Mixed Adeno-Neuroendocrine Neoplasms: Two Cases, One Institution.

Epithelial tumors with neuroendocrine and nonendocrine components constitute the rare yet aggressive entity of neoplasms of the gastro-entero-pancreatic tract. These tumors were first named "mixed adeno-neuroendocrine carcinomas" (MANECs) by the World Health Organization in 2010 and in 2017 renamed "mixed neuroendocrine non-neuroendocrine neoplasms" (MiNENs). Combined adenocarcinoma and neuroendocrine carcinoma neoplasms are a rare occurrence within the gastrointestinal tract.

Spontaneous Enterocutaneous Fistula.

Spontaneous scrotal enterocutaneous fistulas (ECFs) are rare and more common in countries with poor access to medical care. Our patients represent the first two reported adult cases of scrotal ECFs in the United States. Both patients were 83-year-old males who presented from assisted living facilities with past medical histories of prostate cancer.

Colorectal Cancer Screening in the Elderly: Is Age Just a Number?

Introduction: Colorectal cancer screening improved outcomes for patients diagnosed between the age of 45-75. Present life expectancy is beyond this limit, yet there are no guidelines for these ages. We aim to identify outcomes after screening and intervention in patients ≥75 years and correlate with frailty.

One Size Does Not Fit All: Venous Thromboembolism Prophylaxis in Colorectal Cancer.

Background And Objectives: Venous thromboembolisms (VTEs) in patients who have undergone a colorectal cancer operation increases morbidity and mortality, lengthens recovery time, and are costly. The current common standard is a 28-day prophylactic regimen of 40 mg enoxaparin daily. This study aims to examine the variability in prophylaxis discharge prescriptions at one institution, report 30-day postoperative incidence of venous thromboembolisms and bleeding, and to offer a new protocol for VTE prophylaxis in postoperative patients.

Comprehensive enhanced recovery pathway significantly reduces postoperative length of stay and opioid usage in elective laparoscopic colectomy.

Background: A comprehensive enhanced recovery pathway (ERP) was implemented in patients undergoing laparoscopic colectomy in an attempt to reduce postoperative opioid consumption. We hypothesized that improved local analgesia and increased use of non-opioid pain medication, combined with earlier feeding and ambulation, would allow for earlier return of bowel function and shorter postoperative length of stay (LOS).

Methods: We retrospectively reviewed 89 patients who underwent elective partial laparoscopic colectomy with our ERP fully integrated compared to a historical control group of 162 patients.

Colorectal cancer following negative colonoscopy: is 5-year screening the correct interval to recommend?

Background: Despite the high sensitivity of screening colonoscopy, polyps and cancers can still go undetected. With the polyp-to-cancer transformation cycle averaging 7-10 years, present guidelines recommend repeat colonoscopy within 10 years after negative screening. However, not all colorectal malignancies follow this decade-long progression.

Laparoscopic repair of colonic anastomotic leak in an elderly patient.

Background: Laparoscopy to repair iatrogenic colonoscopic perforation of the colon has proven to be a safe, effective, and reproducible means to treat these potentially devastating emergencies. The use of the laparoscope provides exceptional diagnostic yield, and under the hand of a trained surgeon, produces excellent therapeutic results while minimizing recovery time for the patient.

Methods: We report the case of an 86-year-old man who underwent emergent laparoscopic repair of a postoperative anastomotic leak following sigmoid colectomy.

In-hospital and 6-month mortality rates after open elective vs open emergent colectomy in patients older than 80 years.

Background: There are few reports of long-term outcomes in elderly patients after open colectomy.

Objective: This study aimed to determine the in-hospital and 6-month outcomes and identify the variables associated with mortality after colectomy in patients ≥ 80 years of age.

Design: The charts of patients ≥ 80 years of age, who underwent open colectomy, were analyzed.

Laparoscopic colectomy in octogenarians and nonagenarians: a preferable option to open surgery?

Objectives: To determine if laparoscopic colectomy is safer and more effective than open colectomy in patients older than 80 years of age.

Methods: An operating room database of all colectomies performed on patients >or=80 years, from January 2002 to September 2007, was analyzed retrospectively. Data reviewed included type of operation, type of resection, length of procedure, length of stay (LOS), estimated blood loss, American Society of Anesthesiologists (ASA) grade, diagnosis, complications, mortality rates, and discharge destination, with p-values <0.

Increasing the number of attacks increases the conversion rate in laparoscopic diverticulitis surgery.

Background: This study aimed to determine whether the number of diverticulitis or complicated diverticulitis episodes affects the conversion rate or postoperative complication rate in elective laparoscopic sigmoid colectomy.

Methods: In this study, 216 charts were reviewed for baseline characteristics, diverticulitis history, and intra- and postoperative complications. Analysis was performed with the Student's t-test, the chi-square test, and Fisher's exact tests.

Outcomes in patients treated by laparoscopic resection of rectal carcinoma after neoadjuvant therapy for rectal cancer.

Objective: We analyzed the effect of neoadjuvant chemo radiation on feasibility and outcomes in rectal cancer patients undergoing laparoscopic resection of the rectum.

Methods: This was a retrospective analysis of a consecutive series of laparoscopic resections for rectal cancer from 1998 to 2004 (N=60).

Results: Eight patients received preoperative chemoradiation therapy (neoadjuvant group) for rectal cancer and 52 patients did not (primary surgical group).

The influence of prior abdominal operations on conversion and complication rates in laparoscopic colorectal surgery.

Background And Objectives: A history of a prior abdominal operation is common among patients presenting for laparoscopic colorectal surgery, and its impact on conversion and complication rates has been insufficiently studied. This study compares the conversion rates of patients with and without a prior abdominal operation (PAO).

Methods: We analyzed 1000 consecutive laparoscopic colorectal resection cases.

Has the 80-hour work week had an impact on voluntary attrition in general surgery residency programs?

Background: This article attempts to assess the effect of the duty-hour limitations implemented in 2003 on voluntary withdrawal of general surgery residents.

Study Design: A questionnaire asked the program directors how many categorical general surgery residents left voluntarily in 2003 to 2004, their training levels, why they left, and where they went. Results were compared with an identical study of 2000 to 2001 and analyzed statistically using chi-square analysis.

The impact of re-engineering a multi-institutional residency program on resident perceptions of the individual institutions.

Purpose: We report on the development of a survey tool used to assess resident perceptions of support and educational quality among multiple institutions in an integrated surgical residency, as well as its use in measuring the impact of re-engineering on that program.

Methods: The University of Connecticut Integrated General Surgical Residency (UCIGSR) is a multisite program that was placed on probation by the Residency Review Committee in Surgery (RRC) in November 1998. This led to a re-evaluation and a re-engineering of the program.

Comparing results of residents and attending surgeons to determine whether laparoscopic colectomy is safe.

Background: This study was undertaken to compare the technical success and outcomes of laparoscopic colectomy performed by resident surgeons (RS) and attending surgeons (AS).

Methods: A review of 451 consecutive laparoscopic colectomies performed by 2 surgeons either with or without a general surgery resident. Data reviewed included demographics, diagnoses, operative data, and outcomes.