Program Guide ACRS Meeting

ASCRS Premier Partners
The American Society of Colon and Rectal Surgeons recognizes the indispensable role
that health care companies play in helping the Society to maintain its focus on colorectal surgery
and enhance the care that its members provide to patients. ASCRS would like to thank
the following companies for their generous support of this year’s Annual Meeting.
DIAMOND
$250,000 and above
Ethicon Endo-Surgery, Inc., a Johnson & Johnson Company
PLATINUM
$125,000 - $249,999
Adolor and GlaxoSmithKline
Covidien
GOLD
$70,000 - $124,999
Medtronic, Inc.
Applied Medical
SILVER
$25,000 - $69,999
Boston Scientific Endoscopy
Genzyme BioSurgery
Intuitive Surgical, Inc.
Mederi Therapeutics, Inc.
Myriad Genetic Laboratories, Inc.
Olympus America Inc.
Richard Wolf Medical Instruments Corporation
BRONZE
$5,000 - $24,999
American Medical Systems
ConvaTec
Cook Medical
DiagnoCure Oncology Laboratories
Ferndale Laboratories, Inc.
Genentech BioOncology
Konsyl Pharmaceuticals, Inc.
Merck & Co., Inc.
Power Medical Interventions, Inc.
sanofi-aventis U.S.
Stryker Endoscopy
OTHER CONTRIBUTORS
Centocor-Ortho Biotech Services, LLC • Ethicon, Inc. • Genzyme • Microline
Welcome
to the
ASCRS
Annual Meeting
May 2-6, 2009
The Westin Diplomat Resort & Spa
Hollywood, Florida
1
Table of Contents
Page
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Awards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Thank sto Our Corporate Supporters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Social Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Special Programs for Spouses/Guests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
On-Going Video Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Daily Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Committee Meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Saturday Program
Transanal Endoscopic Microsurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Laparoscopic Colectomy Didactic Session . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Hand-Assist Laparoscopic Intestinal Surgery Workshop . . . . . . . . . . . . . . . .26
Laparoscopic Colectomy Workshop: Straight Laparoscopic Cadaver Lab . . .27
Lunch Symposium: Professionalism and Communication . . . . . . . . . . . . . . . . .28
Video Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Symposium: Colorectal Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Allied Health Program for the Physician: Key Components of a
Successful Colorectal Surgery Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Dinner Symposium: Simulation in Colon and Rectal Surgery . . . . . . . . . . . . . .32
Sunday Program
Breakfast Symposium: Prosthetics in Colorectal Surgery . . . . . . . . . . . . . . . . . .33
Allied Health Program for Nurses: The Critical Role of Allied
Health Professionals in the Management of Patients with
Colorectal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Laparoscopic Colectomy: Simulation Colectomy Only . . . . . . . . . . . . . . . . . .35
Symposium: Laparoscopic Colorectal Surgery: Nuts, Bolts and New
Tools for Your Toolbox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Symposium: Technological Advances in the Diagnosis and
Treatment of Colorectal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Core Subject Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Young Surgeons’ Lunch Symposium: Sculpting Your Career:
Career Pearls You Didn’t Learn in Fellowship . . . . . . . . . . . . . . . . . . . . . . .40
Lunch Symposium: Perioperative Considerations . . . . . . . . . . . . . . . . . . . . . . .41
Welcome and Opening Announcements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Presidential Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Research Foundation Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
Research Foundation Workshop: The Leading Edge – Update on the Latest
in Research and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
Symposium: Obstructed Defecation Syndrome . . . . . . . . . . . . . . . . . . . . . . . . .44
Welcome Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
2
Table of Contents
G E N E R A L I N F O R M AT I O N
Monday Program
Breakfast Symposium: Lymph Nodes: Prognostic, Therapeutic and
Quality Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Meet the Professor Break fasts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Residents’ Break fast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Symposium: Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48
Symposium: Enhanced Recovery Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Scientific Session: Neoplasia I – Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . .51
Norman Nigro Research Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Harry E. Bacon Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Traveling Fellows and Impact Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Mark Killingback Prize Winner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Scientific Session: Benign I – Anorectal Conditions . . . . . . . . . . . . . . . . . . . . . .55
Symposium: Energy Devices in Colorectal Surgery . . . . . . . . . . . . . . . . . . . . .57
Poster Walk -Arounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Tuesday Program
Breakfast Symposium: Developments in Colonic Stenting . . . . . . . . . . . . . . . .59
Symposium: Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60
Scientific Session: Outcomes I – Surgical Site Infections and Ileus . . . . . . . . . .61
Symposium: Maintenance of Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Scientific Session: Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . .64
Ernestine Hambrick Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Parviz Kamangar Humanities in Surgery Lectureship . . . . . . . . . . . . . . . . . . .66
Women in Colorectal Surgery Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
Symposium: End of Life Issues for Colon and Rectal Surgeons . . . . . . . . . . . .67
Scientific Session: Neoplasia II – Staging and Prognosis . . . . . . . . . . . . . . . . . .68
ASCRS/SAGES Symposium: Acquiring and Assessing Skills in
Endoscopic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
General Surgery Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Research Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
ASCRS/IFFGD Symposium: Fecal Incontinence . . . . . . . . . . . . . . . . . . . . . . . .75
Residents’ Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75
Dinner Symposium: Understanding Syndromes of Inherited
Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76
3
Table of Contents
Wednesday Program
Symposium: Post Treatment Follow-up of Patients with
Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78
Scientific Session: Benign II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
ASCRS/SSAT Symposium: Single Port Minimally Invasive
Surgery / NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
Scientific Session: Neoplasia III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82
Symposium: Evaluation and Management of Metastatic Colon
and Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Scientific Session: Benign III – Diverticulitis, Colitis and Trauma . . . . . . . . . . .85
ASCRS Business Meeting & State of the Society Address . . . . . . . . . . . . . . . .86
Memorial Lectureship Honoring Dr. Alejandro F. Castro . . . . . . . . . . . . . . .87
Mathews Oration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
Video Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
Scientific Session: Outcomes II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Annual Reception and Dinner Dance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90
Exhibits, Abstracts, Faculty
Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
General Surgery Forum Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Research Forum Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Podium Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108
Poster Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Poster Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
Program Participant Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178
Maps
Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180
4
ASCRS Executive Council
Anthony J. Senagore, MD James W. Fleshman, MD W. Douglas Wong, MD Jacques P. Heppell, MD
President President-Elect Past-President Vice President
Steven D. Wexner, MD Alan G. Thorson, MD José G. Guillem, MD Tracy L. Hull, MD Theodore J. Saclarides, MD
Secretary Treasurer Research Foundation President Member-at-Large Member-at-Large
Susan Galandiuk, MD Neil H. Hyman, MD Janice F. Rafferty, MD Mark L. Welton, MD

Member-at-Large Member-at-Large Member-at-Large Member-at-Large
Officers Members-at-Large
President . . . . . . . . . . . . . . . . . . .Anthony J. Senagore, MD Tracy L. Hull, MD . . . . . . . . . . . . . . . . .Cleveland, OH
Grand Rapids, MI (2006-2009)
President-Elect . . . . . . . . . . . . . . .James W. Fleshman, MD Theodore J. Saclarides, MD . . . . . . . . . . . .Chicago, IL
St. Louis, MO (2006-2009)
Past President . . . . . . . . . . . . . . . .W. Douglas Wong, MD Susan Galandiuk ,MD . . . . . . . . . . . . . . .Louisville, KY
New York, NY (2007-2010)
Vice President . . . . . . . . . . . . . . . .Jacques P. Heppell, MD Neil H. Hyman, MD . . . . . . . . . . . . . . .Burlington, VT
Phoenix, AZ (2007-2010)
Janice F. Rafferty, MD . . . . . . . . . . . . . .Cincinnati, OH
Secretary . . . . . . . . . . . . . . . . . . .Steven D. Wexner, MD (2008-2011)
Weston, FL
Mark L. Welton, MD . . . . . . . . . . . . . . . .Stanford, CA
Treasurer . . . . . . . . . . . . . . . . . . .Alan G. Thorson, MD (2008-2011)
Omaha, NE
Research Foundation . . . . . . . . . . .José G. Guillem, MD
President New York, NY
Administrative Office Diseases of the Colon & Rectum

85 West Algonquin Road, Suite 550 Pat Oldenburg
Arlington Heights, IL 60005 Managing Editor
847/290-9184 Phone/Fax: 507/289-0485
Fax: 847/290-9203 Email: oldenburg.patricia@mayo.edu
www.fascrs.org
5
Program Committee
C. Neal Ellis, MD James Merlino, MD

Program Chair Program Vice-Chair
James Fleshman, MD Alessandro Fichera, MD Christopher Mantyh, MD Robert Sinnott, DO

