Survival following synchronous colon cancer resection.

Background: Synchronous colon cancers, defined as two or more primary colon cancer detected simultaneously at the time of initial diagnosis, account for up to 5% of all colon cancer diagnoses. Management principles and outcomes remain largely undefined.

Methods: A retrospective institutional review of patients undergoing curative intent resection for colon adenocarcinoma (Stages I-III) from 1995 to 2007 was performed.

Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial.

Background: Local excision is an organ-preserving treatment alternative to transabdominal resection for patients with stage I rectal cancer. However, local excision alone is associated with a high risk of local recurrence and inferior survival compared with transabdominal rectal resection. We investigated the oncological and functional outcomes of neoadjuvant chemoradiotherapy and local excision for patients with stage T2N0 rectal cancer.

Fast-track pathway for minimally invasive colorectal surgery with and without alvimopan (Entereg)™: which is more cost-effective?

Multimodal fast-track (FT) pathways for both open and laparoscopic colorectal surgery have been shown to improve gastrointestinal recovery, shorten length of stay, and decrease morbidity. The aim of our study was to determine if using alvimopan (Entereg)™ in the setting of a FT minimally invasive colorectal pathway is beneficial and cost-effective. All minimally invasive colorectal surgeries performed by one surgeon using a multimodal FT pathway with and without alvimopan were reviewed.

Clinical features and oncologic outcomes in patients with rectal cancer and ulcerative colitis: a single-institution experience.

Background: Patients with chronic ulcerative colitis are at increased risk of developing colorectal cancer. Limited data exists in ulcerative colitis patients with rectal cancer regarding clinical and oncologic outcomes, and the ideal operative approach.

Objective: To describe our experience in the management of patients with rectal cancer in the setting of chronic ulcerative colitis and their outcomes.

Uncomplicated diverticulitis, more complicated than we thought.

Introduction: The classification of complicated and uncomplicated diverticulitis has been used for many years. We note variations in the course of uncomplicated diverticulitis. We propose and describe three categories of uncomplicated diverticulitis.

Prophylactic resection, uncomplicated diverticulitis, and recurrent diverticulitis.

The classifications of acute uncomplicated diverticulitis and complicated diverticulitis have served us well for many years. However, in recent years, we have noted the prevalence of variations of uncomplicated diverticulitis, which have not precisely fit under the classification of 'acute resolving uncomplicated diverticulitis', which manifests itself with the typical left lower quadrant pain, fever, diarrhea, elevated white blood count, and CT findings, such as stranding, and which resolves fairly promptly and completely on oral antibiotic therapy. For these other variations, we would suggest we use the term chronic diverticulitis, as a subset of uncomplicated diverticulitis, meaning there is no abscess, stricture, or fistula, but the episode does not respond to the usual antibiotic treatment, and there is a rebound symptomatology once the treatment has stopped, or there is continuing subliminal inflammation that continues, typically, for several weeks after the initial episode without complete resolution.

Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs?

Background: Colorectal surgery is associated with high rates of surgical site infection (SSI). The National Surgery Quality Improvement Program is a validated, risk-adjusted quality-improvement program for surgical patients. Patient stratification and risk adjustment are associated with Current Procedural Terminology codes and primary disease diagnosis is not considered.

Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy.

Background: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy.

Long-term quality of life and sexual and urinary function after abdominoperineal resection for distal rectal cancer.

Background: Permanent colostomy, pelvic dissection, and radiotherapy after abdominoperineal resection can put quality of life and sexual and urinary function at risk; however, there are limited data using validated instruments on patients undergoing abdominoperineal resection regarding these outcome measures.

Objective: We evaluated the quality of life and the sexual and urinary function of patients undergoing abdominoperineal resection for rectal cancer and compared the outcomes of patients who received and did not receive pre- or postoperative pelvic radiotherapy.

Methods: European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and CR38, International Consultation on Incontinence Questionnaire, American Urological Association Symptom Index, Brief Sexual Function Inventory for men, and sexual function module of the Cancer Rehabilitation Evaluation System for women were mailed to 219 patients who underwent abdominoperineal resection between 1994 and 2004.

Management and outcomes of primary coloduodenal fistulas.

Purpose: Primary coloduodenal fistula (CDF) is a rare entity. We review our experience with the management and outcomes of CDF.

Methods: This is a retrospective review from 1975 to 2005 of patients with primary CDF.

Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients.

Background: Despite its introduction in 1991, laparoscopic colectomy is performed in <10% of United States patients requiring colectomy. Laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative times. Hand-assisted laparoscopic colectomy is an alternative technique that addresses these problems while preserving the short-term benefits of laparoscopic colectomy.

Synchronous rectal and hepatic resection of rectal metastatic disease.

Background: The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival.

Study Design: Sixty patients who underwent resection for metastatic rectal disease from 1991 to 2005 at Mayo Clinic were reviewed. Inclusion criteria were: rectal cancer with metastatic liver disease and resectability of metastases.

Primary intestinal lymphoma in patients with inflammatory bowel disease: a descriptive series from the prebiologic therapy era.

