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Abstract
Colorectal surgery is a specialized branch of surgery that involves the diagnosis and treatment of conditions affecting the colon, rectum, and anus. In the recent years, the use of artificial intelligence (AI) has gained considerable interest in various medical specialties, including surgery. Chatbot Generative Pre-Trained Transformer (ChatGPT), an AI-based chatbot developed by OpenAI, has shown great potential in improving the quality of healthcare delivery by providing accurate and timely information to both patients and healthcare professionals. In this paper, we investigate the potential application of ChatGPT in colorectal surgery. We also discuss the potential advantages and challenges associated with the implementation of ChatGPT in the surgical setting. Furthermore, we address the socio-ethical implications of utilizing ChatGPT in healthcare. This includes concerns over patient privacy, liability, and the potential impact on the doctor-patient relationship. Our findings suggest that ChatGPT has the potential to revolutionize the field of colorectal surgery by providing personalized and precise medical information, reducing errors and complications, and improving patient outcomes.
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Affiliation(s)
- Wenbo Li
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yinxu Zhang
- Department of Colorectal Surgery, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, 121001, China
| | - Fengmin Chen
- Department of Colorectal Surgery, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, 121001, China.
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Becerra AZ, Grimes CE, Grunvald MW, Underhill JM, Bhama AR, Govekar HR, Saclarides TJ, Hayden DM. A New Bibliometric Index: The Top 100 Most Disruptive and Developmental Publications in Colorectal Surgery Journals. Dis Colon Rectum 2022; 65:429-443. [PMID: 34108364 DOI: 10.1097/dcr.0000000000002118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A new bibliometric index called the disruption score was recently proposed to identify innovative and paradigm-changing publications. OBJECTIVE The goal was to apply the disruption score to the colorectal surgery literature to provide the community with a repository of important research articles. DESIGN This study is a bibliometric analysis. SETTINGS The 100 most disruptive and developmental publications in Diseases of the Colon & Rectum, Colorectal Disease, International Journal of Colorectal Disease, and Techniques in Coloproctology were identified from a validated data set of disruption scores and linked with the iCite National Institutes of Health tool to obtain citation counts. MAIN OUTCOME MEASURES The primary outcomes measured were the disruption score and citation count. RESULTS We identified 12,127 articles published in Diseases of the Colon & Rectum (n = 8109), International Journal of Colorectal Disease (n = 1912), Colorectal Disease (n = 1751), and Techniques in Coloproctology (n = 355) between 1954 and 2014. Diseases of the Colon & Rectum had the most articles in the top 100 most disruptive and developmental lists. The disruptive articles were in the top 1% of the disruption score distribution in PubMed and were cited between 1 and 671 times. Being highly cited was weakly correlated with high disruption scores (r = 0.09). Developmental articles had disruption scores that were more strongly correlated with citation count (r = 0.18). LIMITATIONS This study is subject to the limitations of bibliometric indices, which change over time. DISCUSSION The disruption score identified insightful and paradigm-changing studies in colorectal surgery. These studies include a wide range of topics and consistently identified editorials and case reports/case series as important research. This bibliometric analysis provides colorectal surgeons with a unique archive of research that can often be overlooked but that may have scholarly significance. See Video Abstract at http://links.lww.com/DCR/B639.UN NUEVO INDICE BIBLIOMÉTRICO: LAS 100 MAS IMPORTANTES PUBLICACIONES EN INNOVACIONES DESESTABILIZADORAS Y DE DESARROLLO EN LAS REVISTAS DE CIRUGÍA COLORRECTALANTECEDENTES:Un nuevo índice bibliométrico llamado innovación desestabilizadora y de desarrollo ha sido propuesto para identificar publicaciones de vanguardia y que pueden romper paradigmas.OBJETIVO:La meta fué aplicar el índice de desestabilización a la literature en cirugía colorectal para aportar a la comunidad con un acervo importante de artículos de investigación.DISEÑO:Un análisis bibliométrico.PARAMETROS:Las 100 publicaciones mas desestabilizadores y de desarrollo en las revistas: Diseases of the Colon and Rectum, Colorectal Disease, International Journal of Colorectal Disease, y Techniques in Coloproctology se recuperaron de una base de datos validada con puntuaciones de desestabilización y se ligaron con la herramienta iCite NIH para obtener la cuantificación de citas.PRINCIPAL MEDIDA DE RESULTADO:El índice desestabilizador y la cuantificación de citas.RESULTADOS:Se identificaron 12,127 articulos publicados en Diseases of the Colon and Rectum (n = 8,109), International Journal of Colorectal Disease (n = 1,912), Colorectal Disease (n = 1,751), y Techniques in Coloproctology (n = 355) de 1954-2014. Diseases of the Colon and Rectum representó la mayoría de las publicaciones dentro de la lista de los 100 mas desestabilizadores y de desarrollo. Esta literatura desestabilizadora se encuentra en el principal 1% de la distribución de la puntuacón desestabilizadora en PubMed y se citaron de 1 a 671 veces. El ser citado con frecuencia se relacionó vagamente con las puntuaciones de desastibilización (r = 0.09). Los artículos de desarrollo tuvieron puntuaciones de desestabilización que estuvieron muy correlacionados con la cuantificación de las citas (r = 0.18).LIMITACIONES:Las sujetas a las limitaciones de los índices bibliométricos, que se modifican en el tiempo.DISCUSION:La putuación de desestabilicación identificó trabajos perspicaces, pragmáticos y modificadores de paradigmas en cirugía colorrectal. Es de interés identificar que se incluyeron una gran variedad de temas y en forma consistente editoriales, reportes de casos y series de casos que representaron una investigación importante. Este análisis bibliométrico aporta a los cirujanos colorrectales de un acervo de investigación único que puede con frecuencia pasarse por alto, y sin embargo tener una gran importancia académica. Consulte Video Resumen en http://links.lww.com/DCR/B639. (Traducción- Dr. Miguel Esquivel-Herrera).
