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MRI is the preferred imaging modality for primary staging of rectal cancer, used to guide treatment. Patients identified with clinical stage I disease receive upfront surgical resection; those with clinical stage II or greater undergo upfront neoadjuvant therapy. Although clinical under-/over-staging may have consequences for patients and presents opportunities for organ preservation, the correlation between clinical and pathologic staging in routine clinical practice within a single institute has not been fully established. This retrospective, Institutional Review Board-approved study, conducted at a National Cancer Institute-Designated Comprehensive Cancer Center with a multi-disciplinary rectal cancer disease center, included patients undergoing rectal MRI for primary staging January 1, 2018-August 30, 2020. Data collection included patient demographics, initial clinical stage via MRI report, pathologic diagnosis, pathologic stage, and treatment. The primary outcome was concordance of overall clinical and pathologic staging. Secondary outcomes included reasons for mismatched staging. A total 105 rectal adenocarcinoma patients (64 males, mean age 57 ± 12.7 years) had staging MRI followed by surgical resection. A total of 28 patients (27%) had mismatched under-/over- staging. Ten patients (10%) were understaged with mismatched T stage group (clinical stage I, pathologic stage II), five (5%) were understaged with mismatched N stage group (clinical stage I, pathologic stage III), and 13 (12%) were overstaged (clinical stage II-III, pathologic stage 0-I). Treatment matched concordance between clinical and pathologic stages was 86%. MRI for primary rectal cancer staging has high concordance with pathology. Future studies to assess strategies for reducing clinically relevant understaging would be beneficial. [ABSTRACT FROM AUTHOR]

High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus on the ideal flap choice or patient for whom this is necessary. This study aimed to evaluate the long-term outcomes of using pedicled gracilis flaps for pelvic reconstruction and to analyze predictors of postoperative complications. This was a retrospective review of a single reconstructive surgeon's cases between January 2012 and June 2021 identifying patients who underwent perineal reconstruction secondary to oncologic resection. Preoperative and outcome variables were collected and analyzed to determine the risk of developing minor and major wound complications. A total of 101 patients were included in the study with most patients (n = 88) undergoing unilateral gracilis flap reconstruction after oncologic resection. The mean follow-up period was 75 months. Of 101 patients, 8 (7.9%) developed early major complications, and an additional 13 (12.9%) developed late major complications. Minor complications developed in 33 patients (32.7%) with most cases being minor wound breakdown requiring local wound care. Most patients (n = 92, 91.1%) did not develop donor site complications. Anal cancer was significantly associated with early major complications, whereas younger age and elevated body mass index were significant predictors of developing minor wound complications. This study builds on our previous work that demonstrated the long-term success rate of gracilis flap reconstruction after large pelvic oncologic resections. A few patients developed donor site complications, and perineal complications were usually easily managed with local wound care, thus making the gracilis flap an attractive alternative to abdominal-based flaps. [ABSTRACT FROM AUTHOR]

This article presents a mixed methods study that aimed to assess the values and goals of patients with rectal cancer regarding their treatment. The study utilized both quantitative and qualitative data collection methods, including a questionnaire and semi-structured interviews. The results showed that the primary goal for patients was cancer control and cure, with functional outcomes being viewed as secondary goals. Patients expressed a willingness to compromise on functional outcomes if it meant prolonging their survival. The study emphasizes the importance of considering patient values and goals when discussing treatment options and promoting shared decision-making. [Extracted from the article]

