Patient and disease characteristics, treatment practices and oncologic outcomes among patients with colorectal cancer: a population-based analysis.

Background: The incidence of colorectal cancer (CRC) is increasing among young adults. We sought to report on patient and disease characteristics, treatment practice patterns and outcomes in this population.

Methods: We conducted a retrospective cohort study using administrative health data from the Alberta Cancer Registry (2004-2015), including demographic and tumour characteristics, and treatment received.

Improved Survival in a Cohort of Patients Aged 75 Years and Older With Fecal Immunochemical Testing-Detected Colorectal Cancer.

Background: Fecal immunochemical testing is an accepted form of colorectal cancer screening and is recommended for adults up to the age of 75 years in Canadian guidelines. However, many individuals 75 years and older continue to receive fecal immunochemical testing despite being outside accepted guidelines.

Objective: This study aimed to determine whether patients aged 75 years and older with screen-detected cancer demonstrated improved outcomes and survival compared with patients with non-screen-detected cancer.

Self-Expanding Metal Stents Do Not Adversely Affect Long-term Outcomes in Acute Malignant Large-Bowel Obstruction: A Retrospective Analysis.

Background: Self-expanding metal stents as a bridge to surgery in acute malignant large-bowel obstruction has gained popularity. However, long-term oncologic outcomes have not been well established.

Objective: To investigate long-term oncologic outcomes of patients undergoing curative resection after the placement of a colonic stent compared with emergency surgery for acute malignant large-bowel obstruction.

Efficacy of perioperative chemotherapy in resected colorectal liver metastasis: A systematic review and meta-analysis.

Background: Nearly half of patients with colorectal cancer develop liver metastases. Radical resection of colorectal liver metastases (CRLM) offers the best chance of cure, significantly improving 5-year survival. Recurrence of metastatic disease is common, occurring in 60 % or more of patients.

Classic and Novel Histopathologic Risk Factors for Lymph Node Metastasis in T1 Colorectal Cancer: A Systematic Review and Meta-analysis.

Background: Treatment of endoscopically resected T1 colorectal cancers is based on the risk of lymph node metastasis. Risk is based on histopathologic features, although there is lack of consensus as to what constitutes high-risk features.

Objective: The purpose of this study was to conduct a systematic review and meta-analysis of histopathologic risk factors for lymph node metastasis.

A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform?

Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown.

Expedited discharge in uncomplicated acute appendicitis: Decreasing the length of stay while maintaining quality.

Background: An expedited discharge protocol for uncomplicated appendicitis was developed at a Canadian academic hospital to determine if patients could be safely discharged home early without negatively impacting care and patient satisfaction.

Methods: A non-randomized prospective quality improvement project was completed between February 01, 2017 and January 31, 2018. The project included patients between 16 and 65 years with uncomplicated appendicitis managed with laparoscopic appendectomy.

Can we improve the efficiency of care in patients with colorectal cancer from the time of their initial referral for colonoscopy to surgical resection?

Delays in the diagnosis and treatment of colon adenocarcinoma are distressing to patients and clinicians alike. Of 224 patients with resected colon cancer identified via a province-wide administrative database, 170 (76%) received their colonoscopy from a gastroenterologist (GI). Patients waited significantly longer between their colonoscopy and surgical resection when the colonoscopy was performed by a GI within an urban city (43 v.

Synchronous colorectal liver metastases: a national survey of surgeon opinions on simultaneous resection and multidisciplinary cooperation.

Background: The management of patients with synchronous colorectal liver metastases (sCRLM) has evolved significantly (improved chemotherapy, hepatic surgery advancements, colonic stenting, consultation synergies). We sought to better understand surgeon viewpoints on optimal referral patterns and the delivery of simultaneous resections.

Methods: A 40 question on-line survey was offered to members of the Canadian surgical community.

Assessing resectability of colorectal liver metastases: How do different subspecialties interpret the same data?

Background: Multimodal treatment of colorectal liver metastases (CRLMs) relies on precise upfront assessment of resectability. Variability in the definition of resectable disease and the importance of early consultation by a liver surgeon have been reported. In this pilot study we investigated the initial resectability assessment and patterns of referral of patients with CRLMs.

Examples of dramatic failures and their effectiveness in modern surgical disciplines: can we learn from our mistakes?

Innovation can be variably defined, but when applied to healthcare is often considered to be the introduction of something new, whether an idea, method or device, into an unfilled void or needy environment. Despite the introduction of many positive surgical subspecialty altering concepts/devices however, epic failures are not uncommon. These failures can be dramatic in regards to both their human and economic costs.

Postoperative Nonsteroidal Anti-inflammatory Drug Use and Intestinal Anastomotic Dehiscence: A Systematic Review and Meta-Analysis.

Background: Nonsteroidal anti-inflammatory drugs are commonly used analgesics in colorectal surgery. Controversy exists regarding the potential association between these drugs and anastomotic dehiscence.

