Current screening guidelines overlook a significant number of patients treated for colorectal cancer.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer (CRC) in adults, beginning at age 50 years and continuing until age 75 years. Screening has led to a decreased incidence of CRC in this subset of patients. Despite these improvements, there has been a significant increase in the incidence of CRC in patients aged 20 to 49 years and those older than age 75 years. We sought to evaluate the appropriateness of the current screening guidelines as it pertained to our patient demographic at Greenville Health System. We retrospectively reviewed the Greenville Health System tumor registry from January 2005 to December 2010. Age at diagnosis, pathologic stage, tumor location, and demographic information were obtained on patients treated for CRC. Data points were stratified across the three age distributions used by the USPSTF. Greater than one-third (34.7%) of patients diagnosed with CRC fell outside of the recommended screening ages. Fifty-eight per cent of patients younger than 50 years old had advanced disease at diagnosis, Stage III or IV, as compared with other groups. Two hundred eight of the 708 patients (29.3%) were diagnosed on screening colonoscopy, whereas 500 patients (70.7%) were found to have CRC on diagnostic colonoscopy or at the time of operation for related complications. There are a significant number of patients who are ultimately treated for CRC that would fall outside the recommended screening parameters at our institution. Re-evaluation of the current CRC screening guidelines and risk factor assessment is needed to account for the changing trends.

The efficacy and morbidity of different surgical treatment techniques for chronic anal fissure: an academic colorectal experience.

Up to 40 per cent of chronic fissures will fail to heal with medical treatment alone. Open (OLIS) and closed (CLIS) lateral internal sphincterotomies are considered by many to be the treatment of choice for chronic anal fissures (CAF). The aim of this study was to compare the efficacy and clinical outcomes of different surgical techniques for treatment of CAF. We performed a retrospective chart review of 387 patients with CAF who underwent surgical intervention performed by colorectal surgeons between 2006 and 2012 at Greenville Hospital System. Of 387 patients, 199 underwent OLIS, 124 CLIS, and 64 patients underwent fissurectomy alone (FE). We investigated the effect of the surgical technique on time of healing, rate of flatus incontinence, wound infection, recurrence, and the need for additional intervention. There was no statistically significant difference among patients undergoing OLIS, CLIS, and FE in demographic characteristic, time of healing, rate of wound infections, and fecal continence, or recurrence rate. Comparison of a combined lateral internal sphincterotomy (LIS) group with FE showed that there is similar time of healing (P = 0.58), no statistical difference in flatus incontinence rate (P = 0.61), urinary retention (P = 1.0), fissure recurrence (P = 0.11), and prolonged healing (P = 0.2). Patients in FE group more likely required additional treatment to complete wound healing (P = 0.02). LIS is a safe and effective technique for treatment of CAF. Although there was no difference in complications rate and healing time, patients in the FE group required additional surgical or medical treatment more frequently to achieve complete healing.

Hand-assisted laparoscopic colectomy: a single-institution experience.

The purpose of this study was to examine the results of a single institution experience with hand-assisted laparoscopic colon resection for benign disease. We conducted a retrospective study of consecutive cases performed by experienced laparoscopic surgeons at a single institution. From August 1999 to June 2001, 37 patients underwent hand-assisted laparoscopic colon resection. Seventeen patients were male, and 20 were female. Median patient age was 58 years (range 20-80). Indications for surgery were: polyp (13), uncomplicated diverticular disease (eight), complicated diverticular disease (i.e., colovesicular fistula, phlegmon, etc.) (seven), chronic constipation (four), rectal prolapse (two), ulcerative colitis (one), endometriosis (one), and fecal incontinence (one). Procedures performed were: sigmoidectomy (14), right colectomy (nine), low anterior resection (seven), subtotal colectomy (five), cecectomy (one), and transverse colectomy (one). Variables examined were: conversion to open procedure, operative time, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. There were no deaths. One case was converted to celiotomy (unable to rule out malignancy). The median operative time was 122 minutes (range 32-240) with a median operative blood loss of 132 mL (range 0-300). Return of flatus was noted (median) at postoperative day 3 (range 1-5), and the median length of stay after operation was 4 days (range 2-8). One patient developed a superficial wound infection, and there was one pelvic abscess (drained percutaneously). One patient developed urinary retention. There were no reoperations. In this single-institution experience hand-assisted laparoscopic elective colectomy for benign disease was successful in both straightforward and complicated cases. A low conversion rate to celiotomy and favorable operative times compared with published "pure" laparoscopic results suggest a flatter learning curve for handoscopy while retaining the benefits of "minimally invasive" surgery such as early return of flatus and short postoperative hospital stay. For these reasons hand-assisted laparoscopy should be considered an acceptable technique in elective colon resection for benign disease.