Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial.

Objective: To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection.

Background: This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum.

Mesh sutured repairs of contaminated incisional hernias.

Background: We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias.

Methods: 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature.

Fecal Incontinence: Epidemiology, Impact, and Treatment.

Fecal incontinence (FI) is a chronic and debilitating condition that carries a significant health, economic, and social burden. FI has a considerable psychosocial and financial impact on patients and their families. A variety of treatment modalities are available for FI including behavioral and dietary modifications, pharmacotherapy, pelvic floor physical therapy, bulking agents, anal sphincteroplasty, sacral nerve stimulation, artificial sphincters, magnetic sphincters, posterior anal sling, and colostomy.

Comparison of the Effect of Instrument Type on Transanal Endoscopic Surgery Learning Curves.

Background: Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the performance of surgical novices using instruments with and without articulating shafts to perform a simulated TES task.

Methods: Medical students each performed 10 repetitions of the Fundamentals of Laparoscopic Surgery circle-cut task.

Should Oral Contrast Be Omitted in Patients with Suspected Appendicitis?

Background: Acute appendicitis is one of the most common surgical emergencies. Our study evaluated patients given the diagnosis of appendicitis and reviewed their workup and clinical outcomes. We specifically focused on the use of oral contrast followed by appendectomy.

The anthropometric definition of the rectum is highly variable.

Purpose: The precise definition of the rectum is essential for localizing colorectal pathology, yet current definitions are nebulous. The objective of this study is to determine the anthropometric definition of common pelvic landmarks in relation to patient characteristics.

Methods: Seventy-one patients underwent open proctectomy with intra-operative measurements from the anal verge to various pelvic landmarks, and patient characteristics were evaluated.

Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial.

Importance: Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease.

Objective: To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen.

Design, Setting, And Participants: A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013.

Sacral Nerve Stimulation in the Treatment of Bowel Disorders.

Defecation problems occur in patients of all ages, but are more prevalent in the elderly, postpartum women, and patients with chronic and debilitating medical conditions. Most of the time, these problems respond to medical therapy and nonsurgical options, but it is not uncommon for patients to require surgical intervention. Sacral nerve stimulation (SNS) presents an alternative for patients with bowel dysfunction combining proven therapeutic benefits and limited surgical risks.

Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database.

Bladder and ureteral injury are serious iatrogenic complications during abdominal and pelvic surgery but are poorly investigated in the general surgery literature. The objective of this study was to examine rates, trends, and patient and surgical characteristics present in lower urinary tract injuries during gastrointestinal surgery using the Nationwide Inpatient Sample (NIS) database. The NIS database was queried from 2002 to 2010 for gastrointestinal surgery procedures including small/large bowel, rectal surgery, and procedures involving a combination of the two.

Cholecystitis.

Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy.

Expression of RORγt marks a pathogenic regulatory T cell subset in human colon cancer.

The role of regulatory T cells (T(regs)) in human colon cancer (CC) remains controversial: high densities of tumor-infiltrating T(regs) can correlate with better or worse clinical outcomes depending on the study. In mouse models of cancer, T(regs) have been reported to suppress inflammation and protect the host, suppress T cells and protect the tumor, or even have direct cancer-promoting attributes. These different effects may result from the presence of different T(reg) subsets.

Development of a feasible transrectal natural orifice transluminal endoscopic surgery (NOTES®) approach in a cadaveric appendectomy model: anterior is better.

Background: The transrectal natural orifice transluminal endoscopic surgery (NOTES) approach is a potentially promising alternative to transgastric or transvaginal approaches for intraperitoneal procedures. However, whether the optimal transrectal approach for intraperitoneal surgery is anterior or posterior remains unknown. To evaluate this, a prospective comparison of anterior and posterior transrectal NOTES approaches in a cadaveric appendectomy model was performed.

Progression to advanced neoplasia is infrequent in post colectomy familial adenomatous polyposis patients under endoscopic surveillance.

Background And Study Aims: Advanced neoplasia may occur in the remaining colon and distal ileum of familial adenomatous polyposis (FAP) patients who have had a prophylactic colon resection. The role of post operative lower GI endoscopic surveillance and management of advanced neoplasia in FAP patients is not well defined. The aims of this study were to determine the prevalence of post operative neoplasia and to evaluate the safety and effectiveness of lower GI endoscopic surveillance and ablative therapy following prophylactic colon resection.

The role of clinical trials in the development of novel surgical techniques.

The new paradigm and standard for medicine and surgery is the evidence-based practice for which the randomized controlled trial is fundamental. Despite the early involvement of surgeons in clinical trials, randomized trials testing novel surgical therapies are not common. Indeed, only 24% of surgical patients are managed based on level 1 evidence.

Impact of pre- and postoperative multimodality therapy on rectal cancer.

Surgery is the primary treatment of rectal cancer. However, variability in surgical outcomes led to development of combined therapies including pelvic radiation and systemic chemotherapy. The evolution of these therapies both individually and combined, their successes and limitations is discussed in the context of an evolving understanding of rectal cancer biology.

Colon and rectal cancer: laparoscopic or open?

Early experiences with laparoscopic colectomy were unfavorable, with higher than expected rates of wound tumor implants and concerns about short and long-term compromised oncologic outcomes. Several international randomized controlled trials were initiated to address concerns regarding compromised oncologic outcomes. Each of the trials was designed to test the hypothesis that level 1 evidence supports the general feasibility and recovery advantage as well as cancer equivalence of laparoscopic colectomy in curable colon cancer.

Minimal access cancer management.

Minimal access approaches in the treatment of a variety of solid tumors of the stomach, large bowel, and genitourinary system are now being advocated in several surgical specialty areas. The laparoscope has evolved from a diagnostic tool to a modality that allows for removal of tumors using small incisions and the application of pneumoperitoneum with carbon dioxide. Through studies using animal models and patient investigation, the immunologic benefits of laparoscopic cancer procedures appear to be beneficial when compared with conventional laparotomy.

Laparoscopic restorative proctocolectomy for ulcerative colitis.

Laparoscopic surgery of the colon has become an established method for the resection of both benign and malignant disease. Complex laparoscopic colon resections were once stigmatized due to their longer operating times and inherent technical difficulty. However, technological innovations and increased surgical experience with laparoscopy have advanced the field of complex laparoscopic surgery, including ileal pouch-anal anastomosis (IPAA) procedure, with safe feasible results.