Core Subject Update

Objectives : At the conclusion of this session, participants should be able to: a) identify etiologic factors that contribute to rectal prolapse, intussussception and solitary rectal ulcer syndrome; understand abdominal and perineal approaches to the surgical treatment of these conditions; b) discuss the epidemiology and theories of pathophysiology of ulcerative colitis; clinical features and diagnosis of ulcerative colitis; the medical management of ulcerative colitis; and the options for surgical treatment of ulcerative colitis, including the use of laparoscopy; c) understand the evaluation and treatment of retrorectal tumors and the evaluation and treatment of anal tumors; d) identify the epidemiological and underlying causative or contributing factors to the development of volvulus; describe the diagnostic evaluation, endoscopic and surgical approaches to management, and outcomes for both cecal and sigmoid volvulus; describe the evaluation and management associated with colon and rectal trauma and describe the differences in surgical outcomes associated with primary repair, resection and diversion for colon and rectal trauma; e) describe the clinical features of a patient with colorectal cancer which are suggestive of an inherited cancer syndrome and discuss the clinical evaluation and management of a patient with a suspected inherited cancer syndrome.

Hemorrhoids, Fissure
Nancy Morin, MD
Prolapse Intussusception SRUS
Madhulika Varma, MD
Ulcerative Colitis
David Maron, MD
Trauma, Volvulus
Scott R. Steele, MD
Hereditary Colon Cancer / Genetic Testing
C. Neal Ellis, MD
Benign and Malignant Anal Tumors Retrorectal Tumors
Kelli Bullard Dunn, MD

Improving the Quality of Care through the Use of Population Data. A Comparison of Four Countries

Objectives : At the conclusion of this session, participants should be able to: understand how population databases are created, maintained, and utilized throughout the world to monitor treatment and quality of surgical care.

How We Do it in Norway
Arne Wibe, MD, PhD
How We Do it in the UK
Jason Smith, MB BS MD DMI (Gen Surg)
How We Do it in Australia
Michael J. Solomon, MSc, MBBS, BAO
How We Do it in Canada
Andrew Smith, MD, MSc

Best Evidence and Practical Advice in Managing Post Operative Ileus- 2008 and Beyond

Objectives : At the conclusion of this session, participants should be able to: a) recognize the impact of POI on patient health; b) implement early monitoring for POI; c) integrate best available evidence in treating POI in their patients; d) effectively manage pain while minimizing the potential for POI; and e) shorten length of stay for patients with POI and reduce health care costs burden on patients.

Post Operative Ileus—An Overview
Steven R. Hunt, MD
Evaluating the Problem—Case-based Approach
Rocco Ricciardi, MD
Latest Developments and Best Available Evidence in the Treatment and Management of POI
Najjia N. Mahmoud, MD

Laparoscopic Techniques: Nuts and Bolts and Beyond

Objectives : At the conclusion of this program, participants should be able to understand the different Laparoscopic surgical approaches that exist for the common colorectal resections; thus, improving surgical skills.

Middle Colic Dissection and Division: Straight Laparoscopic, Inferior Approach
John Marks, MD
Middle Colic Dissection and Division: Straight Laparoscopic, Superior Approach
Conor Delaney, MD, MCh, PhD
Middle Colic Dissection and Division: Hand-assisted Approach
David Rivadeneira, MD
Splenic Flexure Takedown for Transverse Colectomy: Starting at IMV, Medial to Lateral
Daniel Feingold, MD
Pelvic Exposure: Large Uterus: Retraction via Transabdominal Fixation Sutures
Alex Ky, MD
Laparoscopic Uteropexy
Nadav Dujovny, MD
Pelvic Exposure: Large Uterus: Transvaginal Intrauterine Manipulators
Toyooki Sonoda, MD
Retraction and Exposure of Pelvic Dissection Planes Laparoscopically (2 person technique)
Richard Whelan, MD
LAR: Deep Pelvic Rectal Mobilization: Straight Laparoscopic Methods
John R. T. Monson, MD
LAR: Making Window Between Rectum and Mesorectum Intracorporeally During Anterior Resection in Preparation for Distal Bowel and Mesenteric Division: Hand and Straight Lap Methods
Morris Franklin, MD
LAR: Intracorporeal Division of Distal Rectum
John Marks, MD
LAR: Different Staplers for Intracorporeal Division of the Rectum Distally
Sang Lee, MD
Hand-assisted Division of Mesorectum and Rectum via Open Methods via the Hand Port Incision
Sang Lee, MD
Adhesions Talk
Peter Marcello, MD
Surgery in the Obese: Right Colectomy, Medial to Lateral, Straight Lap Approach
Anthony Senagore, MD, MS, MBA
Surgery in the Obese: Right Colectomy, Inferior and Lateral to Medial Approaches
Jonathan Efron, MD
Surgery in the Obese: Omental Peel
Matthew Mutch, MD
Intracorporeal Ileocolic Anastomosis
Mark Whiteford, MD
Surgery in the Obese: Sigmoid / Descending Colon Mobilization, Straight Laparoscopic

