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Circumferential Rectal Cancer Is a Risk Factor for Stricture Formation and Restaging Uncertainties After Neoadjuvant Therapy. 环周直肠癌是新辅助治疗后狭窄形成和重新定位不确定的危险因素。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-05 DOI: 10.1097/DCR.0000000000004015
James G Connolly, James C McCullum, Cody Munroe, Racquel S Gaetani, Jonathan T Bliggenstorfer, Julia T Saraidaridis, Angela H Kuhnen, Peter W Marcello, David A Kleiman, Jonathan S Abelson
<p><strong>Background: </strong>Circumferential rectal tumors treated with total neoadjuvant therapy have the potential to develop into a stricture. These strictures can make assessment of clinical response challenging and are considered a contraindication to nonoperative management according to the National Comprehensive Cancer Network guidelines. However, the incidence of stricture formation and its likelihood of harboring occult residual disease remains poorly understood.</p><p><strong>Objective: </strong>To investigate which patients with locally advanced rectal cancer are at risk for stricture formation after total neoadjuvant therapy and assess residual tumor at the time of surgery.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Setting: </strong>Single tertiary care center.</p><p><strong>Patients: </strong>Patients with stage II or III rectal cancer who underwent total neoadjuvant therapy with curative intent surgery were included.</p><p><strong>Main outcome measures: </strong>The rate of stricture formation after total neoadjuvant therapy and pathologic complete response rate after proctectomy at the primary tumor site.</p><p><strong>Intervention: </strong>Total neoadjuvant therapy.</p><p><strong>Results: </strong>Of the 69 patients included in the analysis, 18 patients (26%) had a circumferential rectal tumor. Four of these 18 patients (22%) developed a stricture at the primary tumor site. No other patients in the study developed a stricture. All 4 patients with a posttreatment rectal stricture underwent proctectomy due to the concern for residual disease within the stricture despite complete response on endoscopy and MRI. Three of the 4 stricture patients (75%) had residual primary disease on final surgical pathology. Fourteen patients with circumferential tumors did not develop a stricture but underwent a proctectomy for incomplete response. Eleven of 14 patients (79%) had a pathologic incomplete response.</p><p><strong>Limitations: </strong>Limited sample size.</p><p><strong>Conclusions: </strong>Seventy-five percent of these patients with a stricture had residual disease on surgical pathology despite classic findings of complete clinical response. This study highlights the inherent difficulty in pursuing nonoperative management in this patient population. See Video Abstract .</p><p><strong>El cncer rectal circunferencial es un factor de riesgo para la formacin de estenosis y la incertidumbre en la reevaluacin tras la terapia neoadyuvante: </strong>ANTECEDENTES:Los tumores rectales circunferenciales tratados con terapia neoadyuvante total pueden desarrollar estenosis. Estas estenosis pueden dificultar la evaluación de la respuesta clínica y se consideran una contraindicación para el tratamiento no quirúrgico según las directrices de la Red Nacional Integral del Cáncer. Sin embargo, la incidencia de la formación de estenosis y la probabilidad de que alberguen enfermedad residual oculta siguen sin conocerse bien.OBJET
背景：全新辅助治疗的直肠周围肿瘤有发展成狭窄的潜力。根据国家综合癌症网络指南，这些狭窄使临床反应评估具有挑战性，被认为是非手术治疗的禁忌症。然而，狭窄形成的发生率及其隐藏残留疾病的可能性仍然知之甚少。目的：探讨局部晚期直肠癌患者在接受全面新辅助治疗后存在狭窄形成的风险，并在手术时评估肿瘤残留情况。设计：回顾性研究。环境：单一三级保健中心。患者：II期或III期直肠癌患者，接受全新辅助治疗和治疗目的手术。主要观察指标：全新辅助治疗后狭窄形成率及原发肿瘤部位保护切除术后病理完全缓解率。干预：全新辅助治疗。结果：在纳入分析的69例患者中，18例（26%）患有直肠周围肿瘤。这18例患者中有4例（22%）在原发肿瘤部位出现狭窄。研究中没有其他患者出现狭窄。所有4例治疗后直肠狭窄的患者均行直肠切除术，尽管内窥镜和磁共振成像完全有效，但由于担心狭窄内残留疾病。4例狭窄患者中有3例（75%）在最终手术病理中存在残留的原发疾病。14例周围肿瘤患者没有发生狭窄，但因反应不完全而接受了直肠切除术。14例中有11例（79%）有病理性不完全缓解。局限性：样本量有限。结论：75%的狭窄患者在手术病理上发现残留疾病，尽管经典的临床表现完全缓解。这突出了在这一患者群体中寻求非手术治疗的固有困难。参见视频摘要。