The ongoing Russia-Ukraine war has significantly increased trauma related civilian injuries and deaths at the front lines and throughout Ukraine. Early assessments identified an immediate need for trauma education and training among first responders due to the rapidly rising trauma volume and strained prehospital resources. In response, an academic-non-governmental organization was formed to develop, and deliver, a live in-person prehospital training course throughout Ukraine. To determine the impact of targeted needs-based training on first responder preparedness, knowledge, and confidence to manage trauma patients. A new 16-hour course containing lectures, skills stations, case studies, and simulation called Prehospital Trauma Fundamentals (PHTF) was developed using needs assessments and international training standards. Course materials were translated into Ukrainian, and courses were taught with live bidirectional interpretation as required. 10 courses were taught from August-November 2022 by both non-Ukrainian and Ukrainian instructors. Pre- and post- knowledge and self-confidence assessments measured course effectiveness. Six-to-eight-week follow-up surveys were also distributed. Data were analyzed using McNemar's test for paired data and Wilcoxon matched-pairs signed-rank test. This project was determined to not require Institutional Review Board approval by the Mass General Brigham Office of Human Research Affairs. 268 first responders were trained in Kyiv, Dnipro, Odessa, and Zaporizhzhia. Participants were predominantly female (65%), median age was 35yrs. Of 193 matched re-to post-course knowledge assessments, scores increased from 53.4%[SD15.4%] to 74.4%[SD15.6%](p<0.001). Assessment scores increased for most participants (93.3%). Self-confidence surveys demonstrated improved comfort handling trauma patients (71.7%v83.3%;p<0.001), preparedness to manage life-threatening conditions (46.1%v66.1%;p<0.0001), and belief in an organized approach to trauma care (59.2%v90.5%;p<00001). Nervousness decreased (63.1%v52.5%;p<0.05) and sense of skill deficit decreased (79.0%v33.7%;p<0.0001). 59 (22.0%) participants completed the follow-up survey; 100% stated the training has or will have a life-saving effect in their patient management. Most (62.7%) had already applied course skills and taught (64.4%) others course skills or information. PHTF increased participant knowledge, preparedness, and confidence to care for trauma patients. Participants successfully applied information taught during the ongoing conflict, which suggests value in delivering targeted educational programs just before or during large-scale events. This course and lessons learned from its development and delivery can serve as a starting point for delivering first responder trauma education in other conflict and austere settings. Additional training through this project remains ongoing. [ABSTRACT FROM AUTHOR]

Individual participants expressed overlapping leadership styles, with I servant i and I transformational i leadership expressed by all 20 participants. I Leadership training i emerged as an additional theme, characterized by descriptions of formal and informal leadership training and by timing of leadership experiences, as either "early" or "late", that promoted leadership development. Women remain under-represented in academic surgery leadership positions, as is evidenced by the declining proportion of female faculty in ascending academic ranks, distributed as follows as of 2020: 60.7% of instructors, 30.2% of assistant professors, 23.1% of associate professors, and 13.5% of professors.[1] In 2020, women represented 8.7% of surgical department chairs in the USA.[2] We aimed to identify leadership styles and characteristics among female surgical chairs. [Extracted from the article]

Background: Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals. Methods: This was a retrospective cohort study using the National Cancer Database to identify patients with malignant peritoneal mesothelioma from 2004 to 2016. Patients were divided according to treating facility type: academic or community. Outcomes were assessed using log-rank tests, Cox proportional-hazard modeling, and Kaplan-Meier survival statistics. Results: In total, 2682 patients with malignant peritoneal mesothelioma were identified. A total of 1272 (47.4%) were treated at an academic facility and 1410 (52.6%) were treated at a community facility. Five hundred forty-six (42.9%) of patients at academic facilities underwent debulking or radical surgery compared to 286 (20.2%) at community facilities. Three hundred sixty-six (28.8%) of patients at academic facilities received chemotherapy on the same day as surgery compared to 147 (10.4%) of patients at community facilities. Unadjusted 5-year survival was 29.7% (95% CI 26.7–32.7) for academic centers compared to 18.3% (95% CI 16.0–20.7) for community centers. In multivariable analysis, community facility was an independent predictor of increased risk of death (HR: 1.19, 95% CI 1.08–1.32, p = 0.001). Conclusions: We demonstrate better survival outcomes for malignant peritoneal mesothelioma treated at academic compared to community facilities. Patients at academic centers underwent surgery and received chemotherapy on the same day as surgery more frequently than those at community centers, suggesting that malignant peritoneal mesothelioma patients may be better served at experienced academic centers. [ABSTRACT FROM AUTHOR]

