Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons.

The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence.

The Association Between Sex and Survival for Anal Squamous Cell Carcinoma.

Background: The incidence of anal squamous cell carcinoma (SCC) is rising, despite the introduction of a vaccine against human papillomavirus (HPV), the most common etiology of anal SCC. The rate of anal SCC is higher among women and sex-based survival differences may exist. We aimed to examine the association between sex and survival for stage I-IV anal SCC.

The Effect of Facility Volume on Survival Following Proctectomy for Rectal Cancer.

Background: Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer.

Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals.

Background: Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals.

Rectal-prolapse repair in men is safe, but outcomes are not well understood.

Introduction: Rectal prolapse is a condition that occurs infrequently in men and there is little literature guiding treatment in this population. The purpose of this study was to evaluate the surgical approach and outcomes of rectal-prolapse repair in men.

Methods: A retrospective multicenter review was conducted of consecutive men who underwent rectal-prolapse repair between 2004 and 2014.

Anatomic Distribution of Colorectal Adenocarcinoma in Young Patients.

Background: The incidence of colorectal cancer has increased in the younger population. Studies show an increased prevalence of left-sided tumors in younger patients; however, exact anatomic distribution is not known.

Objective: We sought to determine the anatomic distribution of colorectal cancer in young patients and to calculate the proportion of tumors that would be within reach of a flexible sigmoidoscopy.

An Apprenticeship Rotation Teaches Chief Residents Nontechnical Skills and ACGME Core Competencies.

Background: Traditionally, surgical training has used an apprenticeship model but has more recently moved to a service-based model, with groups of residents working with groups of attending surgeons. We developed an apprenticeship rotation to enhance one-on-one interaction between chief residents and selected faculty. We hypothesized that the apprenticeship rotation would be effective for teaching nontechnical skills (NTS) and core competencies.

Participation in quality measurement nationwide.

In the interest of improving patient care quality and reducing costs, many hospitals across the nation participate in quality measurements. The three programs most applicable to colon and rectal surgery are the National Surgical Quality Improvement Project, the Surgical Care Improvement Project (SCIP), and the Surgical Care and Outcomes Assessment Program. Participation in each is variable, although many hospitals are eligible and welcome to participate.

Perioperative Beta blockade.

The use of preoperative beta (β) blockade has been through several changes, and it is clear that large, randomized controlled trials on the subject are in need. Currently, a judicious approach to perioperative β blockade is supported. Continuation of β blockers is recommended for the patient taking them prior to surgery.

Management and complications of stomas.

Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications.

Educational value of the operating room experience during a core surgical clerkship.

Background: The amount and content of medical student teaching in the operating room and its alignment with clerkship goals was unknown.

Methods: A qualitative research design using field observations, followed by qualitative and quantitative data coding and analysis.

Results: A mean of 9.

Severe acute gastrointestinal graft-vs-host disease: an emerging surgical dilemma in contemporary cancer care.

Objective: To determine the natural history of and guidelines for the surgical management of severe acute gastrointestinal (GI) graft-vs-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT).

Design: Case series from a prospective database.

Setting: Tertiary care referral center/National Cancer Institute-designated Comprehensive Cancer Center.

Distal pancreatectomy is not associated with increased perioperative morbidity when performed as part of a multivisceral resection.

Purpose: To evaluate the indications for and the outcomes from distal pancreatectomy.

Methods: Retrospective chart review of 171 patients who underwent distal pancreatectomy at Brigham and Women's Hospital between January 1996 and August 2005.

Results: Nearly one-third of distal pancreatectomies were performed as part of an en bloc resection for a contiguous or metastatic tumor.

The ACGME competencies in the operating room.

Background: In 1999, the ACGME introduced the 6 competencies that have become the basis for resident education. Since the operating room (OR) has traditionally been the major focus for resident teaching in surgery, we performed an observational study to determine whether it is an appropriate setting for the teaching and/or assessment of the competencies.

Methods: A 3-person team observed 11 operations and recorded all teaching events.

Surgical residents' perceptions of the effects of the ACGME duty hour requirements 1 year after implementation.

Background: In July 2003, the Accreditation Council for Graduate Medical Education implemented nationwide requirements on resident duty hours with the aim of improving quality of care. Our objectives were (1) to determine the extent and means of compliance with the ACGME requirements within general surgery residency programs and (2) to examine general surgery residents' perceptions of the effects of the ACGME requirements on patient care and residents' training experience.

Methods: A survey was mailed to residents in 19 New England general surgery programs in spring 2004 (n=238).

The future of surgery: today's residents speak.

Introduction: New Accreditation Council for Graduate Medical Education (ACGME) resident duty hour requirements were implemented in July 2003. A recent study suggests that these requirements have resulted in substantial work-hour reductions and improvements in quality of life for general surgery residents. The impact of these changes on the culture of surgery and attitudes about future practice patterns among current surgical residents is unknown.