Background: Intraoperative radiation therapy (IORT) has been proposed as a tool to improve local control in patients with locally advanced primary or recurrent colorectal cancer. Methods: A retrospective review (1999e2015) of all patients undergoing IORT for locally advanced or recurrent colorectal cancer at a single academic center was performed. Patient demographics, oncologic staging, short-term and long-term outcomes were reviewed. Results: There were 77 patients (mean age 63 ± 11 years) identified, of whom 19 had colon cancer, 57 had rectal cancer, and 2 had appendiceal cancers. R0 resection was performed in 53 patients (69%), R1 in 19 (25%) and R2 in 5 (6%). Ten (13%) patients had a local recurrence at 18 ± 14 months and 34 (44%) had a distant recurrence at 18 ± 18 months. Mean survival was 47 ± 41 months. Conclusion: IORT resulted in low local failure rates and should be considered for patients with locally advanced or recurrent colorectal cancers.

Background: Intraoperative radiation therapy (IORT) has been proposed as a tool to improve local control in patients with locally advanced primary or recurrent colorectal cancer. Methods: A retrospective review (1999e2015) of all patients undergoing IORT for locally advanced or recurrent colorectal cancer at a single academic center was performed. Patient demographics, oncologic staging, short-term and long-term outcomes were reviewed. Results: There were 77 patients (mean age 63 ± 11 years) identified, of whom 19 had colon cancer, 57 had rectal cancer, and 2 had appendiceal cancers. R0 resection was performed in 53 patients (69%), R1 in 19 (25%) and R2 in 5 (6%). Ten (13%) patients had a local recurrence at 18 ± 14 months and 34 (44%) had a distant recurrence at 18 ± 18 months. Mean survival was 47 ± 41 months. Conclusion: IORT resulted in low local failure rates and should be considered for patients with locally advanced or recurrent colorectal cancers.

Background: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. Methods: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. Results: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p ¼ 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p ¼ 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p ¼ 0.03). Conclusion: Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique. Summary for table of contents: Anal fissure is a painful condition that when not responding to medical management, often is treated with Botulinum toxin injection or Lateral Internal Sphincterotomy. In this retrospective review and telephone survey, we found that patients who underwent Botulinum toxin injection had worse baseline incontinence than Lateral Internal Sphincterotomy patients and higher recurrence rates. Both patient groups had durable changes in continence, which surgeons must consider when treating patients with anal fissure.

Background: Surgeons often approach anal fissure with chemical denervation (Botulinum toxin, BT) instead of initial lateral internal sphincterotomy (LIS) due to concerns for long-term incontinence. We evaluated the characteristics and outcomes of patients who received BT or LIS. Methods: We performed a retrospective chart review of patients undergoing LIS and BT for anal fissure between 2009 and 2015. In 2015, a telephone survey was performed to evaluate durability, long-term incontinence and patient satisfaction. Results: Ninety-four patients met criteria: 73 LIS and 21 BT. Age (BT 49 vs. LIS 52) was similar between groups (p ¼ 1.0). Cleveland Clinic Fecal Incontinence (CCFI) score pre-intervention was higher in BT than LIS patients (2.1 vs. 0.4, p ¼ 0.007) with fewer BT patients with perfect continence (50% vs. 88%). Telephone survey response was 61%. Fissure recurrence was significantly higher for BT than LIS patients (36% vs. 9%, p ¼ 0.03). Conclusion: Patients undergoing LIS were less likely to recur. Both LIS and BT patients had some durable changes in continence raising the question of whether there is a safe technique. Summary for table of contents: Anal fissure is a painful condition that when not responding to medical management, often is treated with Botulinum toxin injection or Lateral Internal Sphincterotomy. In this retrospective review and telephone survey, we found that patients who underwent Botulinum toxin injection had worse baseline incontinence than Lateral Internal Sphincterotomy patients and higher recurrence rates. Both patient groups had durable changes in continence, which surgeons must consider when treating patients with anal fissure.

