Practice Patterns and Trends in the Surgical Management of Mismatch Repair Deficient Colon Cancer.

Introduction: Defects in the DNA mismatch repair (MMR) pathway can predispose individuals to colorectal cancer (CRC), with germline mutations in this pathway leading to Lynch syndrome. Consequently, universal MMR testing is recommended for all newly diagnosed CRC patients to detect mismatch repair deficient (MMR-D) tumors, enabling informed treatment decisions. Given the increased potential for metachronous disease in patients with Lynch syndrome, the current guidelines for surgical management of Lynch-associated colon cancer recommend extended resection in patients under age 60.

Association Between Chemotherapy-Induced Peripheral Neuropathy and Low Anterior Resection Syndrome.

Introduction: Low anterior resection syndrome (LARS) can be a debilitating condition that develops after undergoing sphincter-preserving surgery for rectal cancer. Chemotherapy-induced peripheral neuropathy is a common side effect of platinum-based chemotherapy agents used as systemic therapy for rectal cancer treatment. The purpose of this study was to determine the potential relationship between CIPN and LARS.

Five-year evaluation of Anal Cancer Screening Program in Men Who Have Sex With Men with HIV at Two Academic Center Clinics.

Background: Guidelines recommend annual anal cytology-based squamous cell carcinoma of anus (SCCA) screening for men who have sex with men (MSM) with HIV aged ≥35 years (eligible population). Recommended threshold for high resolution anoscopy (HRA) depends on its availability: low-threshold (any abnormal cytology) if availability is high, and high-threshold (High-Grade Squamous Intraepithelial Lesion (HSIL) on cytology) if availability is low.

Methods: Retrospective chart review (2018-2022) at academic HIV clinics.

By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative Databases.

Introduction: Diagnosis, outcomes, and costs of care associated with bowel dysfunction after proctectomy for cancer remain underexplored in population-based studies. The lack of administrative coding for bowel dysfunction or low anterior resection syndrome has historically limited secondary data set outcomes analysis. The purpose of this study was to identify a bowel dysfunction phenotype in administrative claims data and characterize its prevalence, predictive factors, and costs.

For whom the bell tolls: assessing the incremental costs associated with failure to rescue after elective colorectal surgery.

Background: Failure to rescue after elective surgery is associated with increased healthcare costs. These costs are poorly understood and have not been reported for colorectal surgery. This study aimed to assess the incremental costs of failure to rescue after elective colorectal surgery.

Rare cases of colonic schwannomas.

Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2-6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed.

The Predictors of Complete Pathologic Response in Rectal Cancer during the Total Neoadjuvant Therapy Era: A Systematic Review.

The modern rectal cancer treatment paradigm offers additional opportunities for organ preservation, most notably via total neoadjuvant therapy (TNT) and consideration for a watch-and-wait (WW) surveillance-only approach. A major barrier to widespread implementation of a WW approach to rectal cancer is the potential discordance between a clinical complete response (cCR) and a pathologic complete response (pCR). In the pre-TNT era, the identification of predictors of pCR after neoadjuvant therapy had been previously studied.

More problems, more money: Identifying and predicting high-cost rescue after colorectal surgery.

Background: Successful rescue after elective surgery is associated with increased healthcare costs, but costs vary widely. Treating all rescue events the same may overlook targeted opportunities for improvement. The purpose of this study was to predict high-cost rescue after elective colorectal surgery.

Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study.

Background: Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals.

Objective: This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care.

Methods: We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer.

Management of Colonic Emergencies.

The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room.

Direct stick embolization of a rectal venous malformation via transanal minimally invasive surgery.

Rectal venous malformations (VMs) are rare clinical entities with variable patterns of presentation. Treatment requires unique, targeted strategies based on the symptoms, associated complications, and location, depth, and extent of the lesion. We present a rare case of a large, isolated rectal VM treated by direct stick embolization (DSE) using transanal minimally invasive surgery (TAMIS).

Idiopathic myointimal hyperplasia of the mesenteric veins: A systematic review and individual patient data regression analysis.

Background And Aim: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is an uncommon cause of colonic ischemia for which surgical treatment is typically curative. We describe clinical, radiologic, and endoscopic findings in IMHMV patients to provide clinicians with a framework for pre-surgical identification of this rare disease.

Methods: We performed a systematic review of seven databases for IMHMV cases and identified additional cases from Yale New Haven Hospital records.

So You Want to be a Program Director? Career Paths of Colon and Rectal Surgery Residency Program Directors.

Background: The trajectory of colon and rectal surgery residency program director (PD) career paths has not been well described, leaving those who aspire for the position with minimal guidance. The goal of this study is to characterize their career paths in the United States. By understanding their experiences, the path to train and educate the next generation of colon and rectal surgeons as a PD will be better illuminated.

How Far Is Too Far? Cost-Effectiveness Analysis of Regionalized Rectal Cancer Surgery.

Background: Regionalized rectal cancer surgery may decrease postoperative and long-term cancer-related mortality. However, the regionalization of care may be an undue burden on patients.

Objective: This study aimed to assess the cost-effectiveness of regionalized rectal cancer surgery.

Do Cultures From Percutaneously Drained Intra-abdominal Abscesses Change Treatment? A Retrospective Review.

Background: Routinely obtaining intraoperative cultures for abdominal infections is not a currently recommended evidence-based practice. Yet, cultures are frequently sent from these infections when they are managed by image-guided percutaneous drains.

Objective: This study aimed to determine the utility of cultures from percutaneously drained intra-abdominal abscesses.

Do You Get What You Pay For? The Relationship of Price and Quality in Hospital Provided Procedures.

Introduction: Starting in 2021, Centers for Medicare and Medicaid Services required hospitals to provide pricing information to allow consumers to compare prices. Patients perceived that the quality of these services also impacts decision-making. This study examines the relationship between procedure price and quality from the patients' perspective.

Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial.

Background: Postoperative hypocalcemia is the most common complication after thyroidectomy. Postoperative supplementation with calcium and calcitriol reduces its occurrence; however, prophylactic preoperative supplementation has not been studied systematically. The primary objective of this study was to determine whether pre- and postoperative calcium and calcitriol supplementation reduces postoperative hypocalcemia after total thyroidectomy compared with postoperative supplementation alone.

Endoscopic Step Up: A Colon-Sparing Alternative to Colectomy to Improve Outcomes and Reduce Costs for Patients With Advanced Neoplastic Polyps.

Background: The optimal strategy for colonic polyps not amenable to traditional endoscopic polypectomy is unknown. Endoscopic step up is a promising strategy for definitive treatment.

Objective: The purpose of this study was to determine whether endoscopic step up leads to improved outcomes and decreased costs compared with planned colectomy for endoscopically unresectable colon polyps.

Has National Colorectal Cancer Awareness Month increased endoscopy screening rates and public interest in colorectal cancer?

Background: National Colorectal Cancer Awareness Month occurs each March to promote awareness and screening for colorectal cancer. The effectiveness of this public health campaign is unknown. The aim of this study was to determine the impact of National Colorectal Cancer Awareness Month on rates of screening endoscopies and on public interest in colorectal cancer.

Should They Stay or Should They Go? The Utility of C-Reactive Protein in Predicting Readmission and Anastomotic Leak After Colorectal Resection.

Background: Hospital readmission and anastomotic leak following colorectal resection have a negative impact on patients, surgeons, and the health care system. Novel markers of patients unlikely to experience these complications are of value in avoiding readmission.

Objective: This study aimed to determine the predictive value of C-reactive protein for readmission and anastomotic leak within 30 days following colorectal resection.