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Holden JR, McIntosh P, Johnson GGRJ, Park J, Hochman DJ, Vergis A, Yip B, Helewa RM, Hyun E. Routine pathologic evaluation of circular stapler anastomotic rings is not useful after resection for colorectal cancer: retrospective study and systematic review with meta-analysis. BJS Open 2022; 6:6758526. [PMID: 36221190 PMCID: PMC9553864 DOI: 10.1093/bjsopen/zrac122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Circular staplers are commonly used for reconstruction after radical resection for colorectal cancer. Pathological analysis of the anastomotic rings is common practice, although the benefits are unclear. The purpose of this study was to evaluate the usefulness of routine histopathological analysis of anastomotic rings in an original series and in a systematic review of the literature. METHOD The retrospective study was performed at two university-associated academic hospitals in Winnipeg, Canada, including patients investigated for colorectal cancers (within 30 cm of the anal verge) who underwent resection between 2007 and 2020. The systematic review involved Ovid MEDLINE, Embase, Scopus, and Web of Science databases, selecting for adult human studies involving analysis of anastomotic rings in elective colorectal cancer resections. The main outcome measure was the proportion of patients with cancer in the anastomotic ring specimens. The frequency of benign pathology findings and changes to patient management were also examined. RESULTS Out of 673 eligible patients, 487 were included in the retrospective analysis. No patients had cancer within the anastomotic ring specimens. Twenty-five patients (5.1 per cent) had benign pathological findings within the anastomotic ring specimens, and patient management was never affected. In the systematic review, 27 articles were included in the final analysis out of 5848 records reviewed. The rate of cancer within anastomotic ring specimens was 0.34 per cent, and the rate of change in patient management was 0.19 per cent. CONCLUSION The likelihood of finding cancer within anastomotic rings is rare and their histopathological examination seldom changes patient management.
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Affiliation(s)
- James R Holden
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Pam McIntosh
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Garrett G R J Johnson
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
- Clinician Investigator Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Park
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Hochman
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Ashley Vergis
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Benson Yip
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, University of Manitoba and St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Eric Hyun
- Correspondence to: Eric Hyun, St. Boniface Hospital, Z3037–409 Taché Avenue, Winnipeg, Manitoba, Canada (e-mail: )
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Neumann K, Randhawa N, Park J, Hochman DJ. Cost Analysis of Laparoscopic Low Anterior Resection vs. Transanal Endoscopic Microsurgery for Rectal Neoplasms. ACTA ACUST UNITED AC 2021; 28:1795-1802. [PMID: 34064717 PMCID: PMC8161775 DOI: 10.3390/curroncol28030167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
Despite the increasing application of transanal endoscopic microsurgery (TEM) for rectal lesions, the cost of the equipment may play a role in a hospital's hesitancy to invest in the platform. This study compares the cost of TEM to laparoscopic low anterior resection (LAR). Patients who underwent laparoscopic LAR (n = 24) for rectal neoplasm between 2006 and 2014 were case-matched based on sex, age, comorbidities, lesion size and location to patients who underwent TEM at a busy secondary care urban hospital. Procedure-related costs and costs associated with readmissions for complications and related subsequent surgeries in the first 3 years were calculated. There were 42 hospital admissions for 24 LAR patients, totalling 326 hospital days. For 24 TEM patients, there were 25 hospital admissions, totalling 56 hospital days. Subsequent operations for LAR patients included 2 washout and diverting ileostomies (8%), 2 adhesionolysis (8%), 4 ventral hernia repairs (16%) and 11 ileostomy reversals (46%). In the TEM group, there was one operation for recurrence (4%). The mean cost of LAR, including all related hospital costs in the subsequent 3 years, was CAD 14,851 (95% CI: CAD 10,124-19,579). The mean cost of TEM was CAD 2449 (95% CI: CAD 2133-2767; p < 0.0001), with a savings of CAD 12,402 per patient. TEM for rectal neoplasm is associated with significantly lower hospital costs, which far outweigh the costs of acquiring and maintaining the technology.
