Surgery is a key component of colorectal cancer treatment, but in more complex cases, it can leave patients with extensive surgical wounds that may increase infection risk. Integrating plastic and reconstructive surgery into the treatment plan from the outset streamlines care, improves healing and leads to better outcomes and fewer complications.
“At Roper St. Francis Healthcare, we recently added two expert plastic surgeons to our team, helping us offer timely, comprehensive surgical care for cancer patients,” says Jorge Lagares-Garcia, MD, Medical Director of Surgery and Digestive Diseases at Roper St. Francis, and one of the nation’s leading experts in robotic colorectal surgery.
Such coordinated surgical care is not common outside major academic medical centers. But it’s a natural fit for Roper St. Francis’s mission of providing top-tier care, in a community setting where patients come first.
Case study: Reconstructive surgery after complex colorectal cancer surgery
One of Dr. Lagares-Garcia’s recent cases highlights the benefits of an integrated approach. The patient, a woman in her 70s, had experienced a recurrence of colorectal cancer for which surgical resection was the only option. Dr. Lagares-Garcia used robotic surgery to resect the entire rectum and anus. With the first stage of the surgery complete, he handed the reins to Federico Perez Quirante, MD, a plastic and reconstructive surgeon who joined Roper St. Francis in 2024 after receiving surgical training in the United States and Europe and also completing a PhD in health care science.
Dr. Perez created a flap of muscle and soft tissue from the patient’s abdomen. He then tunneled the healthy tissue, with its blood supply intact, through the pelvis to reconstruct the posterior vaginal wall and perineum. The patient healed well, experiencing no infections or surgical complications.
“Colorectal cancer patients have often had prior radiation that damages the tissue, making it vulnerable to post-operative infections and skin breakdown,” Dr. Perez explains. “A flap reconstruction allows us to restore the patient’s anatomy with healthy tissue that heals in days rather than months.”
Without such coordination, patients may need to undergo an additional reconstruction procedure at a later date, with more pain and inconvenience, more healing time and more risk. Others may forgo reconstructive surgery entirely, increasing the risk of complications.
“In this case, the resection left the patient with a hole about 3 to 4 inches in diameter. If you close such a large area without reconstruction, the infection rate can be as high as 40% to 60%,” Dr. Lagares-Garcia says. “By reconstructing the area with healthy tissue, the rate of infection is much, much lower.”
Investing in collaborative care
While reconstructive surgery offers clear benefits, coordinating care can be challenging. “In many communities, there aren’t enough plastic surgeons to meet the demand. In worst-case scenarios, cancer surgeons may have to delay treatment until a reconstructive surgeon is available,” Dr. Perez explains.
By embedding two plastic surgeons into the team, Roper St. Francis can provide timely care for people with colorectal cancer, breast cancer, melanoma and any other cancer that may require advanced reconstructive techniques. Plastic surgery can also be valuable beyond the cancer setting, restoring healthy tissue after cauterizing anal condylomas, for example, or following surgery to treat pilonidal cysts or hidradenitis suppurativa.
The collaboration begins in the planning stages, when cancer surgeons meet with the plastic surgeon to discuss the case. “After that consultation, I meet with the patient to explain their options for reconstruction,” Dr. Perez says. “We almost always have multiple ways to address these procedures, so we take a shared decision-making approach.”
The collaborative effort is supported by specialized equipment, including SPY angiography, which uses fluorescent dye to image blood flow and lymphatic vessels during surgery, and surgical microscopes to enable flap surgery and other advanced microsurgical techniques.
“By integrating plastic surgeons and advanced technologies, we are able to provide high-level care for patients with high-acuity needs,” Dr. Perez says.
Leaders in robotic surgery for colorectal cancer
At Roper St. Francis, human collaboration backed by state-of-the-art technology is the norm. In addition to working alongside plastic surgeons, cancer surgeons work closely with medical oncologists and radiation oncologists to ensure each patient gets the best possible care.
When Dr. Lagares-Garcia helped establish our robotic surgery program in 2010, Roper St. Francis became the first hospital in the Southeast to offer the technology. He has performed more than 2,000 robotic cases, practicing alongside a team of surgeons who also specialize in minimally invasive and robotic techniques.
Patients travel to Roper St. Francis not only for our expertise and commitment to leading-edge care, Dr. Lagares-Garcia adds, but also for the feeling they get when they walk in the door.
“Roper St. Francis continues to stand out for providing the highest-quality patient care, while taking the time to forge personal connections with each and every patient,” he says. “It’s rooted in tradition—we’ve been here for more than 170 years and we’re always looking for ways to improve and better serve our community.”
Learn more about Roper St. Francis Physician Partners Colorectal Surgery and Plastic & Reconstructive Surgery.
To refer a patient to Dr. Lagares-Garcia, fax the colorectal surgery department at 843-958-1278. To refer a patient to Dr. Perez, fax plastic surgery at 843-402-1768.