Surgery in the Obese: Sigmoid / Descending Colon Mobilization, Hand-assisted Approach
Jeffrey Cohen, MD
Sigmoid Colectomy for Diverticulitis: Midmesenteric Division, Sparing of Main Sigmoidal Vessels and Nerves
Sharon Stein, MD

International View on Rectal Cancer

Objectives : At the conclusion of this session, participants should be able to understand the workup and treatment of rectal cancer and differences in available treatment strategies.

Preoperative Staging: North American Approach
Juan Nogueras, MD
Preoperative Staging: European Approach
Paul Finan, MD
Optimal Treatment of Stages II and III Rectal Cancer: North American Approach
David Rothenberger, MD
Optimal Treatment of Stages II and III Rectal Cancer: European Approach
Brendan Moran, MD

American Cancer Society Presentation

Objectives : The American Cancer Society (ACS) is committed to fighting cancer through balanced programs of research, advocacy, education, and service to patients, caregivers, and survivors.  Dr. Brawley will discuss current initiatives in each of these areas and educate ASCRS members on the resources available for physicians and patients from the American Cancer Society.

24/7 - How the American Cancer Society is Working for You and Your Patients
Otis Webb Brawley, MD

Louis A. Buie, MD Lectureship

Do We Know What We Know?
Robert D. Madoff, MD

Neoplasia I

Objectives : At the conclusion of this session, participants should be able to: (1) a)analyze the outcomes obtained in a centre of large volume laparoscopic colorectal surgery and b)select suitable cases for laparoscopic proctectomy for rectal cancer; (2) understand the differences in long-term morbidity and oncological outcomes between laparoscopic and open anterior resection for upper rectal cancer; (3) a) recognize that robotic-assisted low anteior resection was performed safely and effectively, using the da Vinci® Surgical System and b) recognize that use of the da Vinci® Surgical System resulted in acceptable perioperative outcomes comparing with laparoscopic low anteior resection; (4) understand that laparoscopic surgery for rectal cancer has favorable outcome with low recurrence rate, negative margins and overall survival rate comparable to open surgery; (5) a0 appreciate the high rate of margin involvement for low rectal tumours treated by abdomino-perineal excision and b) understand that low rectal tumours treated with abdomino-perineal excision tend to be more locally advanced, despite an increased use of neoadjuvant therapies;(6) a) review short-term operative outcomes and long-term oncologic outcomes of extended lymph node dissection for the treatment of rectal cancer and b) understand the prognosis of the patients according to the location of metastatic lymph nodes and develop a plan to treat those patients with metastatic lymph nodes in lateral pelvic wall and/or paraaortic area; (7) understand the characteristics of lymph node metastasis in lower rectal cancer; (8) understand the functional outcomes for patients with pre operative radiation for rectal cancer after restorative procedures; (9) understand the risk of disease recurrence associated with transanal excision or radical resection of early rectal cancer; (10) appreciate the potential for the development of aspirin and other NSAIDs as chemopreventive agents; (11) council patients regarding risk of recurrence following transanal endoscopic microsurgery; and (12) critically analyze the decision for observation versus surgery in patients with locally advanced rectal cancer and assess the relative merits of each option.