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Affiliation(s)
- Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
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Bhama AR, Zoccali MB, Chapman BC, Davids JS, Eisenstein S, Fish DR, Sherman KL, Simianu VV, Zaghiyan KN. Practice Variations in Chemodenervation for Anal Fissure Among American Society of Colon and Rectal Surgeons Members. Dis Colon Rectum 2021; 64:1167-1171. [PMID: 34192713 DOI: 10.1097/dcr.0000000000002194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anuradha R Bhama
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Brandon C Chapman
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer S Davids
- Department of Surgery, University of Massachusetts, Wooster, Massachusetts
| | - Samuel Eisenstein
- Department of Surgery, UC San Diego Health System, La Jolla, California
| | - Daniel R Fish
- Department of Surgery, Baystate Medical Center; Springfield, Massachusetts
| | - Karen L Sherman
- Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington
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Beelen EMJ, van der Woude CJ, Pierik MJ, Hoentjen F, de Boer NK, Oldenburg B, van der Meulen AE, Ponsioen CIJ, Dijkstra G, Bruggink AH, Erler NS, Schouten WR, de Vries AC. Decreasing Trends in Intestinal Resection and Re-Resection in Crohn's Disease: A Nationwide Cohort Study. Ann Surg 2021; 273:557-563. [PMID: 31188225 DOI: 10.1097/sla.0000000000003395] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess time trends in intestinal resection and re-resection in Crohn's disease (CD) patients. SUMMARY OF BACKGROUND DATA CD treatment has changed considerably over the past decades. The effect of these advances on the necessity of intestinal resections and the risk of re-resection is unclear. METHODS In this nationwide cohort study, adult CD patients with ileocolonic, small bowel, colon, or rectum resections between 1991 and 2015 were included. Data were retrieved from the Dutch nationwide network and registry of histopathology and cytopathology (PALGA). Time trends were analyzed with a broken stick model and Cox proportional hazard model with smoothing splines. RESULTS The identified cohort comprised 8172 CD patients (3293/4879 male/female) in whom 10,315 intestinal resections were performed. The annual intestinal resection rate decreased nonlinearly from 1.9/100,000 (1991) to 0.2/100,000 (2015). A significantly steeper-decrease was observed before 1999 (slope –0.13) as compared to subsequent years (slope –0.03) (p<0.001). Analogous trends were observed for ileocolonic, small bowel, and colon resections. Overall cumulative risk of re-resection was 10.9% at 5 years, 18.6% at 10 years, and 28.3% at 20 years after intestinal resection. The hazard for intestinal re-resection showed a nonlinear decreasing trend, with hazard ratio 0.39 (95% confidence interval 0.36-0.44) in 2000 and hazard ratio 0.25 (95% confidence interval 0.18-0.34) in 2015 as compared to 1991. CONCLUSION Over the past 25 years, intestinal resection rate has decreased significantly for ileocolonic, small bowel, and colonic CD. In addition, current postoperative CD patients are at 75% lower risk of intestinal re-resection.