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Affiliation(s)
- Katerina Neumann
- Division of General Surgery, Dalhousie University, 8-819 Victoria Building, VGH, 1276 South Park Street, Halifax, NS B2H 2Y9, Canada
- Correspondence: ; Tel.: +1-902-473-3937
| | - Nirmal Randhawa
- Faculty of Medicine, University of Manitoba, 750 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada;
| | - Jason Park
- Division of General Surgery, Vancouver General Hospital, 5th Floor—2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada;
| | - David J. Hochman
- Division of General Surgery, University of Manitoba, St. Boniface Clinic, 343 Tache Avenue, Winnipeg, MB R2H 2A5, Canada;
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Kennecke HF, Brown CJ, Auer R, Drolet S, Eng C, Gordon VL, Hochman DJ, Moloo H, Wei AC, Chan K, Montenegro A, Loree JM, Tu D, Jonker DJ. CO.28: Neoadjuvant Chemotherapy, Excision and Observation ( NEO) for early rectal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.tps724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS724 Background: CO.28 is a phase II study which aims to determine if patients with stage I/II rectal cancer can be treated with induction chemotherapy (FOLFOX/CAPOX) and organ-preserving transanal microsurgery. Prior studies have explored the use of pelvic chemoradiation followed by transanal microsurgery as a means to increase organ preservation. However, pre-operative radiation may have acute and prolonged impacts such as wound complications and adverse on sphincter, sexual and urinary function. Moreover, patients who develop recurrence following this strategy are difficult to salvage as re-irradiation is not usually an option. There is virtually no prospective experience of neoadjuvant FOLFOX/CAPOX chemotherapy and excision for early rectal tumors. Methods: The primary objective is to determine the rate of organ preservation and the trial will be successful if more than 65% of patients avoid a formal rectal resection. In this two-staged phase II trial, patients are eligible if they have clinical N0 and T1-T3a/bN0M0 rectal tumors and no pathologic high risk features. After 6 cycles of q2weekly FOLFOX or 4 cycles of CAPOX, rectal endoscopy and pelvic MRI are repeated and if there is evidence of tumor response, patients proceed to tumor excision by Transanal Endoscopic Microsurgery (TEMS) or Transanal Minimally Invasive Surgery (TAMIS). It is required that participating surgeons have a minimum experience of 20 TEMS/TAMIS procedures and they are asked to submit an unedited video for central review. Pathologic ypT0 or ypT1N0 tumors are assigned to observation while ypT2+ or any ypN+ tumors are treated with radical surgery and total mesorectal excision (TME). Pre-operative pelvic radiation is suggested only for ypT3+ or node positive tumors. Endoscopic and cross-sectional imaging is repeated every 4-6 months for 36 months. Circulating tumor DNA (ctDNA) will be correlated with tumor response and relapse. A total of 58 patients will be accrued. Study Progress: The study was activated in Canada in late 2017 and at select US Cancer Centers in 2018, with total accrual to date of 4 patients. (NCT03259035) Clinical trial information: NCT03259035.
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Affiliation(s)
| | - Carl J Brown
- Providence Health-St. Paul's Hospital, Vancouver, BC, Canada
| | | | | | - Cathy Eng
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Alice C Wei
- University Health Network, Toronto, ON, Canada
| | | | - Alexander Montenegro
- NCIC Clinical Trials Group, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | | | - Dongsheng Tu
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - Derek J. Jonker
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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4
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Delisle ME, Helewa R, Park J, Hochman DJ, McKay A. Wait times for colorectal cancer patients in a universal healthcare system over a decade: Is it sustainable? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
697 Background: Delays in treatment for colorectal cancer (CRC) may worsen prognosis and increase patient anxiety. This study aims to understand population-based trends and variations in wait times (WTs) for CRC in a universal healthcare system over a decade. Methods: Patients diagnosed with stage I-IV CRC in Manitoba, Canada between 2004 and 2014 were included. Data were obtained through province-wide administrative claims and cancer registry. WTs were defined as time from index contact to pathological diagnosis (diagnosis WT), time from pathological diagnosis to first treatment (treatment WT) and total (diagnosis + treatment WT). Index contact was the consult preceding the first gastrointestinal investigation in the year preceding the date of diagnosis. First treatment was radiation, chemotherapy or surgery. The association between WTs and year of diagnosis was estimated using Negative Binomial regression and reported as incidence rate ratio (IRR). Variability in WTs by year were estimated using the Coefficient of Variation (CV) and average annual percent change (AAPC). A CV > 100 indicates high-variability and < 100 indicates low-variaability. Results: A total of 5359 patients were diagnosed with CRC (1802 rectal vs 3557 colon). WTs increased overall. Total WTs for rectal cancer increased by 6% (IRR 1.06, 95% CI 1.04-1.07, p < 0.01) per year from a median of 90 days in 2004 to 147 days in 2014. This was due increases in time to diagnosis (IRR 1.07, 95% CI 1.06-1.09, p < 0.01) and treatment (IRR 1.04, 95% CI 1.03-1.06, p < 0.01). Total colon cancer WTs increased an estimated 5% (IRR 1.05, 95% CI 1.04-1.06, p < 0.01) per year from a median of 89 days in 2004 to 110 days in 2014. This was due to both time to diagnosis (IRR 1.05, 95% CI 1.04-1.07, p < 0.01) and treatment (IRR 1.03, 95% CI 1.02-1.04, p < 0.01). There was increasing variability in total WTs. The CV increased from 87 in 2004 to 102 in 2014 in rectal cancer (AAPC +3.85%) and from 86 in 2004 to 128 in 2014 in colon cancer (AAPC + 5.04%). Conclusions: Total WTs for CRC in Manitoba have increased from 2004 and 2014. This may reflect the growing challenges in providing increasingly complex cancer care to geographically dispersed populations in a universal healthcare system.