Long Term Results after 16 years Experience with Laparoscopic Restorative Proctectomy
J. Ellis-Clark, MD, John Lumley, MD, A. Stevenson, Russell Stitz, MD
Long-term Morbidity and Oncological Outcomes of Laparoscopic Anterior Resection for Upper Rectal Cancer: 10-year Results of a Prospective Randomized Trial
S. Hon, J. Lee, K. Leung, W. Leung, J. Li, S. Ng, D. Ng, R. Yiu
Robotic-assisted Low Anterior Resection of Rectal Cancer: Short-term Outcome of Prospective Randomized Trial
S. Baik, H. Chi, C. Cho, H. Hur, N. Kim, A. Lee, W. Lee, S. Sohn
Long Term Outcomes of Patients Undergoing Laparoscopic Surgery for Rectal Cancer
Sang Lee, MD, Jeffrey W. Milsom, MD, O. Oliveira, S. Pandey, Toyooki Sonoda, MD, K. Trencheva
Overall and Disease Free Survival for Stage III Colon Cancer Patients is Independent of the Total Number of Lymph Nodes Retrieved
R. Cima, N. Diehl, E. Dozois, G. Kennedy, David W. Larson, MD, R. Qin, V. Tsikitis, Bruce G. Wolff, MD
Impact of Extended Lymph Node Dissection for Rectal Cancer: Its Safety and Long Term Oncologic Outcomes
S. Baik, C. Cho, H. Hur, N. Kim, J. Kim, K. Lee, B. Min, S. Sohn
Impact of Pelvic Sidewall Dissection in Lower Rectal Cancer
J. Hida, S. Kameoka, T. Kato, H. Kobayashi, H. Mochizuki, T. Mori, T. Morita, M. Ono, Y. Saito, K. Shirouzu, K. Sugihara, M. Ueno, M. Watanabe, M. Yasuno
Lymph Node Harvest after Proctectomy for Invasive Rectal Adenocarcinoma following Neoadjuvant Therapy: Does the Same Standard Apply?
M. Berho, M. Cruz Correa, Juan Nogueras, MD, F. Potenti, B. Safar, D. Sands, H. Wang, E. Weiss, Steven D. Wexner, MD, R. Zhao
Bowel Function is Worse after Restorative Procedure with Preoperative Long Course Radiation
I. Lavery, S. Shedda
Long Term Survival after Surgery for T1 Rectal Cancer
J. Guillem, G. Nash, P. Paty, J. Shia, L. Temple, M. Weiser, W. Wong
UK Audit of Transanal Endoscopic Microsurgery for Rectal Cancer
S. Bach, L. Lane, A. Merrie, N. Mortensen, B. Warren
Observation or Surgery in Patients with Rectal Cancer: What is the Preferred Treatment for Clinical Complete Responders to Neoadjuvant Therapy?
E. Elkin, K. Goodman, J. Guillem, H. Neuman, P. Paty, L. Temple, M. Weiser, W. Wong

Benign I

Objectives : At the conclusion of this session, participants should be able to: (13) appreciate the feasibility of laparoscopic peritoneal lavage as an alternative operative approach to generalised peritonitis due to perforated Diverticulitis; (14) appreciate that the advantages of laparoscopic surgery can be applied to the emergency management of complicated Diverticulitis; (15) understand the indications for laparoscopic resection of diverticulitis and the results which may be acheived in centres with the appropriate level of expertise; (16) a) discuss the longer term results with the bioprosthetic anal fistula plug for the management of anal fistulas and b) describe predictors of failure for the bioprosthetic anal fistula plug; (17) a) understand the failure of some fistula treatments;  b) be aware of the necessities for success of treatments and c) be up-to-date with the latest research attempts in fistula treatments;(18) a) know the success and or failure rate of a bioprosthetic plug in the management of anorectal fistulas and b) know the potential complications associated with the use of a bioprosthetic anal fistula plug; (19) a) define the incidence of chronic anal fistula or recurrent perirectal sepsis following a first time anal sepsis and b) list risk factors leading to chronic anal fistula or recurrent perirectal sepsis following a first time anal sepsis; (20) analyze the difference  in outcome of anal fistula repair by endorectal advancement flap or anal fistula plug;(21) a) assess the role of stapled transanal rectal resection in the treatment of obstructed defaecation and b) be aware of complications and limitations of this technique; (22)comprehend the safety and efficacy outcomes associated with Stapled Transanal Rectal Resection (STARR) for obstructed defaecation syndrome; (23) understand that the new procedure of STARR is safe in colorectal surgeons with an interest in pelvic floor and who have been adequately trained; and (24) understand the clinical outcomes associated with the stapled transanal rectal resection and transvaginal rectocele repair for the management of obstructive defecation syndrome.

Laparoscopic Peritoneal Lavage for Generalized Peritonitis Due to Perforated Diverticulitis - A Feasible Alternative
M. Hurley, D. Kavanagh, E. Myers, G. Sullivan, D.C. Winter
Emergency Laparoscopic Surgery for Complicated Diverticular Disease
A. Dixon, G. Greenslade, S. Phillips
Experience of 500 Consecutive Cases Justifies Laparoscopic Resection of Diverticulitis
D. Clark, O. Jones, J. Lumley, A. Stevenson, R. Stitz
Long Term Results with the Bioprosthetic Anal Fistula Plug
C. Ellis, J. Rostos
100% Pre-Clinical Success with a New Sphincter Conserving Treatment for Anal Fistula
C. Cohn, R. Himpson, R. Phillips, P. Sibbons
Treatment of Fistula-in-ano Using Porcine Small Intestinal Submucosa (Surgisis® AFP™)
H. Abcarian, E. Birnbaum, V. Chaudhry, J. Cintron, J. Fleshman, S. Hunt, M. Mutch, M. Poirier, S. Tenfelde
Who is at Risk for Developing Chronic Anal Fistula or Recurrent Sepsis after Initial Perirectal Abscess?
M. Abbas, P. Haigh, A. Hamadani, A. Liu
Treatment of Transsphincteric Anal Fistulas by Endorectal Advancement Flap or Anal Fistula Plug: A Comparative Study
D. Christoforidis, S. Goldberg, R. Madoff, A. Mellgren, M. Pieh
Stapled Transanal Rectal Resection for Obstructed Defaecation Secondary to Rectocoele and Recto-anal Intussusception: A Cautionary Tale
H. Carter, A. Dixon, L. Titu
STARR for Obstructed Defecation Syndrome: 12 Month Follow-up
D. Jayne, O. Schwander, A. Stuto
STARR - Is it Safe?
A. Clarke, A. Dixon, P. Durdey, D. Gold, M. Lamparelli, K. Nugent, C. Oppong, C. Vickery
Clinical Outcomes of Stapled Transanal Rectal Resection as Compared to Transvaginal Rectocele Repair for the Management of Obstructive Defecation Syndrome
J. Aversa, S. DeJesus, A. Ferrara, J. Gallagher, M. Harris, L. Kosinski, S. Larach, L. Norcross, P. Williamson

