Diseases of the Colon & Rectum最新文献

Background: Whether the level of the inferior mesenteric artery ligation affects the incidence of anastomotic leakage remains unclear.

Objective: To assess the impact of the level of inferior mesenteric artery ligation on the blood flow to the anastomotic site and the incidence of anastomotic leakage using indocyanine green fluorescence imaging.

Design: A post hoc analysis of EssentiAL trial.

Settings: This study was conducted at 41 tertiary referral centers in Japan.

Patients: 839 rectal cancer patients (<12 cm from the anal verge).

Main outcome measures: The incidence of anastomotic leakage and perfusion status were compared between the high and low ligation groups.

Results: The median fluorescence time was similar at 25 seconds in both groups (p= 0.74). Although no statistical difference was noted, the high ligation group was more likely to have greater outliers in fluorescence time compared to the low ligation group. The high ligation group demonstrated higher poor perfusion rates than the low ligation group (2.8% vs 1.5%). In the high ligation group, anastomotic leakage occurred in one case of poor perfusion where additional resection was not performed by the surgeon's intraoperative judgment. Additionally, the additional resection rate nearly doubled with the use of indocyanine green fluorescence imaging. After propensity score matching (129 patients per group), the overall anastomotic leakage rate was 13.2% in the high ligation group and 10.9% in the low ligation group (p = 0.57).

Limitations: This study was a post hoc analysis, the sample size was small, and the anastomosis methods varied.

Conclusions: The level of inferior mesenteric artery ligation did not affect blood flow at the anastomotic site or the incidence of anastomotic leakage statistically, but assessing bowel perfusion using indocyanine green fluorescence imaging can offer clinical benefits, optimizing patient outcomes. See Video Abstract.

Trial registration: The Japan Registry of Clinical Trials (jRCTs-CRB3180007), the Japanese Clinical Trials Registry (UMIN-CTR000030240). See Video.

Background: Colon and rectal surgery is a popular fellowship following general surgery residency. The impact of a resident's colon and rectal surgery experience during residency may impact their career trajectory and pursuit of colon and rectal surgery.

Objective: This study aims to identify individual and program factors associated with matriculation into colon and rectal surgery fellowship compared to other career trajectories.

Design: An analysis of case logs and demographic data from graduates of 19 accredited general surgery residency programs from the Accreditation Council for Graduate Medical Education between 2010-2020 was completed utilizing the United States Resident Operative Experience Consortium. The demographics and operative experience of residents who pursued colon and rectal surgery fellowship were compared to those who did not.

Settings: This study is a retrospective review of resident specialty selection, demographic information, and operative case logs.

Participants: Graduates of 19 accredited general surgery residency programs from the Accreditation Council for Graduate Medical Education between 2010-2020 participated in the study.

Main outcomes measures: Resident demographics, general and colon and rectal surgery-related program-specific characteristics, and resident operative case logs associated with entrance into colon and rectal surgery fellowship served as the primary outcome measures.

Results: Those in the colon and rectal surgery cohort were more likely to be female sex and have completed a dedicated research experience. No association was noted with co-location of a colon and rectal surgery fellowship and general surgery residency. Multivariable analysis demonstrated a higher likelihood of colon and rectal surgery fellowship matriculation for female sex residents and residents who completed a clinical fourth-year colon and rectal surgery rotation. Higher logged colon and rectal surgery-specific case volume was associated with those matriculating into colon and rectal surgery.

Limitations: Self-reported case log data, differences in residency structures in offering colon and rectal surgery rotations to clinical fourth-year residents, academic bias of participating residency programs.

Conclusions: This study identified individual and program-specific factors associated with matriculating into colon and rectal surgery fellowship, such factors include female sex, colon and rectal surgery-specific rotation in the fourth clinical year, and higher volume of colon and rectal surgery-specific cases. These data may optimize resident colon and rectal surgery experience and strengthen the colon and rectal surgery fellowship pipeline. See Video Abstract.