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引用次数: 0
Hyperactive Intestinal Peaks Observed Within Hours After Colorectal Surgery Identify Patients Who Develop Postoperative Ileus. 结直肠手术后数小时内观察到的过度活跃的肠道峰值可识别术后肠梗阻患者。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-06 DOI: 10.1097/DCR.0000000000004031
Luca Stocchi, Steve Axelrod, Lindsay A Axelrod, Anand R Navalgund
<p><strong>Background: </strong>Early recognition of postoperative ileus remains difficult.</p><p><strong>Objective: </strong>To determine whether myoelectric activity recorded by a noninvasive, wireless patch system correlated with the onset of postoperative ileus/bowel dysfunction.</p><p><strong>Design: </strong>Single-arm, prospective study. The surgeon was blinded to myoelectric bowel activity until study completion.</p><p><strong>Settings: </strong>Single surgeon, tertiary referral center.</p><p><strong>Patients: </strong>Consecutive adult patients undergoing abdominal colorectal surgery.</p><p><strong>Interventions: </strong>Three wireless patches acquiring myoelectrical GI activity were placed on the abdomen after surgery and removed before hospital discharge/reoperation. All patients followed an enterprise-specific enhanced recovery protocol.</p><p><strong>Main outcome measures: </strong>Ileus (nausea, vomiting, abdominal distention requiring nasogastric tube placement) or bowel dysfunction (similar symptoms without nasogastric tube needed) detected clinically within 30 postoperative days. Daily gut activity prints (histograms of the frequencies of all peaks detected in 10-minute time windows) were created for each patient for every 4-hour period after surgery, and activity was averaged and plotted for each group. Peaks in the 8 to 12 cycles per minute range were assigned to intestinal activity, and the energy under the peaks was summed through day 1, day 2, and day 3 and compared among patients.</p><p><strong>Results: </strong>Patch application on 46 enrolled cases undergoing abdominal colorectal surgery (open in 17, robotic in 11, laparoscopic in 18) was not associated with any adverse events. Hyperactive intestinal activity was significantly higher in 12 patients who developed postoperative ileus/bowel dysfunction within 16 hours postoperatively ( p = 0.041), with a more pronounced difference at 20 and 24 hours ( p = 0.016 and p = 0.013, respectively).</p><p><strong>Limitations: </strong>Data were collected blindly during standard postoperative care; therefore, the integration of technology into clinical practice remains to be tested.</p><p><strong>Conclusions: </strong>Noninvasive measurement of intestinal myoelectrical activity allowed early identification of postoperative ileus/bowel dysfunction. Future studies will assess the possible advantages deriving from the integration of this system into clinical practice. See Video Abstract .</p><p><strong>Los picos intestinales hiperactivos observados pocas horas despus de la ciruga colorrectal identifican a los pacientes que desarrollan leo posoperatorio: </strong>ANTECEDENTES:El reconocimiento precoz del íleo posoperatorio sigue siendo difícil.OBJETIVO:Determinar si la actividad mioeléctrica registrada por un sistema de parches inalámbricos no invasivos se correlacionaba con la aparición de íleo posoperatorio/disfunción intestinal.DISEÑO:Estudio prospectivo de un solo grupo. El cirujano
背景：术后肠梗阻的早期识别仍然很困难。目的：确定无创无线贴片系统记录的肌电活动是否与术后肠梗阻/肠功能障碍的发生相关。设计：单臂前瞻性研究。在研究完成之前，外科医生对肠肌电活动不知情。环境：单一外科医生，三级转诊中心。患者：连续接受腹部结直肠手术的成年患者。干预措施：手术后在腹部放置三个获取胃肠肌电活动的无线贴片，出院/再手术前取下。所有患者都遵循企业特定的增强恢复方案。主要观察指标：术后30天内临床发现肠梗阻（恶心、呕吐、腹胀需要置入鼻胃管）或肠功能障碍（类似症状无需置入鼻胃管）。在手术后每4小时创建肠印图（10分钟时间窗内检测到的所有峰值频率的直方图），对每组进行平均并绘制。8至12 cpm（周期/分钟）范围内的峰值被分配给肠道活动，并在第1天、第2天和第3天对峰值下的能量进行汇总，并在患者之间进行比较。结果：46例入组的腹部结直肠手术患者（开放手术17例，机器人手术11例，腹腔镜手术18例）应用贴片无不良反应。12例术后肠梗阻/肠功能障碍患者在术后16小时内肠活动过度明显增高（p = 0.041），在术后20和24小时差异更明显（p = 0.016和p = 0.013）。局限性：数据是在标准的术后护理期间盲目收集的，因此将技术融入临床实践仍有待检验。结论：无创测量肠肌电活动可以早期识别术后肠梗阻/肠功能障碍。未来的研究将评估将该系统整合到临床实践中可能产生的优势。参见视频摘要。
