Characteristics of pathologic complete response for locally advanced rectal cancer.

BACKGROUND: Neoadjuvant chemoradiation (NACRT) is the standard of care for locally advanced rectal cancers. The purpose of this study was to determine patient and tumor factors associated with a pathologic complete response (pCR). METHODS: The National Surgical Quality Improvement Program proctectomy-targeted database was utilized to identify all patients from 2016 to 2020 who underwent NACRT followed by proctectomy with curative intent for T3-4N0-2 rectal cancers. RESULTS: A total of 1891 patients were included, of which 253 (13.4%) demonstrated a pCR. Pretreatment N0 staging was associated with a higher rate of pCR (18.9%) when compared to N1 (6.7%) and N2 (6.7%) (p < 0.0001). Patients clinically staged at T3N0 had the highest rate of pCR (19.5%). Gender, age, race, weight, smoking status, and tumor height were not associated with pCR. CONCLUSIONS: Patients with cN0 disease were more likely to experience a pCR compared to cN1-2 patients. Tumor height relative to anal verge or patient demographics were not associated with pCR.

Virtual interviews for resident and fellow recruitment.

Since 2020, all general surgery residency interviews have been mandatorily virtual, elevating the importance of social media and online reputation management for applicants and residency programs. This article highlights how virtual interviews changed the way programs and applicants engage each other online, including some pros and cons of these new interactions.

Glycemic Variability in Patients With Stage II-III Colon Cancer Treated With Surgery and Adjuvant Chemotherapy.

OBJECTIVES: To examine glycemic variability within one month and one year following surgery and throughout adjuvant chemotherapy among patients with stage II-III colon cancer, with and without type 2 diabetes (T2D). SAMPLE & SETTING: 58 patients with stage II-III colon cancer treated with surgery and chemotherapy. METHODS & VARIABLES: A retrospective analysis of electronic health record data over one year showed glycemic variability, measured as standard deviation and coefficient of variation. Chi-square, Fisher's exact, and Mann-Whitney U tests and Spearman's correlation coefficient were calculated. RESULTS: Patients with T2D had higher glycemic variability throughout chemotherapy and within one year following surgery. A significant increase in glycemic variability throughout chemotherapy was observed in patients without T2D. Significant associations between glycemic variability and demographic and clinical characteristics differed by T2D status, standard deviation, and coefficient of variation. IMPLICATIONS FOR NURSING: Nurses need to assess serial blood glucose levels in patients with and without T2D. Teaching patients how to maintain glycemic control during treatment is a priority. Research should include predictive models to identify risk factors for higher glycemic variability and cancer-related symptoms and outcomes.

Evaluation and Medical Management of Uncomplicated Diverticulitis.

Uncomplicated diverticulitis is common, and its evaluation and treatment have evolved over time. Most patients present in a nontoxic manner with localized pain, leukocytosis, and reliable findings on computed tomography (CT). Healthy and stable patients are typically treated in the outpatient setting with very high rates of success. Recently, the necessity of antibiotic therapy has come into question, and several alternative agents have emerged, with the jury still out on their relative roles in diverticular disease. Currently, colonoscopy is still recommended after the resolution of an index episode of uncomplicated diverticulitis, and recurrence rates remain low. Several diet and lifestyle modifications have been shown to impact the rates of diverticulitis recurrence.

Prolonged non-operative management of clostridium difficile colitis is associated with increased mortality, complications, and cost.

BACKGROUND: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI). METHODS: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with α = 0.05. RESULTS: Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001-1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014-1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018-1.062, p < 0.001) compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001). CONCLUSIONS: Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment.