Cost of open and laparoscopic distal gastrectomy: surgeon perceptions versus the reality of hospital spending.

Background: Rising health care costs have led to increasing focus on cost containment and accountability from health care providers. We sought to explore surgeon awareness of supply costs for open and laparoscopic distal gastrectomy.

Methods: Surveys were sent in 2015 to surgeons at 8 academic hospitals in Toronto who performed distal gastrectomy for gastric adenocarcinoma.

Robotic simultaneous resection of rectal cancer and liver metastases.

Surgical resection is the only potential cure for colorectal cancer with synchronous liver metastases (SLM). Simultaneous resection of colorectal cancer and SLM using robotic-assistance has been rarely reported. We demonstrate that robotic-assisted simultaneous resection of colorectal cancer and SLMs is feasible, safe, and has potential to demonstrate good oncologic outcomes.

Is quality important to our patients? The relationship between surgical outcomes and patient satisfaction.

Background: With greater transparency in health system reporting and increased reliance on patient-centred outcomes, patient satisfaction has become a priority in delivering quality care. We sought to explore the relationship between patient satisfaction and short-term outcomes in patients undergoing general surgical procedures.

Methods: Satisfaction surveys were distributed to patients following discharge from the general surgery service at an academic hospital between June 2012 and March 2015.

Postoperative day one neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes in bariatric surgery patients.

Background: The neutrophil-to-lymphocyte ratio (NLR) is a marker that reflects systemic inflammation and organ dysfunction. Its use as a prognostic marker to predict complications following surgery has been recently described in the literature.

Objectives: The objective of our study was to evaluate the use of postoperative day one (POD1) NLR as a predictor of 30-day outcomes in patients undergoing bariatric surgery.

Preoperative repeat endoscopy for colorectal cancer: What is its role and when is it necessary?

Many surgeons consider repeat endoscopy to be the standard of care for colorectal cancer; however, its utility in the preoperative setting is not well understood, especially given the lack of standardized guidelines on appropriate tumour localization and colonoscopic reporting. This often results in patients undergoing an unnecessary medical procedure during their preoperative evaluation. We discuss some of the issues surrounding the practice of preoperative repeat endoscopy as well as patient perspectives on the procedure.

Comparison of robotic and laparoscopic colorectal resections with respect to 30-day perioperative morbidity.

Background: Robotic surgery has emerged as a minimally invasive alternative to traditional laparoscopy. Robotic surgery addresses many of the technical and ergonomic limitations of laparoscopic surgery, but the literature regarding clinical outcomes in colorectal surgery is limited. We sought to compare robotic and laparoscopic colorectal resections with respect to 30-day perioperative outcomes.

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery.

Background: Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews.

Discrepancy between gastroenterologists' and general surgeons' perspectives on repeat endoscopy in colorectal cancer.

Background: A myriad of localization options are available to endoscopists for colorectal cancer (CRC); however, little is known about the use of such techniques and their relation to repeat endoscopy before CRC surgery. We examined the localization practices of gastroenterologists and compared their perceptions toward repeat endoscopy to those of general surgeons.

Methods: We distributed a survey to practising gastroenterologists through a provincial repository.

Knowledge and Perception of Bariatric Surgery Among Primary Care Physicians: a Survey of Family Doctors in Ontario.

Purpose: The primary objective of this study was to identify Ontario family physicians' knowledge and perceptions of bariatric surgery.

Methods: The study population included all physicians practicing family medicine in Ontario who were listed in the Canadian Medical Directory. A self-administered questionnaire consisting of 28 questions was developed and validated using a focus group of seven primary care physicians.

Perception and Awareness of Bariatric Surgery in Canada: a National Survey of General Surgeons.

Background: The objective of this study was to assess Canadian general surgeons' knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.

Methods: A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012.

Patient and operational factors affecting wait times in a bariatric surgery program in Toronto: a retrospective cohort study.

Background: Increasing rates of obesity have led to growing demand for bariatric surgery. This has implications for wait times, particularly in publicly funded programs. This study examined the impact of patient and operational factors on wait times in a multidisciplinary bariatric surgery program.

Comparison of clinical and economic outcomes between robotic, laparoscopic, and open rectal cancer surgery: early experience at a tertiary care center.

Background: Robotic surgery has gained popularity in surgical oncology. Rectal cancer surgery, known to be technically challenging, may benefit from robotics in achieving better mesorectal dissection and may contribute to improved perioperative outcomes. The objective of this study was to compare early experience in robotic surgery to conventional approaches with regard to clinicopathologic and economic parameters.

Understanding Quality Issues in Your Surgical Department: Comparing the ACS NSQIP With Traditional Morbidity and Mortality Conferences in a Canadian Academic Hospital.

Introduction: Review of surgical complications in traditional morbidity and mortality (M&M) rounds remains an important mechanism to identify and discuss quality-of-care issues. This process relies on case selection by providers; therefore, complications identified for review may differ from those captured in comprehensive quality programs such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Additionally, although the ACS NSQIP captures robust data on complications in surgical wards, without strategies to disseminate this information to staff and improve practice, minimal change may result.

Preoperative Neutrophil-to-Lymphocyte Ratio is a Better Prognostic Serum Biomarker than Platelet-to-Lymphocyte Ratio in Patients Undergoing Resection for Nonmetastatic Colorectal Cancer.

Introduction: Current risk stratification tools for patients with colorectal cancer (CRC) rely on final surgical pathology but may be improved with the addition of novel serum biomarkers. The objective of this study was to evaluate the utility of preoperative NLR and PLR in predicting long-term oncologic outcomes in patients with operable CRC.

Methods: All patients who underwent curative resection for adenocarcinoma at a large tertiary academic hospital were identified.

The accuracy of three predictive models in the evaluation of recurrence rates for gastrointestinal stromal tumors.

Background: Treatment decisions for gastrointestinal stromal tumors (GIST) are frequently guided by tumor characteristics. An accurate prediction of recurrence is important to determine the benefit from targeted therapy. Our goal was to compare the concordance of three validated risk stratification schemes with observed outcomes in patients undergoing resection for GISTs.

Predictive Ability of Blood Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Gastrointestinal Stromal Tumors.

Background: Recent findings have shown that the neutrophil-to-lymphocyte ratio (NLR) is prognostic for gastrointestinal stromal tumors (GIST). The platelet-to-lymphocyte ratio (PLR) can predict outcome for several other disease sites. This study evaluates the prognostic utility of NLR and PLR for patients with GIST.