mouth and threaded down the esophagus to the stomach. The endoscope is fitted with a mechanical suturing device. Once the device is in the stomach, the physician manipulates the endoscope to apply stitches in the stomach to reduce the stomach size by resizing it into the shape of a sleeve. A variety of other weight loss procedures — endoscopic and surgical — are also offered.
“Roughly 20 percent of all cancer-related deaths are related to obesity,” Chang says.
The CDDC’s beautiful facility reflects the soothing, holistic care provided by its staff. Each patient receives a personalized care plan and the services of a multidisciplinary team.
This is the kind of care and attention that made Baker a fan for life. One night during her six-week hospitalization, she awakened to find Pigazzi in her room to check on her. It was after midnight, and he had just returned to Orange County from a medical conference out of state. Despite the hour, he drove straight to his patient’s bedside, eager to check on how she was doing.
“Now that’s something you just don’t see,” she says.