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Affiliation(s)
- Evelien M J Beelen
- Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
| | - C Janneke van der Woude
- Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
| | - Marie J Pierik
- Maastricht University Medical Center, Department of Gastroenterology and Hepatology, Maastricht, the Netherlands
| | - Frank Hoentjen
- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, the Netherlands
| | - Nanne K de Boer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism Research Institute, Amsterdam, The Netherlands
| | - Bas Oldenburg
- University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, the Netherlands
| | - Andrea E van der Meulen
- Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, the Netherlands
| | - Cyriel I J Ponsioen
- Amsterdam UMC, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands
| | - Gerard Dijkstra
- University of Groningen, Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Annette H Bruggink
- PALGA, Nationwide Network and Registry of Histopathology and Cytopathology in the Netherlands, Houten, the Netherlands
| | - Nicole S Erler
- Erasmus University Medical Center, Department of Biostatistics, Rotterdam, the Netherlands
| | - W Rudolph Schouten
- Erasmus University Medical Center, Department of Surgery, Rotterdam, the Netherlands
| | - Annemarie C de Vries
- Erasmus University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
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Affiliation(s)
- Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Nicholas Farkas
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom.
| | - Michael Conroy
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Holly Harris
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Ross Kenny
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
| | - Mirza Khurrum Baig
- Department of General Surgery, Worthing Hospital, Western Sussex Hospitals NHS Trust, West Sussex, United Kingdom
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ACPGBI Legacy Working Group. Legacy of COVID-19 - the opportunity to enhance surgical services for patients with colorectal disease. Colorectal Dis 2020; 22:1219-28. [PMID: 32857886 DOI: 10.1111/codi.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
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Keller DS, Qiu J, Kiran RP. A National study on the adoption of laparoscopic colorectal surgery in the elderly population: current state and value proposition. Tech Coloproctol 2019; 23:965-972. [PMID: 31598786 DOI: 10.1007/s10151-019-02082-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The economic and clinical benefits of laparoscopic colorectal surgery are proven, yet may be underutilized in appropriate cases, especially in the elderly. Since the elderly constitute the greatest colorectal surgical volume, our goal was to identify trends in utilization and impact of laparoscopy in this cohort. METHODS A national review of elective inpatient colorectal resections from the Premier Inpatient Database between 2010 and 2015 was performed. Patients were included if elderly (≥ 65 years), then grouped into open or laparoscopic procedures. The main outcome measures were trends in utilization by approach and total costs for the episode of care, length of stay (LOS), readmission, and complications by approach in the elderly. Multivariable regression models controlled for differences across platforms, adjusting for patient demographic, comorbidities and hospital characteristics. RESULTS In 70,655 elderly patients evaluated, laparoscopic adoption remained lower than open throughout the study period. Rates increased until 2013, then declined, with increasing rates of open surgery. Laparoscopy was associated with significantly lower mean total costs ($4012 less/case), complications and readmissions (36% and 33% less, respectively), and shorter LOS (2.6 less days) than open cases (all p < 0.0001). When complications occurred, they were less severe and the readmission episodes were less costly with laparoscopy than open colorectal surgery. CONCLUSION The adoption of laparoscopy in the elderly has lagged behind open surgery and even declined in recent years despite being associated with improved clinical outcomes and reduced cost. With this tremendous value proposition to increase use of laparoscopic surgery in the elderly, further work needs to evaluate root causes of the disparity.
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Affiliation(s)
- D S Keller
- Division of Colon and Rectal Surgery, Department of Surgery, NewYork-Presbyterian, Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, 8th Floor, New York, NY, 10032, USA.
| | - J Qiu
- Minimally Invasive Therapies Group, Medtronic, Inc., Boulder, CO, USA
| | - R P Kiran
- Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA
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Ceccarelli D, Basso L, Passannanti D, Gaj F. SICCR Abruzzo-Lazio-Molise tripartite regional meeting: "Reality and concrete perspectives in daily coloproctology: surgical techniques and patient management". Tech Coloproctol 2019; 23:789-791. [PMID: 31410613 DOI: 10.1007/s10151-019-02039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D Ceccarelli
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, Rome, Italy.
| | - L Basso
- Department of Surgery "Pietro Valdoni", Sapienza, University of Rome, Viale del Policlinico 155, Rome, Italy
| | - D Passannanti
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, Rome, Italy
| | - F Gaj
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza, University of Rome, Viale del Policlinico 155, Rome, Italy
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Pellino G, Moggia E, Novelli E, Sturiale A, Martellucci J, Trompetto M, Gallo G. An update of the aims and achievements during the first year of the Young Group of the Italian Society of Colorectal Surgery (Y-SICCR). Tech Coloproctol 2019; 23:291-298. [PMID: 30955103 DOI: 10.1007/s10151-019-01966-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/08/2019] [Indexed: 12/18/2022]
Affiliation(s)
- G Pellino
- Department of Advanced Medical and Surgical Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy.
