Objectives: At the conclusion of this session, participants should be able to: (S2) realize the potential of Staging CT in identifying the cohort of locally advanced colonic tumors suitable for neoadjuvant treatment; (S3) evaluate the role of PET/CT scan in the initial staging of primary colorectal cancer; (S4) a) understand the role of MRI in rectal cancer staging, and b) evaluate the implication of MRI findings for subsequent rectal cancer management; (S5) understand the implications of clinical and pathologic stages on oncologic outcomes of patients with rectal cancer treated with neoadjuvant therapy; (S6) compare the ability of 18F-FDG PET and pathologic-based assessment of rectal cancer response to neoadjuvant chemoradiation to predict long-term outcomes; (S7) a) analyze the effect of neoadjuvant therapy on oncologic and survival outcomes in patients who suffer postoperative complications, and b) develop a postoperative plan of management for patients after rectal cancer resection who develop complications and need adjuvant therapy; (S8) a) recognize the importance of obtaining a multi-generational family cancer history in identifying individuals at high risk for hereditary colorectal cancer syndromes, and b) recognize the need for genetic counseling and testing of individuals at high risk for hereditary colorectal cancer syndromes; (S9) a) determine if stage II rectal cancer benefits from adjuvant chemotherapy after neoajuvant chemoradiation and Proctectomy, and b) set the groundwork for a potential clinical trial for stage II rectal cancer treatment; and (S10) manage patients with local recurrence following transanal excision of T1 rectal cancer.
Objectives: At the conclusion of this session, participants should be able to: (S11) appreciate the use of genes as
markers of disease severity; (S12) use gene signature formula to predict post IPAA associated complications and
improve preoperative surgical patient selection; (S13) understand and quantitatively represent association of preoperative
risk factors with pouch failure; (S14) analyze the difference in functional outcome of IPAA in patients with
pelvic sepsis; (S15) a) understand the role of colectomy and ileorectal anastomosis in patients with Crohn's disease,
b) appreciate the short- and long-term results of IRA for Crohn's, and c) understand that a significant proportion of
patients undergo a proctectomy or redo-IRA in the long-term; (S16) evaluate risks/benefits of pouch excision vs.
permanent diversion (pouch left in situ) when restoration of intestinal continuity is not pursued for patients who
develop pouch failure after ileoanal pouch anastomosis; (S17) assess the role of infiximab as an adjunct to surgery
in management of fistula-in-ano in Crohn's patients; (S18) analyze the surgical and functional outcome over 10
years of the T-pouch continent ileostomy; (S19) a) understand the clinicopathologic features of CRC in patients
with IBD, and b) understand how these differences effect outcome of CRC; and (S20) a) analyze the effect of BMI
on Crohn's disease complications, and b) determine the impact of BMI on specific complications.
Objectives: At the conclusion of this session, participants should be able to: (S21) a) recognize genetic profiles as a
potential means to help stage rectal cancer, and b) explore how tumor genetic profiling may fit into future clinical
treatment algorithms; (S22) use expression levels of cell cycle associated proteins from tumor tissue as prognostic
markers in colon cancer patients; (S23) a) understand the importance of BRAF mutation in colorectal cancer in
terms of patient survival; and b) identify at risk populations for a BRAF mutation; (S24) understand about reflex
testing of microsatellite instability in high risk patients; (S25) a) understand that preoperative diagnosis of Lynch
syndrome can be made on endoscopic biopsy, and b) develop a treatment plan based on the endoscopic biopsy;
(S26) identify prognostic indicators of morbidity and mortality for palliative resection of asymptomatic stage IV colorectal
cancer; (S27) determine the necessity of a diverting colostomy in patients undergoing neoadjuvant
chemotherapy in asymptomatic patients with an endoscopically obstructing rectal cancer; (S28) a) ascertain benefits
of myocutaneous flap placement in the pelvis, and b) determine whether the benefits of increasing a radical
operation are justified by complication rates of myocutaneous flaps in pelvic exenteration patients; (S29) use an
evidence based approach to the use of selective defunctioning ileostomy in restorative rectal cancer surgery; and
(S30) understand the rate of and risk factors associated with residual disease at colectomy following polypectomy
2-Select patients for colectomy following polypectomy.