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引用次数: 0
The Donut and the Hole: A Colorectal Surgeon's Musings on Optimism and Pessimism. 甜甜圈和洞：一位结肠外科医生对乐观与悲观的思考。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-11 DOI: 10.1097/DCR.0000000000003953
Lester Gottesman
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引用次数: 0
Transsacrococcygeal (Kraske) Approach: A Reappraisal. 经骶尾骨（Kraske）入路：重新评估。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-17 DOI: 10.1097/DCR.0000000000003911
Pornraksa Ovartchaiyapong, Woramin Riansuwan
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引用次数: 0
Comment on "Outcomes After Elective Versus Emergency Resection for Right-Sided Colon Cancer": Toward a Bridge-to-Surgery Approach. 对“右侧结肠癌择期与急诊切除的结果”的评论：走向手术前的桥梁方法。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-13 DOI: 10.1097/DCR.0000000000004040
Kenza Koliaï, Rabah Bouzouagh, Nessma K Lardjane, Taous Merabti, Fella Dabouz, Chafik Bouzid
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引用次数: 0
Comment on "Risk Factors for Stricture After Endoscopic Submucosal Dissection of Large Rectal Neoplasms". 内镜下大直肠肿瘤粘膜下剥离后狭窄的危险因素。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-17 DOI: 10.1097/DCR.0000000000004044
Miao Yu, Jinmei Zou
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引用次数: 0
Exploratory Analysis of Urinary and Sexual Dysfunction in Patients With Low Anterior Resection Syndrome Undergoing Sacral Neuromodulation: Insights From the SANLARS Trial. 接受骶骨神经调节的低位前切除术综合征患者尿功能和性功能障碍的探索性分析：来自SANLARS试验的见解。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-02-01 Epub Date: 2025-11-18 DOI: 10.1097/DCR.0000000000004050
Franco Marinello, Pere Planellas, Domenico Fraccalvieri, Nuria Ortega-Torrecilla, Julia Gil, Esther Kreisler, Gianluca Pellino, Eloy Espín-Basany
<p><strong>Background: </strong>Limited evidence is available on the effects of sacral neuromodulation on concomitant nondigestive symptoms of low anterior resection syndrome.</p><p><strong>Objective: </strong>To assess the impact of sacral neuromodulation on urinary and sexual dysfunction in patients with low anterior resection syndrome.</p><p><strong>Design: </strong>Secondary analysis of a randomized, double-blinded, 2-phased, controlled, multicenter crossover trial (NCT02517853).</p><p><strong>Settings: </strong>Three tertiary hospitals.</p><p><strong>Patients: </strong>Patients with major low anterior resection syndrome 12 months after transit reconstruction after rectal resection who had failed conservative treatment.</p><p><strong>Interventions: </strong>Patients underwent an advanced test phase of stimulation for 3 weeks and received a pulse generator implant if a 50% reduction in a low anterior resection syndrome score was achieved. These patients entered the randomized phase in which the generator was left active or inactive for 4 weeks. After a 2-week washout, the sequence was changed. After the crossover, all generators were left activated.</p><p><strong>Main outcome measures: </strong>Improvement of urinary and sexual dysfunction as assessed with validated questionnaires.</p><p><strong>Results: </strong>Data for 35 patients were analyzed. The International Consultation on Incontinence Questionnaire-Short Form for urinary incontinence score at baseline (5.09 ± 6.48) decreased by 46% (p = 0.002) and 35% (p = 0.023) at 6- and 12-month follow-up. The proportion of patients with several urine leaks per day decreased from 17.1% to 5.7% (baseline vs 12-month follow-up, p = 0.001). High confidence in keeping an erection increased from 0 to 13.6% (baseline vs 12-month follow-up, p = 0.002). Improvement in sexual function in the 7 female patients who reported being sexually active was less apparent. The Female Sexual Function Index score at baseline, 6-, and 12-month follow-up were 15.84 ± 3.17, 18.03 ± 1.44 (p = 0.433), and 16.53 ± 2.61 (p = 0.7).