| | - E Moggia
- Department of General Surgery, ASL Alessandria, SS Antonio & Margherita Civil Hospital, Tortona, AL, Italy
| | - E Novelli
- Department of Biostatistics and Clinical Research, S. Gaudenzio Clinic, Novara, Italy
| | - A Sturiale
- Proctological and Perineal Surgical Unit, Cisanello University Hospital, Pisa, Italy
| | - J Martellucci
- General Emergency and Minimally Invasive Surgery, Careggi University Hospital, Florence, Italy
| | - M Trompetto
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
| | - G Gallo
- Department of Colorectal Surgery, S. Rita Clinic, Vercelli, Italy
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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Papazarkadas X, Spartalis E, Patsouras D, Ioannidis A, Schizas D, Georgiou K, Dimitroulis D, Nikiteas N. The Role of 3D Printing in Colorectal Surgery: Current Evidence and Future Perspectives. In Vivo 2019; 33:297-302. [PMID: 30804106 PMCID: PMC6506312 DOI: 10.21873/invivo.11475] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Three-dimensional (3D) printing is an emerging and evolving technology with a variety of possible applications in surgery. The purpose of this study was to examine its potential applications in the field of colorectal surgery, as a tool in pre-operative planning and peri-operative navigation, as well as in training. Its cost-efficiency was also examined. MATERIALS AND METHODS A literature review was conducted on articles specifically presenting various applications of 3D printing in the field of colorectal surgery. PubMed was the primary database researched. RESULTS A total of seven studies were found to meet the inclusion criteria. The majority of the articles employed 3D printing technology to produce patient-specific anatomic replicas to enhance pre-operative planning, providing satisfactory results. One study used 3D printing technology as a therapy tool, stating superior results over traditional methods. CONCLUSION 3D printing is a novel technology with a broad spectrum of possible applications in colorectal surgery. Anatomic replicas specific to the anatomy of a patient with acceptable dimensional correlations can be produced using the currently available technology. Surgical and patient training can also be enhanced. Depending on the technology used, costs greatly vary and can thus hinder popularization of this technology in surgery.
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Affiliation(s)
- Xenofon Papazarkadas
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Dimitrios Patsouras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Argyrios Ioannidis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Dimitrios Schizas
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
- First Department of Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Konstantinos Georgiou
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Wang J. [Imperative trend towards the establishment of training, qualification, and certification system for colorectal and anal surgeons]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:14-17. [PMID: 28105612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Compared to Europe and America, the specialization of colorectal and anal surgery in China started a bit late, and so far there has been no standardized residency program and expert-access system. This review introduces different training systems of colorectal and anal surgery residency in the United States, Europe, and Japan, aiming to provide references for the establishment of residency program in China, which is imperative. Firstly, national uniform identification standards for standardization training bases of colorectal and anal surgeons are required. And then based on these standards, colorectal and anal surgery residency training bases are identified by professional Association/Society. Secondly, the training subjects must be limited in graduates from formal medical school who have successfully completed residency program. Thirdly, training course should be set properly with the main purpose of mastering skills of clinical practice, and 2-4 years is a reasonable training period. Lastly, check and evaluation on colorectal and anal surgeons should be placed with great emphasis, and regarded as a prerequisite of engaging colorectal and anal surgery.
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Affiliation(s)
- Jianping Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 501655, China.
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Bolton L. Evidence Corner: Improving Outcomes of Colorectal Surgery. Wounds 2015; 27:279-281. [PMID: 26479212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Laura Bolton
- Department of Surgery, Rutgers Robert Wood Johnson Medical School
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Saur NM, Wexner SD. Minimally invasive techniques to decrease the impact of colorectal surgery for neoplasia. MINERVA CHIR 2015; 70:257-272. [PMID: 25897590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Minimally invasive colorectal surgery has evolved over the past few decades. Techniques currently in practice to decrease the impact of colorectal surgery for neoplasia include laparoscopy and its derivations, robotic surgery, transanal endoscopic surgery (TES), transanal total mesorectal excision (taTME), natural orifice specimen extraction (NOSE), needlescopic surgery, and advanced endoscopy. Many of the new techniques are variations of standard laparoscopy that aim to decrease the size of the incisions (needlescopic surgery), decrease the number of incisions (single-incision laparoscopic surgery, SILS), or eliminate the need for a specimen extraction incision (taTME). Each variation must be evaluated for safety and efficacy, especially in oncologic outcome. It is imperative that clinicians understand the role and limitation of each minimally-invasive technique. The goal moving forward should be to develop and sustain technology that is safe, effective, and offers superior clinical outcomes when compared to the current gold standards.