Modern Treatment of Diverticulitis

Objectives : At the conclusion of this session, participants should be able to: understand the workup and treatment strategies for patients with diverticulitis.

Optimal Treatment of Diverticulitis in the Young Patient
Steven D. Wexner, MD
Nonoperative Approaches to Diverticulitis
W. Donald Buie, MD
Treatment of Complicated Diverticulitis Including Abscess, Stricture, or Fistula
P. Ronan O'Connell, MD
Early Versus Late Operation for Diverticulitis
Alan Meagher, MD

Norman Nigro Research Lectureship

Antiangiogenesis as Part of a Combined Modality Approach for the Treatment of Cancer
Michael S. O’Reilly, MD

John Goligher Lectureship

Radical Pelvic Exenteration for Advanced and Recurrent Rectal Cancer: Techniques and Outcomes
Michael J. Solomon, MSc, MBBS, BAO

Presidential Address

Cherish the Past, Prepare for the Future
W. Douglas Wong, MD

Neoplasia II

Objectives : At the conclusion of this session, participants should be able to: (25) understand the incidence and risk factors of anal dysplasia in transplant recipients; (26) a) understand the usefullness of anal Hybrid Capture II testing for oncogenic HPV in men who have sex with men and b) understand the predictors of development of anal high-grade dysplasia in men who have sex with men; (27) develop a plan of screening anal dysplasia in high risk population. Understand the hability of anal Pap smear and high resolution anoscopy guided biopsy for detection of anal dysplasia in HIV-infected patients; (28) identify the relative contribution of HIV status to diagnosis and outcomes of anal SCC; (29) recognize the differential expression of selected genes in sessile serrated polyps; (30) a) discuss alterations in gene expression comparing CRCs with LVI compared to those without it and b) discuss the cellular pathways these genes contribute to; (31) a) analyse the genetic profile of sporadic colorectal cancers using SNP and methylation arrays and b) understand the molecular basis for the poor prognosis of microsatellite and chromosome stable colorectal cancers; (32) a) recognize that colon and rectal cancers arise via different mechanisms and b) understand the clinical implications of molecular differences between colon and rectal cancer development; (33) conclude that the total number of lymph nodes retrieved on a surgical specimen, from patients with stage III colon cancer, has no significant correlation with the patients\' oncologic outcomes (i.e overall, cause specific and disease free survival); and (34) a) understand the neoadjuvant therapy significantly reduces the lymph node harvest; b) understand the patients with good primary tumor response have less lynph nodes and c) interpret the lymph node harvest based on the primary tumor response; (35) rationalize the use of whole body FDG PETCT in the clinical management of squamous cell carcinoma of the anus; (36) develop a surveillance strategy for patients with anal canal cancer.

Anal Dysplasia in Renal Allograft Recipients
K. Anderson, L. Downs, J. Hansberger, R. Madoff, J. Ogilvie, I. Park
HPV Typing by Hybrid Capture II and Other Predictors of Anal High-grade Dysplasia in Men Who have Sex with Men
C. Enyinna, S. Goldstone
Screening Anal Dysplasia in HIV-Infected Patients: Is There an Agreement between Anal Pap Smear and High Resolution Anoscopy Guided Biopsy?
S. Araujo, I. Cecconello, R. Genevcius, E. Gutierrez, D. Kiss, C. Marques, C. Nahas, S. Nahas, M. Nakai, E. Silva Filho
HIV and Anal Canal Cancer Outcomes: A Single Institution's Experience
A. Halverson, M. Hogg, D. Popowich
Gene Expression in Sessile Serrated Adenoma
M. Caruso, G. Goodall, J. Moore, A. Ruszkiewicz, M. Thomas
Lymphovascular Invasion in Colorectal Cancer is Associated with Alterations in Cell Adhesion and Cytoskeletal Pathways
M. Alvarado, S. Eschrich, E. Jensen, J. Lewis, Q. Ly, J. McLoughlin, R. Nair, D. Shibata, E. Siegel, T. Yeatman
Copy Number and Methylation Analysis of Microsatellite and Chromosome Stable Colorectal Cancers Associated with Poor Outcome
A. Banerjea, S. Dorudi, L. Hammond, N. Sengupta, A. Silver, N. Suraweera
If Colon and Rectal Cancers Wear Different Genes, Why are they Thrown Together in the Wash?
G. Casey, J. Church, K. DeJulius, M. Kalady, E. Manilich, J. Sanchez
Patients with Low Rectal Cancer Treated by Abdomino-Perineal Excision Worse Tumors and Higher Involved Margin Rates Compared with Those Treated by Anterior Resection
G. Brown, I. Daniels, R. Heald, B. Moran, P. Qurike, O. Shihab
Influence of Aspirin and NSAIDs on Colorectal Cancer Risk and Survival
R. Barnetson, H. Campbell, R. Cetnarskyj, F. Din, M. Dunlop, S. Farrington, M. Porteous, L. Stark, A. Tenesa, E. Theodoratou
The Role of 18- FDG PETCT in the Clinical Management of Anal Squamous Cell Carcinoma
G. Blackman, P. Boulos, P. Ell, A. Engledow, A. Groves, J. Peck
Is Surveillance for Recurrent Anal Cancer Beneficial after Complete Tumor Regression?
B. Davis, D. O'Brien, J. Rafferty

Inflammatory Bowel Disease I

Objectives : At the conclusion of this session, participants should be able to: (37) comprehend the affect of anatomotic type on outcomes for patients developing anastomotic separation after ileoanal pouch anastomoses; (38) understand potential complications and long terms outcomes when using anti-adhesive agents during restorative proctocolectomy; (39) a) recognize factors that result in use of protective diverting ileostomies for IPAA and b) identify factors associated with anastomotic leaks in IPAA; (40) comprehend repeat IPAA; (41) understand the impact of anastomotic leak on functional and quality of life outcomes following restorative proctocolectomy; (42) state whether minimally invasive 3-stage ileal pouch-anal anastomosis can be safely performed in patients with severe or fulminant ulcerative colitis; (43) assess the safety of laparoscopic total colectomy employed in acute severe colitis; (44) a) analyze the impact of laparoscopic vs open total abdominal colectomy for severe colitis and b) analyze the impact of the surgical approach for severe colitis on the subsequent completion restorative proctectomy; (45) understand the benefit of laparoscopic surgery for ulcerative colitis patients; (46) a) analyze the differences of laparoscopic restorative proctocolectomy and total abdominal (47) assess the postoperative results of laparoscopic ileocecal resection in complicated (i.e. fistula, abcess or recurrence) vs uncomplicated Crohn\'s disease; and (48) a) determine the system related factors that play a role in the surgical approach to ileocolonic Crohn\'s disease and b) compare the short-term outcomes associated with laparoscopic versus open surgical approach for Crohn\'s disease.

Outcomes for Patients Developing Anastomotic Leak after Ileoanal Pouch Anastomosis: Does it Matter Whether They had a Handsewn or a Stapled Anastomosis?
V. Fazio, P. Kiran, I. Lavery, L. Lian, F. Remzi
The Effect of Seprafilm on Septic Complications and Bowel Obstruction following Primary Restorative Proctocolectomy
J. Cornish, V. Fazio, R. Kiran, H. Kirat, F. Remzi, E. Tan, P. Tekkis
Gender is a Risk Factor for Anastomotic Leak in Ileal Pouches
M. Cripps, J. Garcia-Aguilar, M. Varma
Repeat Pouch Surgery Safely Salvages Failed Ileal Pouch Anal Anastomosis
V. Fazio, R. Kiran, H. Kirat, I. Lavery, F. Remzi, J. Wu
Septic Complications after Restorative Proctocolectomy Do Not Impair Functional Outcome: Long Term Follow-up from a Specialty Center
J. Bauer, D. Bub, D. Chessin, S. Gorfine, A. Royston, H. Salinas, D. Wong
Minimally Invasive Subtotal Colectomy and Ileal Pouch-anal Anastomosis for Fulminant Ulcerative Colitis: Feasibility and Short-term Outcomes
R. Cima, E. Dozois, S. Holubar, D. Larson, J. Pattanaarun, J. Pemberton
Laparoscopic Total Colectomy and Ileostomy for Acute Severe Colitis
D. Clark
Laparoscopic vs. Open Total Abdominal Colectomy for Severe Colitis: Impact on Recovery and Subsequent Completion Restorative Proctectomy
E. Birnbaum, T. Chung, D. Dietz, J. Fleshman, S. Hunt, J. Lowney, M. Mutch, T. Read, Y. Yan
Laparoscopic Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis. A Comparative Prospective Study on Long-term Functional Results
A. Fichera, R. Hurst, F. Michelassi, M. Rubin, M. Silvestri
Safety and Feasibility of Laparoscopic Surgery as an Initial Treatment for Ulcerative Colitis
S. Lee, Jeffrey W. Milsom, MD, T. Sonoda, K. Trencheva, S. Yun
Impact of Complicated Crohn's Disease on the Outcome of Laparoscopic Ileocecal Resection: a Comparative Clinical Study in 124 Patients
A. Alves, Y. Bouhnik, F. Bretagnol, P. Goyer, Y. Panis
National Trends and Outcomes for the Surgical Therapy of Ileocolonic Crohn's Disease: A Population-based Analysis of Laparoscopic vs. Open Approaches
L. Brounts, R. Lehmann, K. Lesperance, M. Martin, S. Steele

