Trends and outcomes in laparoscopic versus open surgery for rectal cancer from 2005 to 2016 using the ACS-NSQIP database, a retrospective cohort study.

Background: There is controversy regarding the use of laparoscopy for rectal cancer, especially after the ACOSOG Z6051 Randomized Clinical Trial determined that laparoscopy failed to meet non-inferiority compared with open surgery. With these new recommendations, the current practices for the treatment of rectal cancer across the country are unknown.

Methods: Using the ACS-NSQIP database from 2005 to 2016, resections for rectal cancer were studied.

Trends and Outcomes for Minimally Invasive Surgery for Inflammatory Bowel Disease.

Background: The relapsing and remitting nature of inflammatory bowel disease (IBD) predisposes patients to the development of fibrotic strictures, which must often be managed surgically. Laparoscopy provides the potential for enhanced perioperative care. Previous studies comparing morbidity and trends of open versus laparoscopic resection have been constrained by length of study and sample size.

Trends in laparoscopic colorectal surgery over time from 2005-2014 using the NSQIP database.

Background: Laparoscopy, originally pioneered by gynecologists, was first adopted by general surgeons in the late 1980s. Since then, laparoscopy has been adopted in the surgical specialties and colorectal surgery for treatment of benign and malignant disease. Formal laparoscopic training became a required component of surgery residency programs as validated by the Fundamentals of Laparoscopic Surgery curriculum; however, some surgeons may be more apprehensive of widespread adoption of minimally invasive techniques.

The Difficult Colorectal Polyp.

Difficult colorectal polyps represent lesions that pose a challenge to traditional endoscopic snare polypectomy. These polyps have historically been managed by surgical resection. Currently, several less invasive options are available to avoid colectomy.

Prehospital emergency trauma care and management.

Prehospital care of the trauma patient is continuing to evolve; however, the principles of airway maintenance, hemorrhage control, and appropriate resuscitative maneuvers remain central to the role of the emergency medical care provider. Recent changes in the regulations for research in emergency settings will allow randomized trials to proceed to test new devices, drugs, and resuscitative strategies in the prehospital environment. The creation of prehospital research networks will provide the appropriate infrastructure to greatly facilitate the development of new protocols and the execution of large-scale randomized trials with the potential to change current prehospital practice.