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Affiliation(s)
- N M Saur
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA -
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Alkhamesi NA, Aslani N, Schlachta CM. Optimizing technology for the management of colon and rectal diseases. MINERVA CHIR 2015; 70:249-256. [PMID: 25897589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Surgery is one of the most dynamic sciences and the discipline of colorectal surgery continues to progress forward utilizing a combination of new technologies and innovative operative techniques to enhance patients care and improve outcomes.
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Affiliation(s)
- N A Alkhamesi
- Canadian Surgical Technologies and Advanced Robotics (CSTAR), London Health Sciences Centre and Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
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Daher R, Chouillard E, Panis Y. New trends in colorectal surgery: Single port and natural orifice techniques. World J Gastroenterol 2014; 20:18104-18120. [PMID: 25561780 PMCID: PMC4277950 DOI: 10.3748/wjg.v20.i48.18104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 07/28/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of “pure” NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal “down-to-up” total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.
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Abstract
Nosocomial infections are the most frequent complications observed in surgical patients. In colorectal surgery, the opening of the viscera causes the dissemination into the operative field of microorganisms originating from endogenous sources, increasing the chance of developing postoperative complications. It is reported that without antibiotic prophylaxis, wound infection after colorectal surgery develops in approximately 40% of patients. This percentage decreases to approximately 11% after antibiotic prophylaxis. Specific criteria in the choice of correct antibiotic prophylaxis have to be respected, on the basis of the microorganisms usually found in the surgical site, and on the specific hospital microbiologic epidemiology.
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Affiliation(s)
- Francesca Rovera
- Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitaria, Fondazione Macchi, Varese, Italy.
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Dolgikh RN, Leonov SV, Lazarev GV, Gilevskiĭ SG, Potekhin AV, Maniukhin AN. [Development of coloproctology in the Vishnevsky Central Military Clinical Hospital N 3]. Voen Med Zh 2013; 334:27-32. [PMID: 24000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors show the development of colonoproctology in the Vishnevsky Central Military Clinical Hospital N 3. The authors chose and described diagnostic possibilities of the proctologic center: videoendoscopy, ultrasonic diagnosis, computing technologies, methods of anatomical verification. The authors gave a characteristic of patients and methods of treatment. Almost half of all patients are oncology patients. Over the last decade 6750 patients were treated in the proctologic center, 1484 of them suffered with primary bowel cancer. 56,7% of patients suffered with colon cancer, 43,3%--rectal cancer. Special attention is paid to the patients with combat trauma. During the military conflicts on the North Caucasus 659 servicemen were treated in the hospital, 72 of them--with gunshot wounds of the colon. The majority of patients had bullet wounds, 15%--mine-blast injuries. All patients were operated on during the early stages of evacuation. Depending on character and location of injury patients were operated on properly. 68% of 72 patients suffered colon injuries, 32%--rectal injuries. 6 patients died (8,3%). The authors came to conclusion that organization and results of diagnostic and treatment, scientific and educational activity show the successful functioning of integration production treatment of patients with colonic pathology. The further ways of development are designed.
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Bulut O, Brunner W. [Further minimization of minimally invasive surgery for colorectal disease may have a future]. Ugeskr Laeger 2013; 175:1094. [PMID: 23651745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Wexner SD. Introduction to the minimal access colorectal surgery supplement of Techniques in Coloproctology. Tech Coloproctol 2013; 17 Suppl 1:S1. [PMID: 23371341 DOI: 10.1007/s10151-012-0960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Aliev SA, Aliev ES. [The evolution of surgical approach to the tumorous colonic obstruction]. Khirurgiia (Mosk) 2013:92-98. [PMID: 23819163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kellokumpu I. [Fast-track treatment--second revolution of colorectal surgery]. Duodecim 2012; 128:1465-1470. [PMID: 22937605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The fast-track treatment model can be regarded as the second revolution of colorectal surgery after the introduction of laparoscopic surgery. In the gastro-surgical unit of the Central Hospital of Central Finland, results equivalent to international studies in colorectal surgery have been achieved by using fast-track model. In a study setting, this treatment model has resulted in significant decrease of total treatment costs and speeded up discharge of the patients from the hospital. The fast-track treatment model requires both a motivated, trained medical team and a motivated patient.
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de Parades V. [Anal pathology: undeniable progress made]. Rev Prat 2008; 58:1751-1753. [PMID: 19143145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Vincent de Parades
- Service de proctologie médico-interventionnelle, groupe hospitalier Diaconesses Croix-Saint-Simon, site Reuilly, 75012 Paris, France.