Tackling Crohn’s Disease

Objectives : At the conclusion of this session, participants should be able to understand the etiology, workup and treatment strategies available for patients with Crohn\'s disease.

Etiology and Diagnosis of Crohn's Disease
Walter Koltun, MD
Treatment of Perianal Crohn's Disease
Nigel Scott, MD
Ileal Pouch Anal Anastomosis for Crohn's Disease
Scott Strong, MD
Treatment of Complex Crohn’s Disease, Including Phlegmon, Fistula, and Perforation
Ian Jones, MD

Ernestine Hambrick Lectureship

Disparities in Colorectal Cancer Care: A Quality of Care Conundrum
Selwyn O. Rogers, Jr., MD, MPH

Harry E. Bacon Lectureship

Technology and Technique – The Tortuous Path to Competence
Russell Stitz, MD

Parviz Kamangar Humanities in Surgery Lectureship

Can Surgery Save More Lives?
Atul Gawande, MD

Neoplasia III

Objectives : At the conclusion of this session, participants should be able to: (49) understand the impact of anastomotic leak and intra-abdominal abscess on colorectal cancer recurrence and long-term survival; (50) understand that pseudomyxoma peritonei usually originates from a perforated tumour of the appendix; (51) a) appreciate that an association exists between duodenal polyposis and pouch polyposis, a finding that has not been demonstrated previously and b) focus future research on aetiological factors beyond a defective APC gene that are associated with the development of duodenal and pouch polyposis; (52) a) understand the incidence of colorectal metastases to the lungs without liver involvement is not as rare as initially thought and b) manage and ensure that the follow up surveillance of colorectal cancer patients is not compromised; (53) feasiblity and possible advantages of \'the liver first\' approach in patients with locally advanced rectal cancer with synchronous liver metastases; (54) explain how the results show that a simple follow up policy can provide as high a detection rate of asymptomatic recurrence when a secondary curative resection prolongs survival compared to more intensive follow up policies; (55) understand that local recurrence of rectal cancer is still a problem in local excision, nonrestorative resections and tumours within 6cm of the anal verge. Optimal staging, neoadjuvant therapy and surgery might improve outcomes in this high risk group; (56) a) assess current epidemiologic trends of colorectal neoplasia in the United States with respect to age, year, and type of resection and b) consider offering screening colonoscopy to patients before age 50; (57) understand the limitations of endoscopic biopsy for the diagnosis of colorectal cancer and appreciate the role of brush cytology to improve the accuracy of endoscopic biopsy; (58) appreciate that DNA quantification of rectally harvested coloncytes may hold promise as a new screening tool for colorectal cancer; (59) understand the reliability and use of Minimal Preparation CT colonography for the detection of colonic carcinoma; (60) examine the role of screening wih facal occult blood as a tool.