Background: Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer. Methods: Using data from the National Cancer Database, we included all patients with complete baseline information who underwent proctectomy for non-metastatic rectal cancer between 2004 and 2016. Facility volume was defined as the number of rectal cancer cases managed at the treating center in the calendar year prior to the patient's surgery. Overall survival estimates were obtained for facility volumes ranging from 10 to 100 cases/year. Follow-up began on the day of surgery and continued until loss to follow-up or death. Results: A total of 52,822 patients were eligible. Patients operated on at hospitals with volumes of 10, 30, and 50 cases/year had similar distributions of grade, clinical stage, and neoadjuvant therapies. 1-, 3-, and 5-year survival all improved with increasing facility volume. One-year survival was 94.0% (95% CI: 93.7, 94.3) for hospitals that performed 10 cases/year, 94.5% (95% CI: 94.2, 94.7) for 30 cases/year, and 94.8% (95% CI: 94.5, 95.0) for 50 cases/year. Five-year survival was 68.9% (95% CI: 68.0, 69.7) for hospitals that performed 10 cases/year, 70.8% (95% CI: 70.1, 71.5) for 30 cases/year, and 72.0% (95% CI: 71.2, 72.8) for 50 cases/year. Conclusions: Treatment at a higher volume facility results in improved survival following proctectomy for rectal cancer, though the small benefits are less profound than previously reported. [ABSTRACT FROM AUTHOR]

Results Colon Cancer A total of 33,038 colon cancer patients with isolated liver metastases were included (31.3% academic, 68.7% community). Keywords: Colorectal cancer; Liver metastases; Survival EN Colorectal cancer Liver metastases Survival 209 213 5 01/17/22 20220101 NES 220101 Introduction Colorectal cancer is the third leading cause of cancer-related deaths in the USA. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. [Extracted from the article]

Background: Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities. Methods: The NCDB was queried (2004–2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility. Results: A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61–0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70–0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14–1.26 p < 0.001). Conclusions: Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care. [ABSTRACT FROM AUTHOR]

Background: The evaluation of lymph nodes in rectal cancer dictates treatment. The goals of this study are to characterize the contemporary rate of lymph node metastasis in early stage rectal cancer and to re-investigate histologic factors that predict positive lymph nodes. Materials and Methods: Using the National Cancer Database, we identified patients with clinical stage I rectal adenocarcinoma. Multivariable logistic regression was used to determine risk factors for lymph node positivity. Results: 12.2% of patients with T1 tumors and 18.0% of patients with T2 tumors had positive lymph nodes. For T1 tumors, positive lymph nodes were present in 9.3% with neither poor differentiation nor lymphovascular invasion (LVI), 17.3% with poor differentiation alone, 34.7% with LVI alone, and 45.0% with both poor differentiation and LVI. For T2 tumors, positive lymph nodes were present in 11.7% with neither poor differentiation nor LVI, 25.3% with poor differentiation alone, 47.3% with LVI alone, and 41.5% with both poor differentiation and LVI. LVI was an independent predictor of positive lymph nodes (OR;4.75,95%CI;3.17–7.11,p < 0.001) for T1 and (OR;6.20,95%CI;4.53–8.51,p < 0.001) T2 tumors. Conclusions: T1/T2 tumors have higher rates of positive lymph nodes when poor differentiation and LVI are present. These results should be taken into consideration prior to surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Primary small bowel non-Hodgkin's lymphoma is a rare disease representing 2% of small intestine malignancies. There is limited data delineating the optimal treatment for these heterogeneous tumors. We aim to examine relationships between different treatment modalities and surgical outcomes in patients with small bowel lymphoma. Materials and Methods: Patients diagnosed with stage I–III small bowel lymphoma in 2004–2015 who underwent surgery were identified in the National Cancer Database. Two cohorts were created based on systemic chemotherapy treatment status. The primary outcome was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival. Results: 2283 patients met inclusion criteria Of these patients, 826 patients (36%) underwent surgical resection alone, and 1457 patients (64%) underwent resection with systemic chemotherapy. Chemotherapy was associated with improved overall survival in unadjusted (5-year overall survival, 55% versus 70%) and adjusted analysis (HR 0.54, 95% CI 0.47–0.63, p < 0.001). Discussion: Patients with small bowel lymphoma have a low five-year overall survival after surgery. Chemotherapy is associated with improved survival, although one third of patients do not receive this therapy. Several other clinical factors are identified that are also associated with overall survival, including histology subtype, margin status, age, and medical comorbidities. This information can help with prognostication and potentially aid in treatment decision-making. [ABSTRACT FROM AUTHOR]