Background: Primary intestinal lymphoma in the setting of inflammatory bowel disease (IBD) is uncommon and may be associated with immune suppressive therapy. We report clinical features and outcomes in patients with both conditions prior to use of biologic therapy.

Methods: All patients with primary intestinal lymphoma and IBD at our institution from 1960-2000 were retrospectively identified.

Short- and long-term surgical outcomes in patients undergoing proctocolectomy with ileal pouch-anal anastomosis in the setting of primary sclerosing cholangitis.

Background: Primary sclerosing cholangitis occurs in approximately 10% of patients with ulcerative colitis, but studies involving IPAA in patients with cholangitis have been reported in limited numbers.

Objective: This study aimed to examine surgical outcomes in patients with ulcerative colitis and sclerosing cholangitis undergoing total proctocolectomy with IPAA and to identify variables associated with surgical complications.

Design: This is a retrospective cohort study.

Risk factors for splenic injury during colectomy: a matched case-control study.

Purpose: We assessed risk factors for splenic injury during colectomy and associated outcomes for a 15-year period at a single institution.

Methods: All adult general surgery patients who sustained a splenic injury during colectomy at our institution from 1992 to 2007 were retrospectively identified and matched 1:1 to controls without splenic injury. Putative risk factors were assessed using paired univariate analysis and conditional logistic regression.

Perioperative anti-tumor necrosis factor therapy does not increase the rate of early postoperative complications in Crohn's disease.

Background: There have been numerous studies with conflicting results regarding the use of anti-tumor necrosis factor (TNF) therapy and its relationship to postoperative outcome in Crohn disease. The aim of our study was to examine the rate of postoperative morbidity in patients receiving anti TNF therapy in the perioperative period.

Methods: All patients undergoing surgery for Crohn disease from 2005 till 2008 were abstracted from a prospective database.

Peutz-Jeghers syndrome: a study of long-term surgical morbidity and causes of mortality.

Patients with Peutz-Jeghers syndrome (PJS) require lifelong multidisciplinary care for gastrointestinal polyposis and increased risk of cancer. Their long-term morbidities and causes of mortality are unknown. Patients with a definitive diagnosis of PJS (n = 54) were retrospectively reviewed for disease course and outcome.

Alvimopan for the management of postoperative ileus after bowel resection: characterization of clinical benefit by pooled responder analysis.

Background: A pooled post hoc responder analysis was performed to assess the clinical benefit of alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist, for the management of postoperative ileus after bowel resection.

Methods: Adult patients who underwent laparotomy for bowel resection scheduled for opioid-based intravenous patient-controlled analgesia received oral alvimopan or placebo preoperatively and twice daily postoperatively until hospital discharge or for 7 postoperative days. The proportion of responders and numbers needed to treat (NNT) were examined on postoperative days (POD) 3-8 for GI-2 recovery (first bowel movement, toleration of solid food) and hospital discharge order (DCO) written.

Advances in surgical approaches to Crohn's disease: minimally invasive surgery and biologic therapy.

In the last 5 years, significant advances have been made in the surgical approaches to, and medical management of, Crohn's disease (CD). This review summarizes these advances as they relate to the care of surgical patients with CD, with an emphasis on innovations in surgical techniques, specifically minimally invasive (laparoscopic) surgery, as well as on recent developments in biologic pharmacotherapies for CD that have important clinical implications for surgical patients. These include recent insights gained into the role of biologic therapy with infliximab and other newer agents in preoperative and postoperative therapy of CD patients.

Long-term direct costs before and after proctocolectomy for ulcerative colitis: a population-based study in Olmsted County, Minnesota.

Purpose: This study was designed to test the hypothesis that patients undergoing definitive surgery for chronic ulcerative colitis have reduced direct medical costs after, as compared with before, total proctocolectomy.

Methods: A population-based cohort of patients who underwent proctocolectomy for ulcerative colitis from 1988 to 2007 was identified using the Rochester Epidemiology Project. Total direct healthcare costs were estimated from an administrative database.

Splenic salvage after intraoperative splenic injury during colectomy.

Objective: To determine the optimal surgical management of splenic injury encountered during colectomy.

Design: Retrospective review from 1992 to 2007.

Setting: Mayo Clinic in Rochester, Minnesota, a tertiary care center.

Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience.

Background: The use of defunctioning stomas has been advocated to mitigate the adverse sequela from anastomotic dehiscence after rectal cancer resection. The aim of this study was to report our experience with anastomotic dehiscence and overall morbidity of low anterior resections in the era of neoadjuvant therapy, where the use of fecal diversion is part of the standard operative strategy for low (< 5 cm) rectal anastomoses.

Study Design: This retrospective case series included patients who were treated with neoadjuvant therapy and had rectal cancer resection with curative intent, from 1996 to 2007.

Impact of a multimedia e-learning module on colon cancer literacy: a community-based pilot study.

Background: We aimed to determine if an e-learning module could improve colon cancer literacy in a community-based cohort, while obtaining variability estimates for subsequent study.

Methods: A convenience sample of subjects attending a health-education fair was surveyed to determine colon cancer literacy before-and-after viewing a colon cancer e-learning module. The difference in cancer literacy scores was assessed for significance using univariate analysis.