</p><p><strong>Limitations: </strong>This is a secondary analysis of a randomized trial, which could be underpowered for the current aim.</p><p><strong>Conclusions: </strong>Neuromodulation seemed to ameliorate urinary dysfunction associated with low anterior resection syndrome. See Video Abstract.</p><p><strong>Anlisis exploratorio de la disfuncin urinaria y sexual en pacientes con sndrome de reseccin anterior baja sometidos a neuromodulacin sacra conclusiones del ensayo sanlars: </strong>ANTECEDENTES:Existen pocas pruebas disponibles sobre los efectos de la neuromodulación sacra en los síntomas no digestivos concomitantes del síndrome de resección anterior baja.OBJETIVO:Evaluar el impacto de la neuromodulación sacra en la disfunción urinaria y sexual en pacientes con síndrome de resección anterior baja.DISEÑO:Análisis secundario de un ensayo cruzado aleatorizado, doble ciego, en dos fases, controla
背景：关于骶神经调节对低位前切除术综合征伴发的非消化症状的影响的证据有限。目的：探讨骶神经调节对低位前切除术综合征患者泌尿功能障碍和性功能障碍的影响。设计：对一项随机、双盲、2期、对照、多中心交叉试验（NCT02517853）进行二次分析。环境：三家三级医院。患者：直肠切除术后过境重建12个月后保守治疗失败的大低位前切除术综合征患者。干预措施：患者接受为期3周的刺激测试阶段，如果低前切除术综合征评分降低50%，则接受脉冲发生器植入。这些患者进入随机化阶段，在这一阶段，发电机在4周内保持活跃或不活跃。2周洗脱后，改变序列。交叉之后，所有的发电机都处于激活状态。主要结局指标：通过有效问卷评估泌尿和性功能障碍的改善。结果：对35例患者的资料进行分析。在6个月和12个月的随访中，国际尿失禁咨询问卷-基线尿失禁得分简表（5.09±6.48）分别下降了46% （p = 0.002）和35% （p = 0.023）。每天有几次尿漏的患者比例从17.1%下降到5.7%（基线vs 12个月随访，p = 0.001）。保持勃起的高信心从0增加到13.6%（基线vs 12个月随访，p = 0.002）。在7名报告性活跃的女性患者中，性功能的改善不太明显。基线、6个月、12个月女性性功能指数评分分别为15.84±3.17、18.03±1.44 （p = 0.433）、16.53±2.61 （p = 0.7）。局限性：这是一项随机试验的二次分析，可能不足以满足当前的目标。结论：神经调节似乎可以改善与前低位切除综合征相关的尿功能障碍。参见视频摘要。探讨性尿功能障碍患者的前侧下丘脑综合征，有时神经调节骶骨，结论：前侧下丘脑综合征：存在的前列腺癌，可避免的严重损失效应，neuromodulación骶骨下丘脑综合征síntomas无消化伴尿症，síndrome de resección前侧下丘脑。目的：评价性侵患者síndrome - resección前baja对neuromodulación骶骨和disfunción泌尿系统的影响。DISEÑO:Análisis secundario de unencayo cruzado aleatorizado, double ciego, en dos fases, controlado by multicassicro （NCT02517853）。ENTORNO：三家医院。PACIENTES: PACIENTES con una puntuación alta en el síndrome de resección前baja 12 meses despuacos de la reconstrucción del tránsito tras una resección直肠en los que había fracasado el tratamiento conservador。INTERVENCIONES:洛pacientes se sometieron una熔丝德功能avanzada mediante estimulacion杜兰特3数y recibieron el implante de联合国generador de impulsos si se lograba una reduccion del 50% en la puntuacion德尔对de reseccion前巴哈。Estos pacientes entraron是一种具有可选择性的语言，是一种具有可持续性的语言，是一种具有可持续性的语言。Tras un lavado de 2 semanas, see cambió la secuencia。就像埃尔克鲁斯一样，这些人的生活方式和生活方式是一样的。结果医学原理：泌尿性评价的研究进展disfunción。结果：对35例患者的数据进行了分析。国际尿失禁咨询（ICIN） en su versión abreviada para incontinencia尿失禁（5,09±6,48）disminuyó en un 46% (p = 0,002) y un 35% (p = 0,023) en un seguimien 6 y 12 meses。Los pacies con varias pancirdidas de orina día disminuerne = 17.1%和5.71% （valor initial frente al seguimiento a Los 12 meses, p = 0.001）。La confianza en manter una erección aumentó del 0 = 13.64% （valor initial frente a seguimiento a los 12 meses, p = 0.002）。La mejora de La función sexual en las 7 pacentes que declararon ser sexualmente activas fumentes evidence。La puntuación del Índice de Función性女性的性别差异，分别为15、84±3,17、18、03±1,44 （p = 0,433）和16、53±2,61 （p = 0,7）。研究范围：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标：研究目标结论：neuromodulación pareció前尿症disfunción联合尿症síndrome前尿症resección。(AI-generated翻译)。
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引用次数: 0
Patterns and Outcomes of Treatment Failure after Ligation of Intersphincteric Fistula Tract for Cryptoglandular Anal Fistula: Analysis of 200 Failed Ligation of the Intersphincteric Fistula Tract Cases. 隐腺肛瘘括约肌间瘘道结扎后治疗失败的模式及结果：200例括约肌间瘘道结扎失败病例分析。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-01-30 DOI: 10.1097/DCR.0000000000004142
Varut Lohsiriwat, Romyen Jitmungngan, Worrawit Wanitsuwan, Siripong Sirikurnpiboon, Weeraput Chadbunchachai, Punnawat Chandrachamnong, Pornraksa Ovartchaiyapong