Introduction: Abdominoperineal Resection (APR) remains an important option for patients with advanced rectal cancer though some may require multivisceral resection (MVR) in addition to APR. We hypothesized that oncological outcomes would be worse with MVR. Methods: A retrospective review from 2006 to 2015 of 161 patients undergoing APR or MVR for rectal cancer, of whom 118 underwent curative APR or APR with MVR. Perioperative, oncologic and survival metrics were evaluated. Results: There were 82 patients who underwent APR and 36 who underwent MVR. Surgical approach and incidence of complications were similar (All P > 0.05). There was 1 local recurrence in each of the APR and MVR groups at a mean follow-up of 34 and 32 months, respectively. Distant recurrences occurred in 3 APR patients and 4 MVR patients. Conclusions: APR and APR with MVR can be performed with comparable morbidity and oncologic outcomes. Summary For patients with locally advanced or recurrent rectal cancers, abdominoperineal resection remains an important option for curative resection, however some patients may require multivisceral resection in addition to abdominoperineal resection. In our retrospective review of 118 patients who underwent curative resection, we found comparable rates of short-term complications and survival outcomes between patients undergoing abdominoperineal resection alone or in conjunction with a multivisceral resection.

Introduction: Abdominoperineal Resection (APR) remains an important option for patients with advanced rectal cancer though some may require multivisceral resection (MVR) in addition to APR. We hypothesized that oncological outcomes would be worse with MVR. Methods: A retrospective review from 2006 to 2015 of 161 patients undergoing APR or MVR for rectal cancer, of whom 118 underwent curative APR or APR with MVR. Perioperative, oncologic and survival metrics were evaluated. Results: There were 82 patients who underwent APR and 36 who underwent MVR. Surgical approach and incidence of complications were similar (All P > 0.05). There was 1 local recurrence in each of the APR and MVR groups at a mean follow-up of 34 and 32 months, respectively. Distant recurrences occurred in 3 APR patients and 4 MVR patients. Conclusions: APR and APR with MVR can be performed with comparable morbidity and oncologic outcomes. Summary For patients with locally advanced or recurrent rectal cancers, abdominoperineal resection remains an important option for curative resection, however some patients may require multivisceral resection in addition to abdominoperineal resection. In our retrospective review of 118 patients who underwent curative resection, we found comparable rates of short-term complications and survival outcomes between patients undergoing abdominoperineal resection alone or in conjunction with a multivisceral resection.

Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery. OBJECTIVE: The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure. DESIGN: This was a retrospective review. SETTINGS: The study was conducted at a tertiary referral center. PATIENTS: Patients who underwent ileostomy closure (2006–2015) were stratified into early (≤48 hours) and late discharge groups. MAIN OUTCOME MEASURES: The Modified Frailty Index, morbidity, and readmission rates were measured. RESULTS: A total of 272 patients undergoing ileostomy closure were evaluated. Overall length of stay was 3.64 days (±3.23 days), with 114 patients (42%) discharged within 48 hours. Sex, age, and ASA scores were similar between early and later discharge groups (p > 0.2). Univariate logistic regression demonstrated that a Modified Frailty Index score of 0 was associated with early discharge (p = 0.03), whereas a Modified Frailty Index score ≤1 and ≤2 were not. There was no significant association between the Modified Frailty Index and complication or readmission rates. Postoperative complications occurred in 39 patients (14.3%), and 1 patient died secondary to an anastomotic leak. Fifteen patients (5.5%) were readmitted within 30 days. Readmission rate within 30 days was 3.2%, with a Modified Frailty Index score of 0, 6.1% for a Modified Frailty Index score of 1, and 5.9% for a Modified Frailty Index score of 2, for which there was not an association based on univariate logistic regression (Modified Frailty Index = 0, p = 0.13; 1, p = 0.55; 2, p = 0.53). LIMITATIONS: The study was limited by nature of being a retrospective review. CONCLUSIONS: Patients undergoing ileostomy closure with a Modified Frailty Index score of 0 are associated with higher rates of discharge within 48 hours of ileostomy closure surgery than those with a higher Modified Frailty Index, without higher readmission rates. This information can be helpful to better manage patient and resource use expectations for the duration of inpatient recovery.

Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery. OBJECTIVE: The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure. DESIGN: This was a retrospective review. SETTINGS: The study was conducted at a tertiary referral center. PATIENTS: Patients who underwent ileostomy closure (2006–2015) were stratified into early (≤48 hours) and late discharge groups. MAIN OUTCOME MEASURES: The Modified Frailty Index, morbidity, and readmission rates were measured. RESULTS: A total of 272 patients undergoing ileostomy closure were evaluated. Overall length of stay was 3.64 days (±3.23 days), with 114 patients (42%) discharged within 48 hours. Sex, age, and ASA scores were similar between early and later discharge groups (p > 0.2). Univariate logistic regression demonstrated that a Modified Frailty Index score of 0 was associated with early discharge (p = 0.03), whereas a Modified Frailty Index score ≤1 and ≤2 were not. There was no significant association between the Modified Frailty Index and complication or readmission rates. Postoperative complications occurred in 39 patients (14.3%), and 1 patient died secondary to an anastomotic leak. Fifteen patients (5.5%) were readmitted within 30 days. Readmission rate within 30 days was 3.2%, with a Modified Frailty Index score of 0, 6.1% for a Modified Frailty Index score of 1, and 5.9% for a Modified Frailty Index score of 2, for which there was not an association based on univariate logistic regression (Modified Frailty Index = 0, p = 0.13; 1, p = 0.55; 2, p = 0.53). LIMITATIONS: The study was limited by nature of being a retrospective review. CONCLUSIONS: Patients undergoing ileostomy closure with a Modified Frailty Index score of 0 are associated with higher rates of discharge within 48 hours of ileostomy closure surgery than those with a higher Modified Frailty Index, without higher readmission rates. This information can be helpful to better manage patient and resource use expectations for the duration of inpatient recovery.

MRI has a pivotal and established role in detection and staging of gynecological malignancy. Diffusion-Weighted Imaging (DWI)can demonstrate abnormal signals emitted by pathological foci based on differences in molecular diffusion. It also permits the quantitative evaluation of the Apparent Diffusion Coefficient (ADC) that may be useful for distinguishing between malignant and benign tissues and for monitoring therapeutic outcomes. On this basis, the aim of this study was to assess the added value of DWI and ADC values in the evaluation of gynecological malignancy. Materials and methods: Twenty patients with suspected gynecological pathology are examined by MRI.Site of origin of the lesion(corporeal or cervical), zonal distribution, lesion size, lesion shape and signal characteristics were determined. the bladder, rectum, pelvic side wall muscles and lymph nodes were evaluated for each study. descriptive statistical values such as sensitivity, specificity and positive and negative predictive values were measured for each MR imaging findings. Results: MR stage was comparable to operative stage in all cases. The sensitivity and specificity of DWI in detection of abnormal endometrium was 100%. DWI and ADC maps allow differentiation of benign from malignant zones of cervix with sensitivity and specificity 100%. Sensitivity of the ADC in assessment of regional nodal spread was 100% with specificity 67%. Conclusion: Conventional MRI findings in conjunction DWI and quantitative measurement of the apparent Diffusion Coefficient (ADC)are effective method in the diagnosis and staging of gynecological cancer.

MRI has a pivotal and established role in detection and staging of gynecological malignancy. Diffusion-Weighted Imaging (DWI)can demonstrate abnormal signals emitted by pathological foci based on differences in molecular diffusion. It also permits the quantitative evaluation of the Apparent Diffusion Coefficient (ADC) that may be useful for distinguishing between malignant and benign tissues and for monitoring therapeutic outcomes. On this basis, the aim of this study was to assess the added value of DWI and ADC values in the evaluation of gynecological malignancy. Materials and methods: Twenty patients with suspected gynecological pathology are examined by MRI.Site of origin of the lesion(corporeal or cervical), zonal distribution, lesion size, lesion shape and signal characteristics were determined. the bladder, rectum, pelvic side wall muscles and lymph nodes were evaluated for each study. descriptive statistical values such as sensitivity, specificity and positive and negative predictive values were measured for each MR imaging findings. Results: MR stage was comparable to operative stage in all cases. The sensitivity and specificity of DWI in detection of abnormal endometrium was 100%. DWI and ADC maps allow differentiation of benign from malignant zones of cervix with sensitivity and specificity 100%. Sensitivity of the ADC in assessment of regional nodal spread was 100% with specificity 67%. Conclusion: Conventional MRI findings in conjunction DWI and quantitative measurement of the apparent Diffusion Coefficient (ADC)are effective method in the diagnosis and staging of gynecological cancer.