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Affiliation(s)
| | | | - Jason Park
- University of Manitoba, Winnipeg, MB, Canada
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Delisle M, Helewa R, Hochman DJ, Park J, McKay A. Impact of Neoadjuvant Chemoradiation and Centralization of Rectal Cancer Care: A Retrospective Cohort Study. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Maniar RL, Sytnik P, Wirtzfeld DA, Hochman DJ, McKay AM, Yip B, Hebbard PC, Park J. Synoptic operative reports enhance documentation of best practices for rectal cancer. J Surg Oncol 2015; 112:555-60. [DOI: 10.1002/jso.24039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/25/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Reagan L. Maniar
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | - Peter Sytnik
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | | | - David J. Hochman
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | - Andrew M. McKay
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | - Benson Yip
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | - Pamela C. Hebbard
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
| | - Jason Park
- Department of Surgery; University of Manitoba; Winnipeg Manitoba Canada
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Neumann K, Mahmud SM, McKay A, Park J, Metcalfe J, Hochman DJ. Is obesity associated with advanced stage or grade of colon cancer? Can J Surg 2015; 58:140-2. [PMID: 25598175 DOI: 10.1503/cjs.004414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Population-based studies from Europe have suggested that obesity is associated with more advanced stage colorectal cancer on presentation. Obesity is an even more prevalent issue in North America, but comparable data on associations with cancer are lacking. We reviewed the cases of 672 patients with colon cancer diagnosed between 2004 and 2008 in the province of Manitoba who underwent surgical resection at a Winnipeg Regional Health Authority–affiliated hospital. We tested if obesity was associated with more advanced cancer stage or grade. On multivariate analysis, after adjusting for age, sex,tumour location and socioeconomic status, we were unable to show any significant associations between body mass index of 30 or more and advanced stage or grade cancer on presentation. The reasons for the lack of association are likely multifactorial, including the pathophysiology of the disease and process factors, such as screening habits and colonoscopic diagnostic success rates in obese patients.
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Affiliation(s)
- Katerina Neumann
- The Department of Surgery, University of Manitoba, Winnipeg, Man
| | - Salaheddin M Mahmud
- The Department of Community Health Sciences, University of Manitoba, and Cancer Care Manitoba, Winnipeg, Man
| | - Andrew McKay
- The Department of Surgery, University of Manitoba and Cancer Care Manitoba, Winnipeg, Man
| | - Jason Park
- The Department of Surgery, University of Manitoba and Cancer Care Manitoba, Winnipeg, Man
| | | | - David J Hochman
- The Department of Surgery, University of Manitoba and Cancer Care Manitoba, Winnipeg, Man
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Nostedt MC, McKay AM, Hochman DJ, Wirtzfeld DA, Yaffe CS, Yip B, Silverman R, Park J. The location of surgical care for rural patients with rectal cancer: patterns of treatment and patient perspectives. Can J Surg 2015; 57:398-404. [PMID: 25421082 DOI: 10.1503/cjs.002514] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Where cancer patients receive surgical care has implications on policy and planning and on patients' satisfaction and outcomes. We conducted a population- based analysis of where rectal cancer patients undergo surgery and a qualitative analysis of rectal cancer patients' perspectives on location of surgical care. METHODS We reviewed Manitoba Cancer Registry data on patients with colorectal cancer (CRC) diagnosed between 2004 and 2006. We interviewed rural patients with rectal cancer regarding their preferences and the factors they considered when deciding on treatment location. Interview data were analyzed using a grounded theory approach. RESULTS From 2004 to 2006, 2086 patients received diagnoses of CRC in Manitoba (colon: 1578, rectal: 508). Among rural patients (n = 907), those with rectal cancer were more likely to undergo surgery at an urban centre than those with colon cancer (46.5% v. 28.8%, p < 0.001). Twenty rural patients with rectal cancer participated in interviews. We identified 3 major themes from the interview data: the decision-maker, treatment factors and personal factors. Participants described varying input into referral decisions, and often they did not perceive a choice regarding treatment location. Treatment factors, including surgeon factors and hospital factors, were important when considering treatment location. Personal factors, including travel, support, accommodation, finances and employment, also affected participants' treatment experiences. CONCLUSION A substantial proportion of rural patients with rectal cancer undergo surgery at urban centres. The reasons are complex and only partly related to patient choice. Further studies are required to better understand cancer system access in geographically dispersed populations and to support cancer patients through the decision-making and treatment processes.
