UC Davis recently expanded its care for colon and rectal diseases with the arrival of Linda Farkas, a specialist in minimally invasive colon and rectal surgery for both benign and malignant disorders and an expert in hereditary cancers.

Farkas, recruited from Duke University, is chief of the newly created Division of Colorectal Surgery, which also includes fellowship-trained colorectal surgeon Salvador Guevara. The team evaluates and manages all diseases of the colon, rectum, anus and small bowel.

Farkas was one of the first 50 women board-certified in colorectal surgery, and is a pioneer in advancing techniques that improve outcomes for colorectal cancer and benign conditions such as diverticulitis, Crohn’s disease and ulcerative colitis. She has helped refine national guidelines for surgical treatment of colorectal cancer and has particular interest in Lynch syndrome, an inherited disorder that increases risks for many cancers.

Q. Why did you choose colorectal surgery as a career path?

A. I always had an interest in the GI tract, and my major in college was human dietetics and nutritional sciences. I once considered gastroenterology, but after my surgical rotations I discovered my love for the operating room. I was a general surgeon for two years until I realized I wanted to return for a colorectal fellowship. It was a combination of trying to find a niche as a young female surgeon and also a desire to focus again on GI.

I also saw there was a great need in that many women were seeking out female surgeons for their colorectal diseases as they once did for gynecology. Many women I’ve seen have delayed diagnosis and treatment because they were too shy or uncomfortable to see a male physician. If my gender allows patients that would not normally seek care to seek care, then so be it!

Q. Can you describe your role in the spectrum of GI and cancer care here?

A. UC Davis already offered services, but the difference now is to build a division solely focused on colorectal diseases. Having a dedicated team allows us to build protocols with a finite group and quickly make transitions of care as evidenced-based research dictates. We remain actively engaged and current with the most recent technologies and treatment plans for our patients.

Colorectal surgery cannot excel in a vacuum, and I see my role to collaborate with colleagues across specialties to share best practices, optimize care and conduct research. It is all about the patients, and by focusing on them and on collaborative teams, we can continue to excel.

Q. What range of patients does the division serve?

A. We have a strong pediatric surgery program so our division serves adults. Our range of care is diverse. We take care of many diseases ranging from hemorrhoids, fissures, diverticulitis, colorectal cancer and inflammatory bowel disease to pelvic floor disorders. We do try to pursue medical management, frequently in concert with our gastroenterologists. When this isn’t appropriate or fails, we can offer surgical options.

Q. What’s new and on the horizon, and how is this coming into play here?

A. Now is an exciting time for rectal cancer care. I participated as an investigator in the national ACOSOG Z 6051 trial studying laparoscopic vs open surgery for rectal cancer. I also participate in the international ROLARR trail on robotic vs laparoscopic rectal surgery. Especially with low-rectal cancer patients, initial early outcomes suggest laparoscopic may not be the best approach. Robotics may be the answer in selected patients, and a newer procedure (TaTME) may deliver the best oncologic surgery in a minimally invasive manner. Also newer imaging modalities such as rectal MRI, which we now offer here, allow us to better stratify which patients benefit most from pre-op radiation. This multi-D approach is the focus of the Commission on Cancer to optimize rectal cancer care, and we offer all of these elements here.

Q. What are your research interest areas and plans?

A. We are collaborating with UC colleagues to optimize perioperative care. We continue to participate in national and international multi-
institutional trials. Locally we are positioned with colleagues in micro-biology to investigate microbiome changes that occur in select patient populations. Since our pediatric surgeons have done excellent work on functional gut disorders and anorectal malformations, we can also collaborate and study how these children mature and function as adults. This will be a focus of my partner Salvador Guevara.

Q. You helped launch the Lynch Syndrome Surveillance Network. Why this interest area?

A. My interests and passion in Lynch have always revolved around my young patients who succumbed to colorectal cancer, when the warning signs of strong family history were always present. It’s sad to see 40-year-olds with cancer who should have been receiving preventative colonoscopies in their 20s. We know by identifying these patients we can place them in different surveillance programs that can help prevent cancers, or limit them to earlier stages.

Q. Community outreach is one of your missions. What should we know?

A. Colon and rectal cancer are among our most preventable cancers. Screening is extremely important — both for average-risk individuals at recommended ages, but also for groups whose personal histories (such as radiation or IBD) indicate colonoscopies younger and more frequently. Family history or race can also indicate screening before 50. While the colonoscope is the only modality that is diagnostic and therapeutic at the same time, there are other tests patients can choose as part of their screenings, and a professional can help guide which are best for them.