Q&A with Cleveland Clinic’s New Digestive Disease Institute Chair: Conor Delaney, MD, PhD

Cleveland Clinic is thrilled to welcome back Conor Delaney, MD, PhD, as its new Chair of the Digestive Disease Institute.

Dr. Delaney, colorectal surgeon and professor of surgery with more than 25 years of experience, first joined Cleveland Clinic in 1999 as a colorectal surgery fellow and was on staff in the departments of Colorectal Surgery and Minimally Invasive Surgery until 2005. As Chief of the Division of Colorectal Surgery, Surgical Director of the Digestive Health Institute and Vice-Chair of Surgery for the last 10 years, Dr. Delaney built a colorectal team at University Hospitals Case Medical Center. He also served as interim Chair of the Department of Surgery and interim Surgeon-in-Chief for the University Hospitals Health System. His interests include laparoscopic colorectal surgery, reoperative abdominal surgery, colorectal cancer, inflammatory bowel disease and diverticulitis.

Consult QD sat down with Dr. Delaney to get to know this internationally acclaimed surgeon, researcher and teacher, and discuss his vision for the Digestive Disease Institute, which since 2003 has ranked second in the nation for Gastroenterology & GI surgery by U.S. News & World Report.

Q: Let’s start with a little bit about you and your background.

As a clinical surgeon what has mattered most to me over the years is pursuing clinical and technical perfection in order to produce the best possible clinical outcomes in the most efficient manner. That’s why it is so exciting to come back to Cleveland Clinic. It is an institution that is already an international leader and uniquely posed to be the international leader in the medical and surgical treatment of digestive diseases. I hope that I can meaningfully contribute to that goal.

Whilst most of my clinical and colorectal training was in Ireland, I came to the U.S. on two occasions: to University of Pittsburgh in 1993 and in 1999 to Cleveland Clinic. I feel fortunate in my career to have learned from some of the best minds in gastrointestinal surgery, including Drs. John Fung* and Thomas Starzl in Pittsburgh in the area of immunology, hepatobiliary disease and transplantation, and then having come here to train with Dr. Victor Fazio and his team at Cleveland Clinic. I was also fortunate to have the opportunity to learn laparoscopic colorectal surgery at a very early stage in its development from Dr. Anthony Senagore, a pioneer in the field.

I have a strong interest in research, and performed basic science in my early years. As time passed I felt my biggest contribution would be through clinical research and clinical education. Subsequently, I have worked with many colleagues to refine techniques that improve clinical outcomes and develop ways to educate other surgeons about them.

*Dr. Delaney succeeds John Fung, MD, PhD, Director of the Cleveland Clinic Health System Center for Transplantation.

Q: Can you elaborate on your work to improve clinical outcomes?

In addition to my interest in minimally invasive approaches and operative techniques for colorectal surgery, another major area of interest is standardizing and optimizing recovery after surgery. For the last 15 years, I have been continually working on and reporting outcomes using enhanced recovery pathways that allow patients to function almost normally within days to just a few weeks after major abdominal surgery, with minimal chance of mortality and lower chance of complications. This recovery is significantly faster than that seen using traditional recovery protocols. When combined with minimally invasive surgery, this has changed the paradigm for surgical recovery such that up to 20 percent of patients can leave hospital within 24 hours of a colorectal resection.

Q: What other new areas of digestive disease management are you most enthused about?

One of the exciting areas we have been investigating are new ways to deal with rectal cancer, including transanal total mesorectal excision, where laparoscopic equipment is used to operate through the anus to do a cancer operation on the rectum. In fact the whole field of minimally invasive surgery for gastrointestinal disease continues to be hugely exciting. Whether for removal of tumors of the liver or pancreas, or reconstructive procedures on the abdominal wall for hernia repair, or novel techniques for bariatric and metabolic surgery, there will continue to be development of new procedures that are less invasive and that help our patients recover more quickly from their illnesses.

In addition, new endoscopic approaches allow us to treat very advanced polyps and other gastrointestinal pathology, avoiding the need to resort to organ resection. The goal is to continue to pursue these novel approaches and try to accelerate patients’ recovery from interventional procedures, in some cases preventing them from needing surgery at all, whether for the esophagus, stomach, colon or rectum.

Medical developments continue to provide important advances as well. Perhaps the most exciting is the addition of new biological agents for medical management of inflammatory and infectious GI diseases. Particularly when combined with advances in genetics and disease biology, this is allowing us to provide personalized treatment for patients with conditions ranging from hepatitis to inflammatory bowel disease.

Q: What would you like our readers to know about your plans for the Digestive Disease Institute?

We have phenomenal clinical teams in the Digestive Disease Institute: Colorectal Surgery, Gastroenterology, General Surgery and Transplantation. All have historically been very strong and well recognized. I hope to build on the existing collaboration between medicine and surgery and between clinical and basic science research, expand our clinical trials, and pursue educational ventures that cover medical and surgical perspectives of GI disease. I also plan to expand our clinical and research expertise so that we can continue to increase our national and international visibility and our number of destination programs for the treatment of esophageal, gastric, liver, pancreas, intestinal and colorectal disease.

In addition, as hospitals such as Akron General become part of our system, we have a tremendous opportunity to bring quality care to more patients in the area with an integrated regional care network. Not only can we excel at this on a regional level as we grow locally, but we can also do this at a national and international level because of our facilities in Florida, Abu Dhabi and more.

Finally, I think perhaps our biggest impact on healthcare is likely to be through continued efforts to standardize and optimize care, and minimize variations in provision of care. Developing and continuously modifying care pathways and surgical techniques; educating physicians locally, nationally and internationally to use these techniques; and measuring and comparing outcomes with new metrics and technology will probably yield our greatest opportunity to provide high quality, high value care.

Q: What are your thoughts about today’s healthcare environment?

The healthcare environment and healthcare reimbursement are clearly challenges, as are the different priorities and perspectives of patients, physicians, hospitals and payors. As physicians, if we follow the principle of always doing the best thing for each individual patient, we should not go wrong. However, when we standardize and optimize care and minimize impact of our treatments on patients, we have the opportunity to improve outcomes and quality, and at the same time reduce utilization of health care resources. So not only do we improve safety, but we do so more efficiently. Our ultimate mission is to provide high quality care to more patients and provide that care more economically and efficiently. This way, everybody wins and the best value care is provided to the greatest number of patients.

Q: Will you continue to provide patient care in your new role?

Absolutely. Perhaps not as much as I have been to date, but I intend to provide both patient care and continue to perform research. I believe the opportunity to provide and improve patient care is the most important thing a physician can do.

Q: Finally, how do you feel about your new role?

I feel excited, but also very humbled. It is a great honor to be asked to join and take on a leadership role for a group that is as prestigious as the Digestive Disease Institute at Cleveland Clinic. But knowing those who have gone before me and knowing many of the incredible people within the institute makes it even more humbling. I think it is a phenomenal opportunity, as I believe that with a collaborative approach, based on communication, professionalism, teamwork and innovation, we are uniquely poised to become the No.1 program in the nation.