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Affiliation(s)
| | - Andrew M McKay
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - David J Hochman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | | | - Clifford S Yaffe
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - Benson Yip
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - Richard Silverman
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
| | - Jason Park
- From the Department of Surgery, University of Manitoba, Winnipeg, Man
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Maniar RL, Hochman DJ, Wirtzfeld DA, McKay AM, Yaffe CS, Yip B, Silverman R, Park J. Documentation of Quality of Care Data for Colon Cancer Surgery: Comparison of Synoptic and Dictated Operative Reports. Ann Surg Oncol 2014; 21:3592-7. [DOI: 10.1245/s10434-014-3741-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Indexed: 12/17/2022]
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Abstract
BACKGROUND In the spring of 2008, St. Boniface General Hospital in Winnipeg, Man., created an acute care surgical service (ACSS) designed to improve care for emergent, nontrauma surgical patients. We sought to assess the effect of the ACSS on patient care timeliness. METHODS We retrospectively examined the time intervals in care for patients admitted with acute appendicitis, acute cholecystitis and small bowel obstruction in 3 study periods: pre-ACSS, newly formed ACSS and established ACSS. RESULTS There was a 2-fold increase in patient volume after the ACSS was created. Patient characteristics were similar in all 3 groups. Time from triage to surgical consultation was also similar. The ACSS significantly reduced the duration of the surgical consultation (1 h 43 min in period 1 v. 62 min in period 2 and 49 min in period 3, p = 0.029). Time from admission to operation was similar despite a significant increase in patient load after the ACSS was created. Total length of hospital stay was similar except in the subgroup analysis (appendicitis + cholecystitis only), where the length of stay was reduced after creation of the ACSS (2 d 15 h pre- v. 1 d 19 h post-ACSS, p = 0.009). Most operations occurred between 4 pm and midnight. CONCLUSION With the implementation of an ACSS, the number of surgical patients assessed and treated doubled. Despite the increased volume, consultations were completed significantly faster, there was no significant difference in time to operation, and on subgroup analysis length of hospital stay was significantly faster.
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Affiliation(s)
- Andrea M Faryniuk
- Department of Surgery, University of Manitoba, Winnipeg, Man., Canada.
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11
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Helewa RM, Kholdebarin R, Hochman DJ. Attending surgeon burnout and satisfaction with the establishment of a regional acute care surgical service. Can J Surg 2012; 55:312-6. [PMID: 22854111 DOI: 10.1503/cjs.000611] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Establishment of the Acute Care Surgical Service (ACSS) has dramatically changed the management of acute, nontrauma surgical patients in Winnipeg, Manitoba. Its formation was partially driven by increasing strain on surgeons and surgical services. We sought to determine surgeon level of burnout and satisfaction with the ACSS. METHODS All Winnipeg ACSS surgeons were mailed surveys. Burnout was established using the Maslach Burnout Inventory Human Services Survey. Satisfaction was ascertained with a series of questions. RESULTS We attained a response rate of 76%. Most surgeons were married men with children. A burnout level of 61% was determined. Although most surgeons felt the ACSS was a positive change in their careers, they felt that operating room accessibility and teaching opportunities were lacking. CONCLUSION Although a high level of burnout exists among ACSS surgeons, most are satisfied with its establishment. Factors such as operating room accessibility and teaching opportunities must be addressed.