Anastomotic Leak and Intra-abdominal Abscess after Resection for Colorectal Cancer: Do These Complications Really Influence Long-term Survival and Recurrence?
J. Eberhardt, R. Kiran, I. Lavery
Five-year Overall and Disease-free Survival in 170 Patients with Pseudomyxoma Peritonei from a Perforated Appendiceal Tumor following Complete Tumor Removal and Intraperitoneal Chemotherapy
T. Cecil, A. Mirnezami, B. Moran, R. Sexton, H. Yano
Development of Pouch Polyposis after Ileal Pouch Anal Anstomosis for Familial Adenomatous Polyposis is Associated with Severity of Duodenal Polyposis
S. Clark, R. Man, K. Neale, P. Tekkis, A. von Roon, O. Will
How Uncommon are Isolated Lung Metastases in Colorectal Cancer? A Review of 754 Patients over 4 1/2 Years
G. Lopes, R. Sim, K. Tan
The "Liver First Approach" for Patients with Locally Advanced Rectal Cancer with Synchronous Liver Metastases
J. de Wilt, A. Eggermont, J. Nuytens, A. Planting, A. van der Pool, C. Verhoef
The Value of CEA and CT in Early Diagnosis of Colorectal Cancer Recurrence
P. Boulos, D. Gore, D. Raptis
Local Recurrence following Rectal Cancer Surgery in a Specialist Unit: Incidence, Site and Outcome in a Consecutive Series of 459 Cases
T. Cecil, A. Mirnezami, B. Moran, A. Myers, R. Sexton
An Argument for Screening Colonoscopy before Age 50: Current Epidemiologic Trends in the United States
K. Alavi, E. Cooley, J. Maykel, J. McPhee, J. Simons, W. Sweeney, J. Tseng
Endoscopic Brush Cytology for the Diagnosis of Colorectal Cancer
R. Brouwer, J. Gunn, J. Hartley, A. MacDonald, R. Matthews, J. Monson
Detection of Colorectal Cancer by DNA Quantification of Exfoliated Colonocytes
A. Bajwa, P. Boulos, R. Navaratnam, A. Obichere, O. Ogunbiyi, D. Raptis
Minimal Preparation CT Colonography: A Reliable Test for Detection of Colonic Carcinoma in Elderly Patients
H. Adams, S. Akhtar, M. Davies, G. Williams
Impact of the National Bowel Cancer Screening Program Utilizing Fecal Occult Blood Test Screening on the Diagnosis of Colorectal Cancer
F. Chen, P. Gibbs, I. Hastie, I. Hayes, A. Hunter, I. Jones, S. McLaughlin, N. Reiger, S. Shedda, I. Skinner, M. Steele

Benign II

Objectives : At the conclusion of this session, participants should be able to: (61) describe the predictors of a poor outcome after colectomy for fulminant clostridium difficile infections; (62) identify parameters associated with poor outcome in patients with C. difficile colitis; (63) a) describe a technique to repair parastomal hernias using bioprosthetics and b) discuss the safety and efficicy of a bioprosthetic for the management of parastomal hernias; (64) understand what extent reoperations after stapler hemorrhoidpexy are necessary; (65) a) appreciate the effectiveness of biofeedback in pelvic floor dysfunction type constipation and b) appreciate the need for quality research in pelvic floor dysfunction; (66) differentiate local perianal repair vs. pouch reconstruction with Ileoana pouch salvage surgery. Secondly, patients with crohn\'s disease suited for pouch excision; (67) understand the difference in views between pregnant women and clinicians with regards to potential complications associated with vaginal delivery and elective caesarean section; (68) appreciate the advantages of minimally invasive surgery and an anterior rectal mobilization for both external and internal rectal prolapse; (69) a) gain an understanding of the community prevalence of fecal incontinence (FI) in the Western world, which is often underestimated; b) develop an understanding of symptom severity, quality of life, risk factors and medical care seeking behavior for individuals with FI in the community and c) develop an appreciation for ethnic differences in rates of FI and the methodology required to explore such a difference; (70) a) understand the indications for Sacral nerve stimulation for fecal incontinence and b) appreciate the likely results of this technique in the medium term; (71) sacral nerve stimulation (SNS) is a valid option to treat patients with fecal incontinence (FI). Implant procedure is safe and non-invasive, and clinical effectiveness is maintained at medium-term period. However, long-term results are still unknown; (72) develop a strategy for neurostimulator programming in patients undergoing sacral nerve stimulation for fecal incontinence.

Correlates of Post-operative Mortality among Patients Undergoing an Emergency Colectomy for Fulminant Clostridium Difficile Infection
M. Boutros, S. Dial, A. Labbe, E. Marcotte, C. Patino, J. Pepin, C. Vasilevsky, T. Vo
C. Difficile Colitis - Predictors of Fatal Outcome
H. Dudukgian, D. Etzioni, C. Gonzalez-Ruiz, A. Kaiser, E. Sie
Results with the Use of a Bioprosthetics for the Management of Parastomal for the Management of Parastomal
C. Ellis, M. Knight
Reoperations after Stapled Hemorrhoidopexy
J. Bock, A. Eberstein, J. Jongen, V. Kahlke, H. Peleikis
Effectiveness of Biofeedback in Adults with Pelvic Floor Dysfunction
C. Koh, M. Solomon, C. Young, J. Young
Reoperative IPAA Surgery - Factors Predictive of Success
A. Belizon, J. Nogueras, D. Sands, S. Shawki, E. Weiss, S. Wexner
Vaginal Delivery Compared with Elective Caesarean Section: The Views of Pregnant Women and Clinicians
C. Benness, J. Ludlow, H. Phipps, M. Solomon, C. Turner, J. Young
Laparoscopic Anterior Rectopexy for External and Internal Rectal Prolapse
R. Collinson, C. Cunningham, I. Lindsey
The Community Prevalence of Fecal Incontinence: A New Zealand Cross-Sectional Study
I. Bissett, A. Macmillan, A. Merrie, P. Reid, A. Sharma
Sacral Nerve Neuromodulation is Effective Treatment for Fecal Incontinence in the Presence of a Sphincter Defect or Previous Sphincter Repair
R. Brouwer, G. Duthie
Sacral Nerve Stimulation in Fecal Incontinence: Results 5 Years after Implant
D. Altomare, E, Ganio, P. Lolli, C. Ratto, R. Villani
Improving the Efficacy of Sacral Nerve Stimulation for Fecal Incontinence by Alteration of Stimulation Parameters
T. Dudding, A. Gibbs, M. Kamm, C. Vaizey

