Colorectal cancer is the second most common cause of cancer deaths in men and women combined in the U.S., with an estimated 53,010 deaths in 2024. However, the rate of colorectal cancer diagnoses has dropped due to more people getting screened and being aware of colorectal cancer risk factors.
Leading edge innovations in colorectal surgery such as robotic-assisted surgery and minimally-invasive procedures are allowing patients to return to their normal activities much quicker than ever before.
Theodoros Voloyiannis, M.D., FACS, FASCRS, colon and rectal surgeon at Texas Colon & Rectal Specialists–Webster, has performed more than 2,000 single incision laparoscopic and robotic colorectal abdominal surgeries over the past 15 years. He recently participated in a surgical simulation aboard the International Space Station (ISS) that, as he says, “has the potential to reshape the future of colorectal surgery.”
With the stage set in March for Colorectal Cancer Awareness Month, Dr. Voloyiannis shares more insights on his journey into space and the potential for treating patients with colorectal cancer in remote areas, as well as trends around the rise of colorectal cancer among younger patients and the importance of screenings.
You recently participated in the first successful simulation of surgery in space. What was the purpose of this simulation and how does it shape the future of colorectal surgery?
I was one of six doctors selected to participate in an experiment to assess the impact of zero gravity on performing simulated surgical tasks remotely using a surgical robot, known as SpaceMIRA, located on the International Space Station.
From a lab in Lincoln, Nebraska, we took part in a demonstration guiding the robot using hand and foot controls to cut through and remove rubber bands with scissors and a grabber mimicking a dissection.
It is the hope that this type of technology will allow physicians in the future to perform specialized surgery for patients living in remote or rural areas who do not have access to a specialized surgeon.
I never thought I would do surgery in space — it was truly an out-of-this-world experience! That was one small rubber band, but a great leap for surgery!
How could remote robotic surgery impact patients in rural areas?
The potential impact of remote surgery has the capacity to be felt around the world and one day, in space. So many communities do not have access to a local surgeon, much less a specialty one such as a colorectal surgeon. While the number of new surgeons is expected to rise in the next 10 years, considering the time and training specialty surgeons require, access to remote robotic surgery could be a game-changer, especially in rural communities or smaller hospitals where surgeons may only have basic skills.
Texas ranks 49th out of all 50 states in terms of colorectal cancer screenings, with only 53% of eligible adults receiving a screening test on the recommended schedule. Why do you think this is?
I attribute this to the general lack of awareness about colorectal cancer and lack of focus on prevention. Also, during COVID, the number of screenings, such as colonoscopies, dropped considerably, which led to a spike in advanced cases being diagnosed later. We have a long way to go in Texas, despite excellent physicians who are doing their best to increase awareness and emphasize the importance of screening for colorectal cancer.
There is a stigma around colonoscopies. How do you approach a patient who is hesitant to get a colonoscopy because of their own fears or negative perceptions?
The topics of colonoscopies and colorectal cancer are not openly discussed as opposed to other types of cancer. Some of the stigma stems from stories by a friend or family member and their experience about the “prep” and how horrible it was for them or bloating after the procedure. Colonoscopies and the prep have come a long way. There are new, easier-to-use prep kits and enhanced use of IV anesthesia where patients feel nothing and can continue with their daily activities soon after.
Colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S. (excluding skin cancers). While rates of colorectal cancer have declined among adults 50 years and older, colorectal cancer is increasing among adults under age 50. What’s behind the trend?
Rates of colorectal cancer are decreasing due to better screening and removal of polyps before they become a cancer. The increase of colorectal cancer in younger adults under the age of 45, however, is still unexplained. Some theories attribute it to nutrition or a sedentary lifestyle, but we just don’t have a clear answer yet.
For those at average risk, colonoscopies are recommended beginning at age 45. However, people with concerning symptoms such as rectal bleeding, unintentional weight loss, changes in bowel habits, or a family history of colorectal cancer are considered at higher risk and should consult with their physician to determine the appropriate age to begin colorectal cancer screening.