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Affiliation(s)
- Ramzi M Helewa
- The Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Helewa RM, Turner D, Park J, Wirtzfeld D, Czaykowski P, Hochman DJ, Singh H, Shu E, McKay A. Longer waiting times for colorectal cancer surgery are not associated with decreased survival. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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Kholdebarin R, Helewa RM, Hochman DJ. Evaluation of a regional acute care surgery service by residents in general surgery. J Surg Educ 2011; 68:290-293. [PMID: 21708365 DOI: 10.1016/j.jsurg.2011.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/20/2011] [Accepted: 03/04/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND Acute care surgery (ACS) services dedicated to care of acute general surgery patients have been established in many tertiary centers across Canada. Little is known about the impact of this trend on postgraduate education. In this study we aimed to evaluate ACS through a cross-sectional survey of general surgery residents in Winnipeg, Manitoba. METHODS General surgery residents at the University of Manitoba were asked to complete an anonymous survey. Basic demographic data were obtained. The educational value of ACS was assessed using 10 statements derived from the CanMEDS framework for training physicians. Resident burnout was measured using the Maslach Burnout Inventory, on emotional exhaustion, depersonalization, and personal accomplishment. RESULTS The response rate was 70% (14/20). ACS was evaluated positively based on the CanMEDS roles by the following proportions of responders: surgical skills (79%), clinical knowledge (100%), communicator (100%), collaborator (100%), manager (86%), health advocate (100%), scholar (64%), and professional (93%). Fifty percent of responders had a high score on emotional exhaustion, 43% on depersonalization, and 0% on low sense of personal accomplishment. The overall burnout was 64%. CONCLUSIONS ACS provides a comprehensive clinical experience based on the CanMEDS competencies. Despite an increased sense of personal accomplishment, residents experienced a high incidence of burnout, as demonstrated by high scores on emotional exhaustion and depersonalization of patients.
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Affiliation(s)
- Ramin Kholdebarin
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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Hochman DJ, Nivatvongs S, Selvasekar CR, Tantitemit T. The Noble plication: new indication for a historical procedure. Tech Coloproctol 2007; 11:152-4. [PMID: 17510738 DOI: 10.1007/s10151-007-0347-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Received: 10/03/2006] [Accepted: 11/01/2006] [Indexed: 10/23/2022]
Abstract
Complications following ileal pouch-anal anastomosis (IPAA) have been well-described in the literature. While rare, small bowel volvulus following IPAA has been described. We describe the successful use of the modified Noble plication in such a patient with small bowel volvulus about an elongated mesentery. This largely 'historical' technique is well-suited to manage small bowel volvulus, especially when non-resectional management is preferred.
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Affiliation(s)
- D J Hochman
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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15
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Hochman DJ, Pemberton JH. Hand-assisted Laparoscopic Total Proctocolectomy and Ileal Pouch-Anal Anastomosis After Liver Transplant for Primary Sclerosing Cholangitis. Surg Laparosc Endosc Percutan Tech 2007; 17:56-7. [PMID: 17318059 DOI: 10.1097/01.sle.0000213764.48052.f1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 12/22/2022]
Abstract
Chronic ulcerative colitis (CUC) is associated with extraintestinal manifestations such as primary sclerosing cholangitis (PSC). The onset of PSC can precede the diagnosis of CUC, and require liver transplantation in some patients. Surgical management of CUC posttransplant has traditionally been open total proctocolectomy and ileal pouch-anal anastomosis. Herein, we present a case of a woman with a previous liver transplant for PSC who subsequently developed CUC with dysplasia, successfully treated with hand-assisted laparoscopic total proctocolectomy and ileal pouch-anal anastomosis. Hand-assisted laparoscopic surgery is an excellent option for patients with previous complex abdominal surgery. It can be performed safely and expediently, providing the benefits of reduced hospital stay and early return of bowel function.
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Affiliation(s)
- David J Hochman
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo College of Medicine, Rochester, MN.
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Selvasekar CR, Hochman DJ, Larson DW. Capsule endoscopy: A note of caution. Surgery 2007; 141:123-4. [PMID: 17188180 DOI: 10.1016/j.surg.2006.07.046] [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] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Revised: 07/21/2006] [Accepted: 07/28/2006] [Indexed: 11/24/2022]
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