Objectives: At the conclusion of this session, participants should be able to: (S31) recognize that disparities in the
utilization of and access to healthcare impact outcomes after surgery for diverticulitis; (S32) a) compare the morbidity
and mortality rates between a Hartmann procedure and a resection with primary anastomosis for left-sided
diverticulitis; and b) analyze safety of resection and primary anastomosis for left-sided perforated diverticulitis;
(S33) describe the utilization frequency of gold standard diagnostic criteria for outpatient diverticulitis; (S34) determine
the efficacy of TGD for pelvic collections in a large colorectal cohort and to assess the risk of subsequent fistula;
(S35) recognize the mode and severity of recurrent sigmoid diverticulitis; (S36) understand that Doppler
assistance has no advantage after suture ligation of hemorrhoids; (S37) understand the LIFT procedure in complex
anorectal fistula's; (S38) understand the anatomy of LIFT failures; and (S39) a) understand the extent of division of
the internal and external anal sphincter during fistulotomy, and b) understand the value of three dimensional
endoanal endosonography in assessing the fistula height and the amount of sphincter divided during fistulotomy.
Objectives: At the conclusion of this session, participants should be able to: (S40) a) treat grade III and IV internal
rectal prolapse; and b) understand differences in functional outcomes after anterior laparoscopic mesh rectopexy
to treat rectal prolapse; (S41) learn short-term results using biological mesh for ventral rectopexy; (S42) evaluate
the results of short- and long-term outcomes for patients with pure slow transit constipation (STC) compared to
those with slow transit and obstructive defecation (STCOD); (S43) recognize the predictors of outcomes and quality
of life (QOL) following overlapping sphincteroplasty (OSR) for fecal incontinence due to obstetric injury; (S44) a)
understand the principles of anal reinforcement procedures (surgery) for fecal incontinence, b) understand the fundamental
differences between the Magnetic Anal Sphincter and the Acticon Neosphincter, and c) understand the
role each of these devices plays in the treatment continuum of fecal incontinence; (S45) identify the role of tibial
nerve stimulation in the treatment of fecal incontinence; (S46) understand the long-term outcomes of sacral nerve
stimulation for fecal incontinence; (S47) determine the most common complications and their management after
treatment of fecal incontinence with sacral nerve stimulation; (S48) analyze the factors that could influence on the
prevalence of posterior pelvic floor dysfunctions in women; and (S49) understand importance of psychological
approach of colorectal disfunctional disorders.
Objectives: At the conclusion of this session, participants should be able to: (S50) a) analyze the long-term outcomes
in stent-laparoscopic surgery compared with open emergency surgery, and b) develop a plan of acute leftcolon
and rectal obstruction with stent-laparoscopic surgery; (S51) evaluate the safety and feasibility of single-port
laparoscopic right hemicolectomy for benign and malignant disease of the right colon; (S52) compare outcomes of
patients after single port vs. multi-port laparoscopic colon surgery; (S53) understand the utility and benefits to
Hybrid Laparoscopic approach to low anterior resection; (S54) assess the role of the laparoscopic approach on
long-term complications in the obese patients randomized to elective right or left hemicolectomy; (S55) a) assess
the most sensitive markers for the learning process for Laparoscopic Total Mesorectal Excision (LTME) in a single
institution including 245 patients; and b) evaluate the effect of surgical volume on short-term outcome using
CUSUM curve; (S56) a) understand the risks and outcomes of laparoscopic colectomy in obese patients, and b)
develop a plan to manage these outcomes; (S57) understand long-term outcomes of patients undergoing combined
endo-laparoscopic surgery for benign colon polyps; (S58) recognize the importance of serrated polyps of the
large bowel as premalignant lesions and be able to optimize their detection on colonoscopy; (S59) understand the
feasibility and safety of advanced endoscopic polypectomy for benign colorectal polyps.
