Remote monitoring after elective colorectal surgery, a pilot study.

Background: Multiple studies have demonstrated safety of short stay after colorectal resections. Remote patient monitoring may allow earlier discharge home after surgery. Remote patient monitoring feasibility after elective colorectal surgery in a largely rural state was evaluated.

Modern Trends in Surgical Site Infection Rates for Colorectal Surgery: A National Surgical Quality Improvement Project Study 2013-2020.

Background: Few studies have investigated trends in global surgical site infection rates in colorectal surgery in the past decade.

Objective: This study seeks to describe changes in rates of different surgical site infections from 2013 to 2020, identify risk factors for surgical site infection occurrence, and evaluate the association of minimally invasive surgery and infection rates in colorectal resections.

Design: A retrospective analysis of the National Surgical Quality Improvement Program database 2013-2020 identifying patients undergoing open or laparoscopic colorectal resections by procedure codes was performed.

Characteristics and symptomatology of colorectal cancer in the young.

Background: The incidence of colorectal cancer in patients <50 years has rapidly risen recently. Understanding the presenting symptoms may facilitate earlier diagnosis. We aimed to delineate patient characteristics, symptomatology, and tumor characteristics of colorectal cancer in a young population.

Colostomy as a definitive treatment in an ALS patient with acute colonic Pseudo-obstruction refractory to medical management, a case report.

Background: Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease, and ALS patients may experience disturbed gastrointestinal motility often resulting in acute colonic pseudo-obstruction (ACPO). There is currently a paucity in the literature to guide the treatment of patients with both ALS and ACPO.

Case Presentation: Here we describe a 39-year-old male patient with advanced ALS who developed ACPO.

Male gender, smoking, younger age, and preoperative pain found to increase postoperative opioid requirements in 592 elective colorectal resections.

Purpose: With increased awareness of the opioid epidemic, understanding contributing factors to postoperative opioid use is important. The purpose of this study was to evaluate patient and perioperative factors that contribute to postoperative opioid use after colorectal resections and their relation to pre-existing pain conditions and psychiatric diagnoses.

Methods: A retrospective review was conducted identifying adult patients who underwent elective colorectal resection at a single tertiary center between 2015 and 2018.

Surgical management of large, connected perineal and pelvic epidermal inclusion cysts mimicking a dumbbell-shaped lesion in an adult male.

Introduction And Importance: Epidermal inclusion cysts are a common benign finding, and they are predominantly asymptomatic. They can rarely form in the pelvis or abdomen, however, and may cause symptoms secondary to mass effect. This case highlights management of an anterectal epidermal inclusion cyst connected to the perineal cyst, mimicking a dumbbell-shaped lesion, found in a male.

Evaluation of Urinalysis-Based Screening for Urothelial Carcinoma in Patients With Lynch Syndrome.

Background: Approximately 5% to 10% of patients with Lynch syndrome develop urothelial carcinoma. Current screening recommendations vary and are based on expert opinion. Practices need to be evaluated for clinical effectiveness.

Robotic surgery training during general surgery residency: a survey comparing attitudes towards a robotic training curriculum within general surgery, urology, and OBGYN residents and attendings.

General surgery residents are increasingly exposed to robotic surgery during their training. However, there is no standardized robotic educational curriculum across United States residency programs. Prior to implementing a robotic surgery curriculum, we surveyed our residents and attendings to ascertain their attitude towards robotic surgery training in residency.

Anastomotic Technique-How to Optimize Success and Minimize Leak Rates.

Determining when to perform a bowel anastomosis and whether to divert can be difficult, as an anastomosis made in a high-risk patient or setting has potential for disastrous consequences. While the surgeon has limited control over patient-specific characteristics, the surgeon can control the technique used for creating anastomoses. Protecting and ensuring a vigorous blood supply is fundamental, as is mobilizing bowel completely, and employing adjunctive techniques to attain reach without tension.

Impact of EcSOD Perturbations in Cancer Progression.

Reactive oxygen species (ROS) are a normal byproduct of cellular metabolism and are required components in cell signaling and immune responses. However, an imbalance of ROS can lead to oxidative stress in various pathological states. Increases in oxidative stress are one of the hallmarks in cancer cells, which display an altered metabolism when compared to corresponding normal cells.

Clinically actionable findings on surveillance EGD in asymptomatic patients with Lynch syndrome.

Background And Aims: Lynch syndrome (LS) predisposes patients to multiple cancers including of the gastric and small bowel. Data supporting EGD surveillance in LS are limited. Our aim is to describe upper GI (UGI) findings in asymptomatic LS patients undergoing EGD surveillance within a hereditary colorectal cancer registry.

Male sex, ostomy, infection, and intravenous fluids are associated with increased risk of postoperative ileus in elective colorectal surgery.

Background: Postoperative ileus is a common and costly complication after elective colorectal surgery. Effects of intravenous fluid administration remain controversial, and the effect of ostomy construction has not been fully evaluated. Various restrictive intravenous fluid protocols may adversely affect renal function.