Background: Despite generally favorable outcomes of ligation of intersphincteric fistula tract for anal fistula, several patients experience persistent or recurrent disease.

Objective: This study aimed to identify patterns of treatment failure after ligation of intersphincteric fistula tract and evaluate their outcomes.

Design: Multicenter retrospective study.

Setting: Five university hospitals in Thailand.

Patients: Those diagnosed with persistent or recurrent cryptoglandular anal fistula after ligation of intersphincteric fistula tract between 2012 and 2020.

Main outcome measures: Fistula characteristics, patterns of treatment failure and outcomes of subsequent management were analyzed.

Results: A total of 200 patients were included, of whom 12.5% had persistent fistulas and 87.5% had recurrence. Median time to recurrence was 6 months (range, 1-48). Most treatment failures (n = 186, 93%) occurred within one year after surgery. Six distinct patterns of treatment failure were identified. The most common was type 1 (I-E, tract running from the previous internal opening (I) to an external opening (E) - known as an original fistula: n=116, 58%), followed by type 2 (I-L, tract running from the previous internal opening (I) to an unhealed intersphincteric wound - known as an intersphincteric fistula: n = 56, 28%). Type 1 failure was effectively treated by redo- ligation of intersphincteric fistula tract with an 87% success rate. Overall, the healing rate was 90.5% - with a median follow-up period of 18 months (range, 12-38).

Limitations: Exclusion of non-cryptoglandular fistulas may limit generalizability. The retrospective multicenter design and surgeon-dependent decision-making may have introduced selection bias and heterogeneity in surgical technique.

Conclusions: Most treatment failures occurred within one year after ligation of intersphincteric fistula tract. Understanding the six distinct failure patterns enables more appropriate surgical decision-making. The majority represented either recurrence of the original tract or persistence within the intersphincteric space. See Video Abstract.

