May 26th, 2009

2009 Annual Meeting Webcast

Objectives : Return to Annual Meeting Archive Introduction This scientific program is designed to provide surgeons with an in-depth and up-to-date knowledge relative to surgery for diseases of the colon, rectum and anus with emphasis on patient care, teaching and research. The purpose of all sessions is to improve the quality of care of patients with diseases of the colon and rectum.  Target AudienceThe program is intended for the education of colon and rectal surgeons as well as general surgeons and others involved in the treatment of diseases affecting the colon, rectum and anus.Minimum System RequirementsAny high spped internet connection. An internet browser with flash 8 or later installed.Privacy StatementThe American Society of Colon&Rectal Surgeons is committed to maintaining the privacy of the personal information of visitors to its sites.  Our policies are designed to disclose the information collected and how it will be used.  This policy applies solely to the information provided while visiting this website.  The terms of the privacy policy do not govern personal information furnished through any means other than this website (such as by telephone or mail).AgreementAll images contained in this presentation are copyrighted  by the American Society of Colon and Rectal Surgeons.Disclaimer The primary purpose of the ASCRS Annual Meeting and this webcast is education. Information, as well as technologies, products and/or services discussed, are intended to inform participants about the knowledge, techniques and experiences of specialists who are willing to share such information with collagues.   A diversity of professional opinions exist in the specialty and the views of the American Society of Colon and Rectal Surgeons disclaims any and all liability for information, technologies, products and/or services discussed.

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

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

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

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, MDEvaluation Form
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

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

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

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

Inflammatory Bowel Disease II

Objectives : At the conclusion of this session, participants should be able to: (85) have a better understanding of the frequency and type of perianal surgical disease in patients with Crohns disease; (86) discuss indications for use of infliximab, indications for surgery in patients with inflamatory bowel disease, differences in surgical presentation of patients treated with or without infliximab and their choice of surgical procedures; (87) understand the long term outcome of inflixamab in the treatment of complex perianal Crohn\'s fistulas; (88) describe the patient and disease charateristics that are associated with early resection in a population cohort; (89) discuss the outcome of ileal pouch-anal anastomosis in patients with indeterminate colitis; (90) a) recognize S. typhimurium as a novel cytokine delivery vehicle and b) understand the rationale for utilization of this construct for treatment of experimental inflammatory bowel disease; (91) understand that recurrence occurs in half of the patients with crohn\'s disease after laparoscopic ileocolectomy. Use of post operative immunomodulating prophylaxis may be of limited benefit in delaying recurrence; (92) a) discuss the importance of inflammation in regards to colectomy for chronic ulcerative colitis and b) understand the risk factors for colectomy in patients with chronic ulcerative colitis; (93) understand the incidence and implications of pre-pouch ileitis following IPAA Understand how to manage patients with pre-pouch ileitis; (94) understand that abdominal CT scan does not impact the rate of same admission colectomy in patients with toxic colitis; (95) appreciate the consensus opinion of UK Coloproctologists and Gastroenterologists in the management of terminal ileitis in the acute and elective setting trainees will be able to use this information in making their own informed decision in the scenarios presented; and (96) understand the advantages in clinical outcomes, quality of life and cost effectiveness of percutaneous drainage followed by elective surgery vs. primary surgery for Crohn\'s disease presenting with abdomino-pelvic abscess.

Surgery for Perianal Disease in a Population-based Crohn's Disease Cohort
M. Barclay, F. Frizelle, R. Gearry
Preoperative Treatment with Infliximab does not Increase Rate of Emergent or Multi-step Abdominal Surgery
L. Bordeianou, R. Hodin, J. Korzenik, H. Kunitake, B. Sands, P. Shellito
Long Term Outcome of Infliximab in the Treatment of Complex Perianal Crohn
W. Buie, A. MacLean, R. Panaccione, D. Topstad
Characteristics of Resectional Surgery in a Population-based Inflammatory Bowel Disease Cohort
M. Barclay, F. Frizelle, R. Gearry
A Prospective Evaluation of the Long-Term Outcome of Ileal Pouch-anal Anastomosis in Patients with Indeterminate Colitis
P. Fleshner, Z. Murrell
IL-10 Producing Attenuated Salmonella Typhimurium is Beneficial for Treatment of DSS Induced Murine Inflammatory Bowel Disease
C. Heise, J. Lan
Risk Factors for Recurrence and the Impact of Post-operative Prophylaxis in Ileal Colonic Crohn's Disease
R. Cima, E. Dozois, W. Faubion, R. Gullerud, D. Larson, E. Loftus, K. Malireddy, D. Pardi, R. Qin, W. Sandborn, B. Wolff
Severity of Inflammation as a Predictor of Colectomy in Patients with Chronic Ulcerative Colitis
D. Chessin, N. Harpaz, M. Hefti, R, Steinhagen, T. Ullman
CT Scan for Severe Acute
M. Baker, V. Fazio, I. Mor, A. Moreira, J. Vogel, R. Zhang
Terminal Ileal Crohn's Disease - Aggressive Physician and Conservative Surgeon?
S. Brown, H. Narula, U. Shariff, W. Speake
Outcomes of Crohn's Disease Presenting with Abdomino-Pelvic Abscess: A Decision Analysis
V. Fazio, A. Moreira, L. Stocchi, E. Tan, P. Tekkis

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

John Goligher Lectureship

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

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
Michael Parker, MD
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

Louis A. Buie, MD Lectureship

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

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

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

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

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 Metastas