Women are underrepresented as recognition award recipients across several medical specialties. This phenomenon has not been investigated in surgery. This study investigates the prevalence of female award recipients among the major American surgical societies. Publicly available lists of surgical society award recipients from 1998 to 2017 were analyzed. Awards intended primarily for physicians presented a minimum of five times were included. The primary outcome was the percentage of award recipients who were female. Trainee-specific and nontrainee-specific percentages of female award winners were compared with national percentages of female surgeons. Analysis was performed for awards based on the type of award (achievement, research, and service). Society-specific analyses were performed. Of the 1,222 awards presented by 20 societies studied, 420 (25.6%) were awarded to women. A total of 37.7% of trainee-specific awards and 20.6% of nontrainee-specific awards were presented to women. Women received 12.9% of achievement, 29.9% of research, and 24.0% of service awards. Society-specific rates of female award recipients ranged from 5.3% to 50.0%. Overall, female trainees are proportionately represented as winners of awards from surgical societies, but nontrainees receive a disproportionately higher percentage of awards as compared with the national rates of female surgeons. However, there is significant variation among societies. Further research is warranted to elucidate why this variation exists and what can be done to remedy it. [ABSTRACT FROM AUTHOR]

Appendectomy is the most commonly performed emergency operation in the United States, with approximately 370,000 patients undergoing the procedure every year. Although laparoscopic appendectomy is associated with decreased complications when compared with open appendectomy, the risk for infectious complications, including surgical site infection, intra-abdominal abscess, and sepsis, remains a significant source of postoperative morbidity and health care cost. The goal of this study is to determine whether the appendix retrieval technique during laparoscopic appendectomy affects risk of infectious complications. The American College of Surgeons National Surgical Quality Improvement Program database and the Appendectomy Procedure Targeted database were used to conduct this retrospective study. Patients who underwent laparoscopic appendectomy in 2016 were identified. The primary outcomes were infectious complications of superficial site infection and intra-abdominal abscess. A total of 10,578 (92.2%) patients underwent laparoscopic appendectomy using an appendix retrieval bag and 897 (7.8%) patients underwent laparoscopic appendectomy without an appendix retrieval bag. There was no significant difference in preoperative sepsis, smoking status, wound class, complicated appendicitis, or American Society of Anesthesiologists class between patient groups (all P >.05). In the univariate analysis, there was no difference in the rate of superficial site infection (0.9% vs 0.6%, P =.28) or intra-abdominal infection (2.7% vs 3.8%, P =.06) between retrieval bag use and non-use. In the multivariable analysis, appendix retrieval bag use was an independent predictor of intra-abdominal infection and associated with a 40% decrease in intra-abdominal infection rates (odds ratio: 0.6, 95% confidence interval: 0.42–0.95, P =.03). Appendix retrieval bags are associated with a decreased risk of postoperative intra-abdominal abscess. The use of appendix retrieval bags should be the standard of care during laparoscopic appendectomy. [ABSTRACT FROM AUTHOR]

Abstract Background The rate of unplanned reoperation for rectal cancer can provide information about surgical quality. We sought to determine factors associated with unplanned reoperation after low anterior resection and abdominoperineal resection for patients with rectal cancer and outcomes after these reoperations. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to conduct this retrospective study. Patients who underwent elective low anterior resection and abdominoperineal resection for rectal cancer from 2012–2014 were identified. The primary outcomes were 30-day reoperation rates and postoperative complications. Results A total of 454 low anterior resection patients (5.9%) and 289 abdominoperineal resection patients (8.1%) required reoperation within 30 days of their index operation. The most common reasons for reoperation were infection, bleeding, and bowel obstruction. Multivariate analysis revealed that male sex (odds ratio: 1.5, P =.001), poor functional status (odds ratio: 2.2, P =.04), operative time (odds ratio: 1.001, P =.01), low preoperative albumin (odds ratio: 0.79, P =.04), and lack of ostomy (odds ratio, 0.66, P =.005) were independent risk factors for reoperation after low anterior resection. Smoking (odds ratio: 1.7, P =.001), chronic obstructive pulmonary disease (odds ratio: 1.8, P =.03), poor functional status (odds ratio: 2.1, P =.032), operative time (odds ratio: 1.003, P <.001), low preoperative albumin (odds ratio: 0.69, P =.007), and open approach (odds ratio: 1.5, P =.02) were independent risk factors for reoperation after abdominoperineal resection. Postoperative complication rates are high for those undergoing reoperation, often leading to non-home discharge (P <.001) after reoperation. Conclusion Reoperation after low anterior resection and abdominoperineal resection for rectal cancer is not uncommon. This study highlights the indications for reoperation, potentially modifiable preoperative risk factors for reoperation, and the morbidity associated with such operations. [ABSTRACT FROM AUTHOR]