Traveling Fellows and Impact Paper

The Robert W. Beart, MD 2007 Impact Paper of the Year Award: Microarray Gene Expression Profiling for Predicting Complete Response to Preoperative Chemoradiotherapy in Patients with Advanced Rectal Cancer
Sun-A Ahn, Hee Jin Chang, Hyo Seong Choi, Sang-Geun Jang, Seung-Yong Jeong, Kyung Hae Jung, Hio Chung Kang, Il-Jin Kim, Dae Yong Kim, Duck-Woo Kim, Seok-Byung Lim, Hye-Won Park, Jae-Hyun Park, Jae-Gahb Park, Dae Kyung Sohn
ASCRS International Scholarship Winner: Management of Distal Rectal Cancer Following Neoadjuvant CRT – The Rationale of the "Watch and Wait Strategy" after Complete Clinical Response
Rodrigo Oliva Perez, MD
ASCRS International Scholarship Winner: Sacrectomy and Longterm Outcome
Chucheep Sahakitrungruang, MD
British Traveling Fellow: Molecular Stool Analysis: The Future of Screening for Colorectal Cancer?
R. Justin Davies, MA, MChir, EBSQ
Mark Killingback Prize Winner: Patient Recall of Informed Consent Information Prior to Colonoscopy
Iain Thomson, MD

Understanding Quality Measures and How They Affect Your Practice

Objectives : At the conclusion of this session, participants should be able to: understand how outcome measures are developed, implemented, and affect your clinical practice.

How to Interpret Studies and Develop Quality Measures
Robin McLeod, MD
How Do Quality Measures Influence Outcome: European Experience
Arne Wibe, MD, PhD
Do We Need Centers of Excellence: Canadian Experience
Hartley Stern, MD
Development of Quality Measures in the US
Frank Opelka, MD

Outcomes

Objectives : At the conclusion of this session, participants should be able to: (73) understand the importance of a centralized service to improve the standard of care in the management of these rare tumors; (74) understand the impact of different aspects of organizational infrastructure on patient outcomes following bowel cancer surgery; (75) a) understand the Delphi approach to development of consensus and b) informed of the research questions of greatest importance to ASCRS members; (76) understand how population demographic shifts impacts the demand for colorectal surgical services; (77) a) stratify colorectal patients with respect to risk of development of post-operative surgical site infection and b) interpret national quality outcomes data as it pertains to colorectal surgery; (78) comprehend the importance of Clostridium difficile in regards to the in-patient population and its subsequent impact upon the colorectal service; (79) a) understand the common causes of death after Colectomy and b) define the relationship of surgeon error to death after Colectomy; (80) a) assess the predicted mortality of patients with liver disease undergoing colorectal surgery and b) develop an operative plan for the patient with cirrhosis undergoing colorectal surgery; (81) analyze the similarities and differences between colorectal surgery fellowship programs in Australia, the United Kingdom, and North America; (82) a) laparoscopic colorectal resections can be learnt safely and b) understand the learning curve continues beyond 200 cases; (83) a) understand the major mortality and hospital stay benefits of laparoscopic colorectal surgery and b) comprehend the volume of laparoscopic colorectal surgery undertaken by British surgeons over the last decade; and (84) a) appreciate the power of a standardized, centralized quality data collection processes; b) become familiar with the important lessons elucidated through from a non-VA collaboration and c) recognizes the stengths and weaknesses specific to the clinical relavance of large database analysis.

The Treatment and Outcomes of Peritoneal Tumors through a Centralized National Service
M. Davies, A. Farquharson, P. Fulford, S. O'Dwyer, A. Renehan, S. Rout, M. Wilson
The National Bowel Cancer Audit Project: The Impact of Organizational Structure on Outcome in Operative Bowel Cancer within the United Kingdom
J. Cornish, J. Smith, E. Tan, P. Tekk