Objectives: At the conclusion of this session, participants should be able to: (S60) a) identify the risk factors for
anastomotic leak in diabetic patients undergoing colectomy, and b) summarize the prevalence and potential outcome
effects of preoperative hyperglycemia in patients undergoing colectomy; (S61) evaluate the short-term outcome
of patients with compromised renal function who underwent colorectal surgery; (S62) understand the
importance of normothermia in the perioperative period and perioperative core body temperature effects outcomes
in the post operative period; (S63) recognize important process and outcome measures in colorectal surgery;
(S64) recognize that the analysis of the AUROC's demonstrates that predictive models for morbidity in
colectomy patients are marginal at best, b) understand that laparoscopy is even less helpful in understanding morbidity
predictor models, and c) appreciate that NSQIP risk models tend to emphasize co-morbidities rather than
intraoperative details and therefore it is possible that the technical aspects of surgery are not adequately modeled
by existing methods; (S65) describe the association between length of hospital stay and readmission rates after
colectomy surgery; (S66) a) determine a patients risk of readmission after colorectal surgery, and b) to identify
strategies to reduce readmission; (S67) identify perioperative risk factors for unplanned return to operating room
following index colorectal surgeries; (S68) a) identify risk of non-restorative procedures in patients with rectal cancer,
and b) delineate risk of death following surgery in patients with rectal cancer; (S69) a) analyze the difference in
outcome among colon cancer among left vs. right sided colon cancer, and b) analyze the difference in outcome
among colon cancer patients, stratified by age, race and gender.
Evidence Based Reviews in Surgery (EBRS), an internet-based journal club, is a joint program of the Canadian Association of General Surgeons and the ACS. The aim of the program is for participants to evaluate the clinical article, further their knowledge about the topic and to learn critical appraisal skills that can be used to evaluate future articles. Each monthly package includes: methodological and clinical articles, reviews completed by methodological and clinical experts and a listserv discussion.
In this symposium, the audience will actively participate in a "typical" EBRS monthly package. Participants will hear what the evidence is, what the experts say, learn how to navigate through the EBRS website, and have an opportunity to discuss the issues with a panel of experts. The specific topic reviewed will be "Should Mesh Be Used to Prevent Parastomal Hernia?"
Objectives: At the conclusion of this session, participants should be able to: a) describe what is Evidence Based
Reviews in Surgery; b) describe the use of EBRS for continuing medical education and journal club activities;
c) navigate the EBRS website; and d) discuss the use of mesh in prevention of parastomal hernias.
Objectives: At the conclusion of this session, participants should be able to: a) describe the importance of professionalism
and communication in the design and delivery of a safe, high-quality, and cost-effective care;
b) describe the importance of professionalism and communication in the attraction, retention and high performance
of physicians and other clinicians; and c) outline an easy-to-use approach to creating a culture with
high regard for professionalism and effective communication.
Objectives: At the conclusion of this session, participants should be able to: a) explain a new randomized international
clinical trial comparing the effectiveness of robotic and laparoscopic surgery for radical rectal cancer
surgery; b) explain the rationale and objectives behind the ACOSOG Z6051 trial comparing laparoscopicassisted
vs. open resection for rectal cancer; c) understand the rationale for proposing a selective use of combined
modality therapy in locally advanced rectal cancer, based on the current available data on the risk of local
or recurrence after complete total mesorectal excision; d) articulate the indications and rationale for the study of
neoadjuvant chemotherapy for locally advanced rectal cancer; e) understand the clinical significance and design
of the ongoing NSABP C-11 trial in advanced colorectal cancer, focusing on the controversies regarding the role
of neoadjuvant and adjuvant chemotherapy in patients undergoing liver resection; f ) discuss the rationale and
objectives behind the CALGB 80702 trial testing both the duration of adjuvant therapy for stage III colon cancer
and the role of celecoxib as adjunctive therapy to improve disease-free survival; g) understand the potential role
of Eflornithine (DFMO)/Sulindac to prevent secondary tumors in the setting of colon cancer and describe the eligibility
criteria, study format, and objectives of S0820; h) understand how longitudinal double-blinded, longterm
studies are constructed and how to engage partners in industry for support and collaboration, and
understand the various factors that may influence surgical site infections in elective colorectal surgery;
and i) provide an overview of a study investigating mechanical bowel preparation.