Staged Approaches to Restorative Proctocolectomy with Ileoanal Pouch-When and Why?

Restorative proctocolectomy (RPC) with ileal pouch anal-anastomosis (IPAA) is commonly performed for patients with ulcerative colitis, familial adenomatous polyposis, and selected phenotypes of Crohn's disease (CD). Due to concerns about the effects of surgical complications on pouch functional outcomes, debate remains surrounding when and whether RPC with IPAA should be performed in a staged manner. Particularly debated are the timings of the IPAA, whether it is constructed at time of the proctocolectomy and whether to utilize temporary fecal diversion with a loop ileostomy.

Intra-abdominal and Anorectal Abscesses.

Intra-abdominal and anorectal abscesses are common pathologies seen in both inpatient and outpatient settings. To decrease morbidity and mortality, early diagnosis and treatment are essential. After adequate drainage via a percutaneous or incisional approach, patients need to be monitored for worsening symptoms or recurrence and evaluated for the underlying condition that may have contributed to abscess formation.

Impact of routine mismatch repair screening on genetic counseling and surgical management in colorectal cancer patients.

Background: Mismatch repair (MMR) deficiency in colorectal cancer (CRC) should prompt consideration of genetic counseling (GC) as a Lynch syndrome (LS) diagnosis may have several implications for the patient and family. The study aims were to examine how routine MMR testing influences the rate of GC and surgical resection extent.

Methods: A single-institution retrospective review was performed on CRC specimens (including colonoscopic biopsies) routinely screened for MMR deficiency from 2012 to 2018.

Teaching and Mentoring Early in Surgical Practice.

Background: Transitioning from trainee to independent surgeon is challenging, with teaching and mentoring learners adding complexity. This study aimed to identify benefits and challenges of teaching and mentoring residents early in surgical practice.

Materials And Methods: A mixed-methods survey with multiple choice and open-ended questions was developed for early career (first 3 years) and experienced (more than 3 years) surgeons working with residents.

Impact of KRAS status on tumor response and survival after neoadjuvant treatment of locally advanced rectal cancer.

Background: Mutation of the KRAS oncogene (mKRAS) in colorectal cancer has been associated with aggressive tumor biology, resistance to epidermal growth factor inhibitors, and decreased overall survival (OS). The aim of the current study was to analyze the association of mKRAS with pathologic complete response (pCR) and neoadjuvant rectal (NAR) score, and its impact on the survival of patients with locally advanced rectal cancer who were managed with multimodality therapy.

Methods: The National Cancer Database was queried for stage II-III rectal cancer patients with a known KRAS status who underwent neoadjuvant chemoradiation therapy (nCRT) and proctectomy between 2004 and 2015.

Neuroendocrine Tumors of the Appendix, Colon, and Rectum.

Neuroendocrine neoplasms of the colon and rectum are rare, although surgeons are likely to encounter appendiceal neuroendocrine tumors while caring for patients with appendicitis. Surgery remains the primary treatment, provided disease is resectable, although for small rectal lesions endoscopic resection is often sufficient. Metastastic disease has a variety of treatment options.

The Impact of KRAS Mutation on the Presentation and Prognosis of Non-Metastatic Colon Cancer: an Analysis from the National Cancer Database.

Introduction: Approximately 40% of colorectal cancers have a KRAS mutation. The prognostic significance of KRAS mutations in patients with non-metastatic colon cancer has not been well elucidated. The National Cancer Database (NCDB) was used to analyze factors associated with KRAS mutation as well as its impact on the presentation and survival of patients with stages I-III colon cancer.

Positive circumferential resection margins following locally advanced colon cancer surgery: Risk factors and survival impact.

Background: While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. The aim of the current study was to determine national rates for positive CRM in locally advanced colon cancer, associated factors, and survival impact.

Methods: The National Cancer Database was queried to identify patients with stage II-III adenocarcinoma of the colon (2004-2015).

Guideline-Recommended Chemoradiation for Patients With Rectal Cancer at Large Hospitals: A Trend in the Right Direction.

Background: Many patients with rectal cancer are treated at small, low-volume hospitals despite evidence that better outcomes are associated with larger, high-volume hospitals.

Objectives: This study aims to examine trends of patients with rectal cancer who are receiving care at large hospitals, to determine the patient characteristics associated with treatment at large hospitals, and to assess the relationships between treatment at large hospitals and guideline-recommended therapy.

Design: This study was a retrospective cohort analysis to assess trends in rectal cancer treatment.

The Role of Multiagent Chemoradiation in the Management and Prognosis of Anal Squamous Cell Carcinoma.

Introduction: The standard treatment for anal squamous cell carcinoma (ASCC) is multiagent chemotherapy with radiation (CRT). This is based on several randomized trials demonstrating lower recurrence and colostomy-free survival rates with multiagent CRT; however, these studies could not confirm an overall survival (OS) benefit. We hypothesized that the lack of improved OS was due to limited sample sizes and follow-up, and that multiagent CRT is associated with higher OS.