背景：尽管括约肌间瘘管束结扎治疗肛瘘的效果普遍良好，但仍有一些患者出现持续性或复发性疾病。目的：本研究旨在确定括约肌间瘘道结扎后治疗失败的模式并评估其结果。设计：多中心回顾性研究。环境：泰国的五所大学医院。患者：2012年至2020年间，括约肌间瘘道结扎后诊断为持续性或复发性隐腺肛瘘者。主要观察指标：分析瘘管特征、治疗失败模式及后续处理结果。结果：共纳入200例患者，其中持续性瘘管占12.5%，复发占87.5%。中位复发时间为6个月（范围1-48）。大多数治疗失败（n = 186, 93%）发生在手术后1年内。确定了六种不同的治疗失败模式。最常见的是1型(I-E，从先前的内部开口（I)到外部开口(E)，称为原始瘘：n=116, 58%），其次是2型（I- l，从先前的内部开口(I)到未愈合的括约肌间伤口，称为括约肌间瘘：n= 56, 28%）。再次结扎括约肌间瘘道可有效治疗1型失败，成功率为87%。总体而言，愈合率为90.5%，中位随访期为18个月（范围12-38）。局限性：排除非隐腺瘘管可能会限制推广。回顾性多中心设计和依赖外科医生的决策可能会导致手术技术的选择偏倚和异质性。结论：大多数治疗失败发生在括约肌间瘘道结扎后1年内。了解六种不同的失败模式有助于更适当的手术决策。大多数表现为原发束复发或持续存在于括约肌间隙内。参见视频摘要。
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引用次数: 0
A Critical Appraisal of Colorectal Surgery Fellowship Standardized Letters of Recommendations Using Objective Criteria. 使用客观标准对结直肠外科奖学金标准化推荐信进行批判性评估。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-01-28 DOI: 10.1097/DCR.0000000000004091
Shan L Kalmeta, Wendelyn M Oslock, Mahmoud H Abdel-Rasoul, Lisa R Coleman, Sabrena F Noria, Matthew F Kalady, Syed G Husain

Background: Standardized Letter of Recommendation was introduced to capture more meaningful fellowship applicant evaluations. There are concerns that this letter may introduce subjectivity to assessments traditionally measured by objective metrics, such as board scores and publications.

Objective: To evaluate the influence of individual application elements on ranking by referee.

Design: Collected data included applicant demographics and objective assessments of academic performance, including in-service exam percentiles, Step 1 and Step 2 scores, and publication count. Summary statistics and odds ratios from repeated measures logistic regression models using the method of generalized estimating equations are reported.

Settings: Standardized letters submitted to a single institution during the 2019 application cycle were analyzed.

Main outcome measures: To determine if objective applicant parameters are associated with being subjectively ranked #1 by the referee.

Results: Among 302 standardized LOR forms, 51.3% of the applicants were ranked #1 by the referee. Applicants ranked #1 had higher junior and senior in-training exam percentiles (60.3 vs 50.9, p = 0.0002 and 59.5 vs 48.0, p < 0.0001, respectively), Step 1 scores (235 vs 231, p = 0.0287) and average number of publications (5.9 vs 3.5, p = 0.0011). For each unit rise of in-training percentile and publication number, the odd ratio for being ranked #1 improved by 1.03 (p = 0.002) and 1.08 (p = 0.013), respectively. Ranks lower than #1 did not demonstrate the expected decline in objective performance metrics with decreasing rank except Step 1 percentile (p ≤ 0.001). Technical ability was the strongest predictor of a #1 ranking.

Limitations: Analyses limited to elements included in standardized letters.

Conclusions: Standardized letters retain the relationship between objective performance metrics and subjective ratings for applicants ranked #1 by referee. However, this relationship is lost when applicants are ranked lower than first place. Our findings provide valuable insights and inform best practices for employing standardized letters of recommendation in the context of fellowship selection. See Video Abstract.