Objectives: At the conclusion of this session, participants should be able to: a) recognize quality of life outcomes
in regard to bladder and sexual function following robotic rectal surgery; b) identify newer applications
of robotic surgery in the field of MIS colon resection; and c) identify future directions of robotic surgery, applications,
training, and standardization of technique.
Objectives: At the conclusion of this session, participants should be able to: a) identify potential complications
specific to colon and rectal surgery and implement risk modification strategies; b) diagnose and treat sexually
transmitted diseases of the colon, rectum, and anus; c) discuss the evaluation, medical and surgical treatment of
constipation; d) discuss the surgical management of Crohn's disease in the setting of newer medical therapy;
e) demonstrate an understanding of colonoscopy and its use in treatment of colonic pathology; and
f) demonstrate an understanding of the current management of advanced colon and rectal cancer.
Objectives: At the conclusion of this session, participants should be able to understand: a) various laparoscopic
approaches to mobilization of the colon; b) techniques of managing intra-operative complications laparoscopically;
c) techniques of single-site laparoscopic colon surgery; and d) techniques for endoscopic management of
colonic strictures and large colonic polyps not amenable to standard polypectomy.
Objectives: At the conclusion of this session, participants should be able to: a) describe the gross pathologic
features of a proctectomy specimen from a total mesorectal excision; b) describe the pertinent findings of MRI
for rectal cancer; c) discuss the importance of the radial margin in rectal cancer resections; d) discuss the mechanism
for establishing quality measures for surgery for rectal cancer; and e) describe the technique of complete
mesocolic resection for colon cancer.
Objectives: At the conclusion of this session, participants should be able to discuss: a) the appropriate elements
of the history, physical exam, and physiology testing useful in managing patients with obstructed defecation;
b) the useful findings in cinedefecography, dynamic MRI and dynamic US for the evaluation of obstructed defecation
syndrome; c) the usefulness and technique of biofeedback in functional causes of ODS; and d) the technique,
benefits and complications of STARR and transvaginal or transperineal rectocele repair with biologic
mesh for the treatment of ODS.
Objectives: At the conclusion of this session, participants should be able to understand: a) the indications and uses
for advanced endoscopic techniques for polypectomy (submucosal resection, combined laparoscopic and endoscopic
techniques, uses of endoscopic clips); b) the indications, technical aspects and adoption of single incision
laparoscopy; c) the indications, patient benefits, and adoption of robotics in colon and rectal surgery; and d) the
associated procedural and societal costs for laparoscopy and newer technologies in colon and rectal surgery.
Objectives: At the conclusion of this session, participants should be able to: a) discuss the assessment of IBD
disease severity; b) describe the advantages and disadvantages of treating UC patients with biologics or surgery;
c) describe the use of enhanced colonoscopy techniques in the surveillance of patients with long-standing
IBD; and d) describe the management of patients found to have dysplasia or polyps at surveillance colonoscopy
Objectives: At the conclusion of this session, participants should be able to: a) describe the appropriate selection
of patients for stapled hemorrhoidopexy and Doppler-guided hemorrhoid artery ligation; b) describe the most
serious complications of stapled hemorrhoidopexy; c) understand the use of topical agents in the treatment of
anal fissures; and d) understand the role of cutaneous advancement flap for the treatment of anal fissure.
Supported by an educational grant from CareFusion