Oncologic outcomes following transanal total mesorectal excision: the United States experience.

Aim: The benefits and short-term outcomes of transanal total mesorectal excision (taTME) for rectal cancer have been demonstrated previously, but questions remain regarding the oncologic outcomes following this challenging procedure. The purpose of this study was to analyze the oncologic outcomes following taTME at high-volume centers in the USA.

Methods: This was a multicenter, retrospective observational study of 8 tertiary care centers.

Racial disparities in survival of early onset colon cancer (Age<50): A matched NCDB analysis.

Background: Early-onset colon cancer (EOCC) has increasing incidence and disproportionately affects African-Americans. This analysis aims to compare EOCC survival among Black and White patients after matching relevant socio-demographic factors and stage.

Methods: The 2004-2017 NCDB database was queried for Black and White patients, age<50, who underwent colectomy for adenocarcinoma.

Multicenter phase II trial of transanal total mesorectal excision for rectal cancer: preliminary results.

Background: Transanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report long-term oncologic and functional results. We report early results from a North American prospective multicenter phase II trial of taTME (NCT03144765).

Cost associated with diverting ostomy after rectal cancer surgery: a transnational analysis.

Background: Diverting ileostomy and colostomy after total mesorectal excision reduces the risk of complications related to anastomotic leakages but is associated with a reduction in health-related quality of life and long-term economic consequences that are unknown. Our objective was to estimate the lifetime costs of stoma placement after rectal cancer resection in the U.S.

Discordance in Total Mesorectal Excision Specimen Grading in a Prospective Phase 2 Multicenter Rectal Cancer Trial: Are We Overestimating the Quality of Our Resections?

Objectives: To report the results of a rigorous quality control (QC) process in the grading of total mesorectal excision (TME) specimens during a multicenter prospective phase 2 trial of transanal TME.

Background: Grading of TME specimens is based on the macroscopic assessment of the mesorectum and standardized through synoptic pathology reporting. TME grade is a strong predictor of outcomes with incomplete (IC) TME associated with increased rates of local recurrence relative to complete or near complete (NC) TME.

Assessing the Quality of Online Health Information and Trend Data for Colorectal Malignancies.

Introduction: Patients often refer to the internet to learn about different health conditions. This study aims to assess the landscape of online health information on malignant colorectal conditions, focusing on the popularity, quantity, and quality of internet resources pertaining to these conditions. This information can be used as a guide for surgeons to supplement patient information at the time of surgical evaluation and to help design optimal online health information.

Management of left-sided malignant colorectal obstructions with curative intent: a network meta-analysis.

Background: Several management options exist for colonic decompression in the setting of malignant large bowel obstruction, including oncologic resection, surgical diversion, and SEMS as a bridge-to-surgery. Consensus has yet to be reached on optimal treatment pathways. The aim of the present study was to perform a network meta-analysis comparing short-term postoperative morbidity and long-term oncologic outcomes between oncologic resection, surgical diversion, and self-expanding metal stents (SEMS) in left-sided malignant colorectal obstruction with curative intent.

Patient and surgeon preferences for early ileostomy closure following restorative proctectomy for rectal cancer: why aren't we doing it?

Background: Early ileostomy closure (EIC), ≤ 2 weeks from creation, is a relatively new practice. Multiple studies have demonstrated that this approach is safe, feasible, and cost-effective. Despite the demonstrated benefits, this is neither routine practice, nor has it been studied, in North America.

Efficacy and satisfaction of asynchronous TeleHealth care compared to in-person visits following colorectal surgical resection.

Background: The feasibility of remote visits following abdominal colorectal surgery has not been studied in relation to efficacy, patient satisfaction, and surgeon satisfaction. This study aims to assess reliability and satisfaction with a web-based questionnaire for post-operative visits following abdominal colorectal surgery.

Methods: This was a prospective single-arm cohort study at single-tertiary care center during admission for abdominal colorectal surgery.

S184: preoperative sarcopenia is associated with worse short-term outcomes following transanal total mesorectal excision (TaTME) for rectal cancer.

Introduction: Malnutrition and deconditioning impact postoperative morbidity and mortality. Computed tomography (CT) body composition variables are used as markers of nutritional status and sarcopenia. The objective of this study is to evaluate the impact of sarcopenia, using CT variables, on postoperative outcomes following transanal total mesorectal excision (TaTME) for rectal cancer.