背景：标准化推荐信的引入是为了获得更有意义的奖学金申请人评价。有人担心，这封信可能会给传统上由客观指标（如董事会分数和出版物）衡量的评估引入主观性。目的：评价个别申请要素对审稿人排名的影响。设计：收集的数据包括申请人的人口统计数据和客观的学术表现评估，包括在职考试百分位数、步骤1和步骤2分数和论文数量。本文报道了使用广义估计方程方法的重复测量逻辑回归模型的汇总统计量和比值比。设置：分析2019年申请周期内提交给单一机构的标准化信函。主要结果测量：确定申请人的客观参数是否与主观上被推荐人评为第一名有关。结果：在302份标准化的LOR表格中，51.3%的申请人被推荐人评为第一名。排名第一的申请者有更高的初级和高级培训考试百分位数（60.3 vs 50.9, p = 0.0002和59.5 vs 48.0, p < 0.0001），第一步分数（235 vs 231, p = 0.0287）和平均发表数（5.9 vs 3.5, p = 0.0011）。培训百分位和发表数每增加一个单位，排名第一的奇数比分别提高1.03 （p = 0.002）和1.08 （p = 0.013）。除了第1步的百分位数（p≤0.001）外，低于第1步的排名并没有显示出客观绩效指标随着排名的下降而预期的下降。技术能力是排名第一的最强预测因素。局限性：分析仅限于标准化字母中包含的元素。结论：标准化信函保留了客观绩效指标与推荐人排名第一的申请人主观评级之间的关系。然而，当申请人的排名低于第一名时，这种关系就消失了。我们的研究结果提供了有价值的见解，并为在奖学金选择中使用标准化推荐信提供了最佳实践。参见视频摘要。
{"title":"A Critical Appraisal of Colorectal Surgery Fellowship Standardized Letters of Recommendations Using Objective Criteria.","authors":"Shan L Kalmeta, Wendelyn M Oslock, Mahmoud H Abdel-Rasoul, Lisa R Coleman, Sabrena F Noria, Matthew F Kalady, Syed G Husain","doi":"10.1097/DCR.0000000000004091","DOIUrl":"https://doi.org/10.1097/DCR.0000000000004091","url":null,"abstract":"<p><strong>Background: </strong>Standardized Letter of Recommendation was introduced to capture more meaningful fellowship applicant evaluations. There are concerns that this letter may introduce subjectivity to assessments traditionally measured by objective metrics, such as board scores and publications.</p><p><strong>Objective: </strong>To evaluate the influence of individual application elements on ranking by referee.</p><p><strong>Design: </strong>Collected data included applicant demographics and objective assessments of academic performance, including in-service exam percentiles, Step 1 and Step 2 scores, and publication count. Summary statistics and odds ratios from repeated measures logistic regression models using the method of generalized estimating equations are reported.</p><p><strong>Settings: </strong>Standardized letters submitted to a single institution during the 2019 application cycle were analyzed.</p><p><strong>Main outcome measures: </strong>To determine if objective applicant parameters are associated with being subjectively ranked #1 by the referee.</p><p><strong>Results: </strong>Among 302 standardized LOR forms, 51.3% of the applicants were ranked #1 by the referee. Applicants ranked #1 had higher junior and senior in-training exam percentiles (60.3 vs 50.9, p = 0.0002 and 59.5 vs 48.0, p < 0.0001, respectively), Step 1 scores (235 vs 231, p = 0.0287) and average number of publications (5.9 vs 3.5, p = 0.0011). For each unit rise of in-training percentile and publication number, the odd ratio for being ranked #1 improved by 1.03 (p = 0.002) and 1.08 (p = 0.013), respectively. Ranks lower than #1 did not demonstrate the expected decline in objective performance metrics with decreasing rank except Step 1 percentile (p ≤ 0.001). Technical ability was the strongest predictor of a #1 ranking.</p><p><strong>Limitations: </strong>Analyses limited to elements included in standardized letters.</p><p><strong>Conclusions: </strong>Standardized letters retain the relationship between objective performance metrics and subjective ratings for applicants ranked #1 by referee. However, this relationship is lost when applicants are ranked lower than first place. Our findings provide valuable insights and inform best practices for employing standardized letters of recommendation in the context of fellowship selection. See Video Abstract.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Price of Free Advice. 免费咨询的代价。
IF 3.7 2区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Diseases of the Colon & Rectum
Pub Date : 2026-01-28 DOI: 10.1097/DCR.0000000000004046
Lester Gottesman
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引用次数: 0
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