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Bielecki K, Wegrzyn Z. Future of education in colorectal surgery in Poland and in Great Britain (opinion of general surgeons). Colorectal Dis 2008; 10:408-9. [PMID: 18266881 DOI: 10.1111/j.1463-1318.2008.01480.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Affiliation(s)
- Henrik Kehlet
- Section for Surgical Pathophysiology 4074, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
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Abstract
Many factors have effect on the enhanced recovery after colon surgery. Not only the technical skill but the perioperative events needed to be optimized by the pre- and postoperative issues. Articles were obtained with search for keywords in Medline electronic database and evidences have been ranked according to the recommendation of the Oxford Evidence-Based Medicine Centre. Multicentric, randomised studies have proved that preoperative bowel emptying could not decrease the number of anastomotic insufficiency and wound infection rate; the use of abdominal drains is not necessary in every case; the proper, early oral intake is safe and well tolerated in colo-rectal surgery, and with laparoscopic surgery the same results can be achieved as with open ones. The evidences found even are not used completely. The advantage of laparoscopic surgery can be improved with fast track methods. To use correctly the affecting factors it is essential to know the current literature.
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Affiliation(s)
- Péter Sipos
- Semmelweis Egyetem, Altalános Orvostudományi Kar II, Sebészeti Klinika, Budapest, Kútvölgyi út 4. 1125
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Affiliation(s)
- Gerhard Weyandt
- Department of Dermatology, Venereology and Allergy, University of Würzburg, Germany.
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Abstract
INTRODUCTION There has been a gradual introduction of transanal endoscopic microsurgery (TEM) into UK practice although the uptake remains variable. This study aimed to assess the availability, application and referral pattern of TEM amongst colorectal surgeons. METHODS A questionnaire was sent to all consultant members of the Association of Coloproctology. This considered their practice, the availability, application and referral pattern for TEM, and their views on application regarding a selection of rectal tumour scenarios. RESULTS There were 142 replies representing 116 hospitals and 297 colorectal surgeons. The median catchment area was 280,000 (range 70,000-1,000,000). TEM was available in 18% of hospitals and 72% either performed or referred patents for TEM. Of 21 units performing TEM, 15 received referrals. From 305 TEM procedures performed over the previous year, 206 were referred cases. Eighty-five per cent of consultants considered TEM a necessary technique for optimum management of rectal lesions. Although 61% of consultants considered endoanal excision optimal for low benign rectal tumours, 58% said TEM was optimal for midrectal lesions and between 30% and 55% for high rectal lesions depending if the tumour position was anterior or posterior, respectively. One-third of consultants would perform TEM for a low T1 rectal carcinoma although half would proceed to anterior resection. DISCUSSION TEM is considered to have a significant role in the optimal management of rectal lesions. The presence of the technique in a limited number of hospitals does appear to provide adequate resources although audit should continue to be centralized.
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Affiliation(s)
- H S Tilney
- Department of Surgical Oncology and Technology, St Mary's Hospital, London, UK
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Abstract
The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and N0), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life.
© 2006 The WJG Press. All rights reserved.
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Affiliation(s)
- Glen-C Balch
- Colorectal Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1077, New York, NY 10021, USA
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Abstract
Despite advances in medical therapy, surgery is required in approximately 30-40% of patients with ulcerative colitis (UC) and 70-80% of patients with Crohn's disease (CD) at some point during their lifetime. For patients with UC, surgery may be curative, whereas recurrence of CD following surgery is common due to the potentially pan-enteric distribution of the disease. As a result, the indications and surgical management of the disease may be quite different. For UC, the surgeon is involved in the identification of new cases, management of severe disease, recognition of dysplasia and restorative proctocolectomy. Most of the advances in surgery for UC have been in novel techniques relating to the ileal pouch-anal anastomosis, which can now be performed safely for UC with a 10% pouch failure rate long term. For CD, the surgeon is involved in the management of small bowel and ileo-colonic disease, Crohn's colitis and perianal disease. Advances in the surgical management of CD include strictureplasty for extensive small bowel disease, laparoscopic ileo-caecal resection and a combined medical and surgical approach to perianal disease. For both CD and UC close liaison between the gastroenterologist and colorectal surgeon is essential.