Abstract Anal squamous cell carcinoma (SCC) is a rare cancer and accounts for approximately 4% of all cancers of the lower alimentary tract. The dominant etiology is infection with human papilloma virus (HPV), which is the most common sexually transmitted disease in the United States. Integration of HPV DNA into the host genome seems to be the driving mechanism behind carcinogenesis. Vaccines directed against oncogenic HPV serotypes exist, and their utility for preventing anal neoplasia is under investigation. Additional risk factors for developing SCC include HIV infection, anal receptive intercourse, smoking, and immunosuppression. Patients with known anal intraepithelial neoplasia (AIN) must be carefully screened with periodic digital rectal exam and anoscopy. The most common presenting symptom is bleeding, with up to one third of patients presenting asymptomatic. Once tissue diagnosis is made, staging of primary tumor is accomplished with either MRI or transanal ultrasound. Distant disease is evaluated with CT of chest abdomen and pelvis vs whole body PET/CT. The gold standard treatment for stage I-III disease remains the Nigro protocol, first described in 1974. Stage I disease not involving sphincter may be treated with local excision. Distant disease is treated with systemic chemotherapy with radiation reserved for locoregional symptoms. Careful surveillance is mandatory after completion of chemoradiation. Salvage abdominoperineal resection can achieve locoregional control in up to 77% of patients with persistent or recurrent disease. Morbidity is high, mostly owing to wound complications, and as such a flap reconstruction of the perineum is warranted. [ABSTRACT FROM AUTHOR]

More than a billion people live in fragile, conflict-affected, and vulnerable settings requiring humanitarian support, where cancer is a substantial health issue. Despite its substantial effect on populations, cancer care remains underprioritised in emergency preparedness and response frameworks and humanitarian operational planning. This Policy Review summarises the perspectives and actionable recommendations from the First Global High-Level Technical Meeting on Non-communicable Diseases in Humanitarian Settings, with a focus on cancer. The paper highlights the challenges of providing cancer care in fragile, conflict-affected, and vulnerable settings and proposes a comprehensive roadmap to address both immediate and long-term needs of patients with cancer living in these settings. Key solutions include: integrating the cancer care continuum into national preparedness and response plans to enhance health-care system resilience; integrating cancer into humanitarian responses efforts; addressing the specific needs of paediatric patients with cancer; improving cancer intelligence and surveillance systems; and developing strategies to navigate the logistical and financial challenges of providing cancer care during crises. Additionally, the paper outlines practical actions and next steps for international cooperation needed to drive a shift in global health priorities and elevate cancer in the global health security agenda. We hope the presented notions will help prevent millions of avoidable deaths among people with cancer. [ABSTRACT FROM AUTHOR]

Background: Compared with nonprocedural fields, procedural specialization requires longer training, less flexible schedules, and greater physical demands. The impact of these factors on pregnancy, maternity outcomes, and career satisfaction has not been well described.Study Design: Data were gathered from 738 US postgraduate medical trainee mothers via an anonymous, IRB-approved online survey. Univariate analysis was performed using chi-square tests. A logistic regression model was used to investigate the impact of procedural training on odds of assisted reproduction use and pregnancy complications, adjusting for age at first pregnancy.Results: Of the 738 respondents, 221 (30.0%) were in procedural fields. A greater percentage of procedural trainees were more than 30 years old at the time of first pregnancy (52.9% vs 43.1%; p = 0.01). Controlling for maternal age, procedural trainees were significantly more likely to require assisted reproduction (odds ratio [OR] 1.28; 95% CI 1.01 to 1.61; p = 0.04), and trended toward increased odds of prolonged time to conceive (OR 1.62; 95% CI 0.99 to 2.65; p = 0.06). After delivery, procedural trainees also had higher adjusted odds of shorter maternity leave (OR 1.52; 95% CI 1.06 to 2.18; p = 0.03) and were significantly more likely to report a desire to have chosen a less demanding specialty or job (OR 1.95; 95% CI 1.40 to 2.72; p < 0.001).Conclusions: Procedural trainees have higher rates of assisted reproduction, shorter maternity leave, and are ultimately more likely to express career dissatisfaction. These findings illustrate the need for adequate support for trainee mothers, particularly in procedural specialties. [ABSTRACT FROM AUTHOR]