Oncologic Outcomes After Transanal Total Mesorectal Excision for Rectal Cancer.

Background: Recent series have raised concerns about the oncologic outcomes of transanal total mesorectal excision for mid and low rectal cancer. There is a paucity of large data sets from the United States to contribute to the ongoing international discourse.

Objective: This study aimed to investigate the rate of local recurrence and other oncologic outcomes in patients undergoing transanal total mesorectal excision for rectal adenocarcinoma.

Development of a Practice Guideline for Discharge Opioid Prescribing After Major Colorectal Surgery.

Background: Better alignment of opioid prescription quantities with patient need could help reduce excessive prescribing.

Objective: The study sought to develop an institutional prescribing guideline based on defined opioid consumption patterns after inpatient colorectal operations.

Design: This was a retrospective cohort study.

Total Transperineal Laparoscopic Proctectomy for the Treatment of Crohn's Proctitis.

Introduction: Completion proctectomy is traditionally performed using a combination of abdominal and perineal approaches. Access to and exposure of the pelvis through the abdominal cavity can be limited in patients with prior surgery or inflammatory conditions. We describe a novel technique for a total transperineal approach for proctectomy for Crohn's proctitis, avoiding technical challenges, risks, and recovery associated with abdominal surgery.

Prospective Evaluation of a Tiered Opioid Prescribing Guideline for Inpatient Colorectal Operations.

Objective: This study sought to prospectively validate an institutional prescribing guideline based on previously defined opioid consumption patterns following inpatient colorectal operations.

Background: In light of the opioid epidemic, reducing excess prescription quantities is key while still tailoring to patient needs.

Methods: This is a cohort study of elective colorectal operations (colectomies, proctectomies, and ostomy reversals) at a single tertiary care medical center.

Use of medical chaperones by colon and rectal surgeons in outpatient practice.

Background: The purpose of this study is to determine the frequency and motivations for medical chaperone use during anorectal exams by colon and rectal surgeons in the outpatient setting.

Study Design: This cross-sectional study examined factors impacting chaperone use via an anonymous online survey distributed via the American Society of Colon and Rectal Surgeons email list. Routine chaperone use was defined as ≥ 90%.

Defining Anastomotic Leaks After Colorectal Surgery: Results of a National Survey.

Background: Anastomotic leaks are a dreaded complication after colorectal surgery. Although anastomotic leak is often used as a metric to compare patient outcomes, a standard definition does not exist.

Materials And Methods: A web-based survey was developed and distributed to US surgeons.

Transanal Minimally Invasive Surgery: An Effective Approach for Patients Who Require Redo Pelvic Surgery for Anastomotic Failure.

Background: Anastomotic leaks cause significant patient morbidity that may require redo pelvic surgery. Transanal minimally invasive surgery facilitates direct access to the pelvis with increased visualization and maneuverability for technically difficult redo surgery.

Objective: This study aimed to assess the feasibility and outcomes of transanal minimally invasive surgery in redo proctectomy for anastomotic complications.

Opioid Consumption Patterns After Anorectal Operations: Development of an Institutional Prescribing Guideline.

Background: Closer scrutiny of prescription patterns following surgery could contribute to the national effort to combat the opioid epidemic.

Objective: This study aimed to define opioid consumption patterns following anorectal operations for development of an institutional prescribing guideline.

Design: This was a retrospective cohort study.

Not All Discharge Settings Are Created Equal: Thirty-Day Readmission Risk after Elective Colorectal Surgery.

Background: Discharge to nonhome settings after colorectal resection may increase risk of hospital readmission.

Objective: The purpose of this study was to determine the impact of various discharge dispositions on 30-day readmission after adjusting for confounding demographic and clinical factors.

Design: This was a retrospective cohort study.

Diverticulitis: An Update From the Age Old Paradigm.

For a disease process that affects so many, we continue to struggle to define optimal care for patients with diverticular disease. Part of this stems from the fact that diverticular disease requires different treatment strategies across the natural history- acute, chronic and recurrent. To understand where we are currently, it is worth understanding how treatment of diverticular disease has evolved.