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Affiliation(s)
- L Hancock
- Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, UK
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Jewell DP. New patients, new lessons, new thinking in inflammatory bowel disease: World Congress of Gastroenterology Symposium, Montreal, Canada, September 2005. Colorectal Dis 2006; 8 Suppl 1:1-2. [PMID: 16594956 DOI: 10.1111/j.1463-1318.2006.00984.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Manuel CRJ, Eduardo VS, Luis RRJ, Oscar CRL. Globalization comes to colon and rectal surgery. Dis Colon Rectum 2006; 49:532; author reply. [PMID: 16555034 DOI: 10.1007/s10350-005-0314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Affiliation(s)
- Elisa H Birnbaum
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
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Siproudhis L. [Eulogy of baroque proctology]. Gastroenterol Clin Biol 2006; 30:158-9. [PMID: 16514405 DOI: 10.1016/s0399-8320(06)73139-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Van Outryve M, Debongnie JC. GLEM/LOK report on proctology practice in Belgium. Results, comments and recommendations. Acta Gastroenterol Belg 2006; 69:25-30. [PMID: 16673559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The article summarizes the response of eighty-eight Belgian gastroenterologists to a questionnaire on proctology practice, established by the common evaluation groups (GLEM/LOK) of medical practice. The results of the inquiry concerning haemorrhoids, anal fissure, abscess and fistula, and faecal incontinence are discussed separately. Each chapter is completed by specific therapeutic and/or diagnostic recommendations. These are based on the official statements of the American Gastroenterological Association and on our own clinical practice. There are still no official guidelines on proctology in Belgium and neighbouring countries. The diagnostic and therapeutic quality of the approach of our proctologic patients should improve by appropriate proctologic education and training in selected centres.
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Affiliation(s)
- M Van Outryve
- Department of Gastroenterology and Hepatology, Universitair Ziekenhuis Antwerpen, UA, Edegem, Belgium.
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Filingeri V, Gravante G, Cassisa D. Physics of radiofrequency in proctology. Eur Rev Med Pharmacol Sci 2005; 9:349-54. [PMID: 16479739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Radiosurgery is a new technique that utilizes an instrument, the radiofrequency bistoury, which is able to simultaneously cut and coagulate tissues with the emission of radiofrequencies. The first experiments about the utilization of radiofrequency currents on man were conducted between the end of the 19th century and the beginning of the 20th century. The first medical field of application was in oncology leading to the development of hyperthermia as an anticancer treatment. During the 80's the radiofrequencies have been introduced in cardiology to thermally ablate stable arrhythmic foci. Actually ear, nose, and throat surgery, dermatology, plastic surgery, vascular surgery, orthopaedics, neurosurgery and minimally invasive surgery use this new tool in their practice. The authors show the classification of radio fre quencies in the electromagnetic field, describe their historic development, their physics and their initial clinical applications by making a systematic review of the literature.
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Affiliation(s)
- V Filingeri
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Rasmussen PC, Bülow S. [Future organisation of colorectal cancer surgery in Denmark]. Ugeskr Laeger 2005; 167:4191-2. [PMID: 16266578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We recommend that in the future, surgery for colorectal cancer (CRC) in Denmark should be done in 10 to 15 colorectal units with an uptake zone of 350,000-500,000 citizens each. These units should perform both acute and elective CRC surgery and acute surgical treatment of other intestinal diseases. In each unit, a senior colorectal surgeon should be available on a 24-hour shift, and there should be sufficient diagnostic and theatre capacity to ensure optimal treatment levels. A stoma clinic should be available Monday to Friday. The units should perform research according to international standards. Each senior surgeon should document his or her relevant continuing surgical education. A national postgraduate education should be ensured to all members of the multidisciplinary team according to the standards in force in Great Britain. The treatment of primary advanced T4 tumors and local recurrence should be done in only one to two colorectal units in Denmark, and the treatment of local recurrence with spread to the pelvis should be done in only one unit in Denmark.
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Dong WG, Zhan WH, Wang JP. [Indications and prognostic analysis of sphincter preservation operation for rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2005; 8:294-6. [PMID: 16167243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To explore the indications of sphincter preservation operation (SPO) for rectal cancer, and factors influencing selective indications of SPO. METHODS From April 1994 to April 2004, clinical data of 708 cases with rectal cancer were analyzed retrospectively. The patients received either SPO (SPO group, n=481) or abdominoperineal resection (APR group, n=227). Clinical pathologic parameters and survival rate were compared between the two groups. RESULTS There were 66 patients with tumor located in sigmoid-rectum borderline, 138 in upper rectum, 195 in middle rectum, 309 in lower rectum. Dixon operation was performed in 449 patients, Bacon operation in 12, and "J" Poch anastomosis in 20 and Hartman operation in 13. There was no differences in sex, ages, liver metastasis, size, depth of invasion and Dukes stages between APR and SPO groups, but there was significant difference in lower bowel obstruction, tumor location, differentiation degree, infiltrated circumference of intestine, lymph node metastasis and radical approaches between the two groups. Radical excision was performed in 660 rectal cancer cases with radical excision rate of 91.5% . SPO was performed in 481 cases with preservation rate of 66.7%, including 135 lower rectal cancer with preservation rate of 43.7%. The operative mortality was 0.4% (3/708), regional recurrence rate was 5.51% (39/708) after operation. The median survival time was (65.0+/- 6.9) months in SPO group and (42.2+/- 5.6) months in APR group (P< 0.01), the 5-year survival rate was 59.3% and 42.3% in SPO and APR group (P< 0.001). CONCLUSIONS SPO should be considered as primary choice for rectal cancer patients, but it must be ensured that complete radical resection be performed. Indications for SPO in lower rectal cancer depend on tumor location,differentiation degree,and infiltrated circumference of intestine,lymph node metastasis.