Objective: This study aimed to determine whether postoperative nonsteroidal anti-inflammatory drug use is associated with intestinal anastomotic dehiscence.

A comparison of outcomes between laparoscopic and open appendectomy in Canada.

The benefit of a laparoscopic approach to appendectomy continues to be debated. We compared laparoscopic (LA) with open appendectomy (OA) for appendicitis in Canada using the Canadian Institute for Health Information database (2004-2008). The odds of female patients undergoing LA were 1.

Bowel obstructions and incisional hernias following trauma laparotomy and the nonoperative therapy of solid organ injuries: A retrospective population-based analysis.

Background: Small bowel obstruction (SBO) and incisional hernia (IH) represent the most common long-term complications of laparotomy. They may also be more common among injured patients than for elective/nontrauma emergency scenarios. Unfortunately, the population-based incidence of SBO and IH following trauma laparotomy is unknown.

The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department.

Background: The natural evolution of an acute care surgery (ACS) service is to develop disease-specific care pathways aimed at quality improvement. Our primary goal was to evaluate the implementation of an ACS pathway dedicated to suspected appendicitis on patient flow and the use of computed tomography (CT) in the emergency department (ED).

Methods: All adults within a large health care system (3 hospitals) with suspected appendicitis were analyzed during our study period, which included 3 time periods: pre- and postimplementation of the disease-specific pathway and at 12-month follow-up.

Colonoscopy following nonoperative management of uncomplicated diverticulitis may not be warranted.

Background: Following the nonoperative management of acute diverticulitis, guidelines recommend routine follow-up colonoscopy; however, evidence to support this recommendation are lacking.

Objective: This study aims to determine the diagnostic yield of endoscopy for clinically significant neoplasia following the successful nonoperative management of acute diverticulitis.

Design: This study is a retrospective review.

Role of Evidence-Based Reviews in Surgery in teaching critical appraisal skills and in journal clubs.

Background: Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents' opinions regarding EBRS and journal clubs.

Methods: We surveyed postgraduate year 2-5 residents from 15 general surgery programs.

Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department.

Background: Acute care surgery (ACS) services are becoming increasingly popular.

Methods: Assessment, flow, and disposition of adult ACS patients (acute, nontrauma surgical conditions) through the emergency department (ED) in a large health care system (Calgary) were prospectively analyzed.

Results: Among 447 ACS ED consultations over 3 centers (70% admitted to ACS), the median wait time from the consultation request to ACS arrival was 36 minutes, and from ACS arrival to the admission request it was 91 minutes.

Primary colorectal lymphoma-clinical outcomes in a population-based series.

Purpose: The purpose of this study was to investigate the characteristics and the outcomes of primary colorectal lymphomas using a population-based registry.

Methods: All cases of colorectal lymphoma diagnosed between 1980 and 2007 were identified using a provincial cancer registry. Patients meeting Dawson's criteria and having a negative bone marrow biopsy were included.

Elective resection of colon cancer by high-volume surgeons is associated with decreased morbidity and mortality.

Background: The purpose of this study was to determine whether morbidity and mortality in patients undergoing elective resection of colon cancer are associated with surgeon or hospital volume.

Methods: Using the Nationwide Inpatient Sample database, we identified all adult patients who underwent elective resection for colon cancer as their primary procedure between 2003 and 2007. Cases were divided into three groups according to the mean number of resections performed annually by each surgeon: low volume (≤4/year), intermediate volume (5-9/year), or high volume (≥10/year).

Morbidity and mortality following colorectal surgery in patients with end-stage renal failure: a population-based study.

Purpose: The risk of abdominal surgery in patients with end-stage renal failure is poorly defined. Our objective was to describe outcomes of colorectal surgery in dialysis patients from a population-based perspective.

Methods: We analyzed the 1993 to 2007 Nationwide Inpatient Sample to identify patients hospitalized for colorectal surgery.

Dramatic innovations in modern surgical subspecialties.

Innovation is defined as the introduction of something new, whether an idea, method or device. In this article, we describe the most important and innovative concepts and techniques that have advanced patient care within modern surgical subspecialties. We performed a systematic literature review and consulted academic subspecialty experts to evaluate recent changes in practice.

Postoperative complications following surgery for rectal cancer.

Objective: This systematic review was designed to determine postoperative complication rates of radical surgery for rectal cancer (abdominal perineal resection and anterior resection).

Summary Of Background Data: Lack of accepted complication rates for rectal cancer surgery may hinder quality improvement efforts and may impede the conception of future studies because of uncertainty regarding the expected event rates.

Methods: All prospective studies of rectal cancer receiving radical surgery published between 1990 and August 2008 were obtained by searching Ovid MEDLINE, EMBASE, as well as ASCO GI, CAGS, and ASCRS meeting abstracts between 2004 and 2008.