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Affiliation(s)
- Wen-guang Dong
- Department of Gastrointestinalpancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
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Abstract
Multi-modal rehabilitation with an emphasis on preoperative information, reduction of surgical stress responses, optimized dynamic pain relief with continuous epidural analgesia and early mobilization and oral nutrition may reduce hospital stay, morbidity, convalescence, and costs (fast-track surgery). Current results from fast-track colonic surgery suggest that postoperative pulmonary, cardiovascular, and muscle function are improved and body composition preserved as well as a normal oral intake of energy and protein can be achieved. Consequently, hospital stay is reduced to about 2-4 days, with decreased fatigue and need for sleep in the convalescence period. Despite a higher risk for readmissions, overall costs and morbidity seem to be reduced. Existing data from several institutions support the concept of fast-track colonic surgery to improve postoperative organ functions, thereby allowing for early rehabilitation with decreased hospital stay, convalescence, and costs. Further data are needed from multi-national institutions on morbidity, safety, and costs.
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Affiliation(s)
- Henrik Kehlet
- Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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Person B, Wexner SD. Novel technology and innovations in colorectal surgery: the circular stapler for treatment of hemorrhoids and fibrin glue for treatment of perianal fistulae. Surg Innov 2005; 11:241-52. [PMID: 15756393 DOI: 10.1177/155335060401100407] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of new techniques and technologies in medical science is both stimulating and controversial. This article is a review of the current status of two such advances. Since its first description, the so-called "stapled hemorrhoidectomy" has been gaining increasing popularity, at first in Asia and Europe, and more recently in the United States. It is obviously a misnomer, since no excision of hemorrhoidal tissue is undertaken in this procedure. It is probably the most significant change in the surgical treatment of hemorrhoids since the introduction of conventional hemorrhoidectomy. Patients routinely experience less postoperative pain and have excellent control of symptoms, with few serious complications in most series. Despite a relatively simple operative technique, the procedure still has specific steps and features that must be followed and mastered to help insure success. The use of fibrin glue for treatment of perianal fistulae has also been a controversial issue, thus it is seldom included in any algorithm as a therapeutic step for fistula-in-ano. The reported success rates of the treatment range from 0% to 100% owing to the heterogeneity of the clinical trials, treatment protocols, patients, etiologies, and types of fistulae. However, the benign nature, simplicity, negligible morbidity, and repeatability of the treatment, potentially makes fibrin glue an attractive first line treatment for perianal fistulae.
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Affiliation(s)
- Benjamin Person
- The Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Wexner SD. Recent advances in colorectal surgery. Surg Innov 2005; 11:221-4. [PMID: 15756390 DOI: 10.1177/155335060401100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION Major changes are imminent in the mode of surgical training and the manner both ''general'' and ''specialist'' surgeons provide services. This is the first interactive survey of UK Coloproctology trainees. METHODS At the 2004 DUKES Club (colorectal trainees) meeting an interactive digital-media voting system enabled blinded assessment of members regarding training and organisational issues in Coloproctology. RESULTS 78% of trainees intended to be colorectal specialists. 92% thought a specialist qualification necessary, 90% believed it should be administered at the time of certificate of completion of training (CCT). Overall, 40%, 40% and 20% would pay 1000 <, 1000-3000 pounds and > 5000 pounds respectively per year for adequate training. Over 80% thought low anterior resection, APER, major lower GI-bleeding, pelvic floor, IBD and rectal cancer surgery should only be performed by specialists, and many thought colonic cancer surgery (46%), diverticular surgery (52%), and perianal sepsis (38%) management was a specialist necessity. CONCLUSION UK Colorectal trainees believe a specialist exam necessary, colorectal specialists should treat a defined group of conditions/cases and would pay for adequate training.
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Affiliation(s)
- Alan Cook
- Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont 05401, USA
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Affiliation(s)
- Neil H Hyman
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT 05401, USA
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