Council Rep Eugene Foley, MD David Maron, MD Toyooki Sonoda, MD
Maher Abbas, MD Charles Friel, MD James McCormick, DO Jenny Speranza, MD
Robert Akbari, MD Stephen Gorfine, MD Dan Metcalf, MD Randolph Steinhagen, MD
Tracey Arnell, MD Charles Heise, MD John Migaly, MD Scott Strong, MD
Jennifer Ayscue, MD Jacques Heppell, MD Matthew Mutch, MD Michele Thomas, MD
Anil Bahadursingh, MD Jon Hourigan, MD Michael Page, MD Kelly Tyler, MD
Elisa Birnbaum, MD Steve Hunt, MD Lisa Poritz, MD Madhulika Varma, MD
Robin Boushey, MD Andreas Kaiser, MD Sonia Ramamoorthy, MD Paul Vignati, MD
W. Donald Buie, MD Pokala Ravi Kiran, MD David Rivadeneira, MD Martin Weiser, MD
Frank Caliendo, MD Alex Ky, MD John Rombeau, MD Eric Weiss, MD
José Cintron, MD Sang Lee, MD Lester Rosen, MD Kirsten Bass Wilkins, MD
Philip Cole, MD David Levien, MD Dana Sands, MD W. Douglas Wong, MD
Conor Delaney, MD Najjia Mahmoud, MD Anthony Senagore, MD Massarat Zutshi, MD
Future ASCRS Annual Meetings

2010 2011 2012 2013
Minneapolis, MN Vancouver, Canada San Antonio, TX Phoenix, AZ
May 15-19 May 14-18 June 2-6 April 27-May 1

Hilton Minneapolis Hotel Vancouver Convention Henry B. Gonzalez Phoenix Convention
& Convention Center & Exhibition Centre Convention Center and Center &
Grand Hyatt Hotel Sheraton Phoenix Hotel
6
General Information
Educational Objectives
House Rules This scientific program is designed to provide surgeons
with an in-depth and up-to-date knowledge relative to
• Moderators should ensure sessions start and finish
surgery for diseases of the colon, rectum and anus with
on time.
emphasis on patient care, teaching and research. Presen-
• Questions from the floor are encouraged. Please tation formats include podium presentations followed by
identify yourself by name and city when asking ques- audience questions and critiques, panel discussions,
tions. Strict time limitations may prevent us from ad- walk-around poster presentations and discussions, video
dressing all questions from the podium. Authors have presentations, and symposia focusing on specific state-of-
been asked to remain in the foyer outside of the hall the-art diagnostic and treatment modalities. The purpose
for further discussion after their session. of all sessions is to improve the quality of care of patients
• Please fill out the evaluation forms. We DO read them with diseases of the colon and rectum. At the conclusion
and take them into consideration in our planning. of this meeting, participants should be able to:
• Dress casually and for comfort. • Recognize ways to improve physician-patient

communication, and enhance standards of physician
• Audible cell phones or pagers are strictly prohib- professionalism
ited in meeting rooms.
• Understand the technical steps of laparoscopic col-
• Photographing and videotaping any portion of the orectal resection, for both routine and complicated
scientific sessions or exhibit hall is prohibited. cases, as well as review the current status of laparo-
scopic procedures for diseases of the colon and rectum
Thank you for your cooperation
• Understand the role of laparoscopy in the treatment of
rectal cancer
Accreditation • Review current recommendations and strategies for

colorectal cancer screening
The American Society of Colon and Rectal Surgeons
(ASCRS) is accredited by the Accreditation Council for • Understand ways to better integrate a new provider
Continuing Medical Education to provide continuing into your practice, and appreciate some of the biases
medical education for physicians. ASCRS takes respon- that one may encounter when working with a new
sibility for the content, quality, and scientific integrity of partner of a different gender, race, or ethnicity
this CME activity. • Identify the value of simulation, and understand how
it is affecting education, training, and patient care
Continuing Medical Education Credit • Review the technologic advances in the field of col-
The ASCRS designates this continuing medical educa- orectal surgery
tion activity for a maximum of 49 AMA PRA Category 1
• Review the current initiatives to improve perioperative
Credit(s)TM. Physicians should only claim credit com-
care and explore how to implement these initiatives in
mensurate with the extent of their participation in the
practice
activity.
• Understand the importance of lymph node harvest in
Disclosure the management of colorectal cancer, and review
emerging technology to improve harvest rate
Each speaker has been requested to complete a faculty
disclosure statement. The names of speakers declaring • Review current management of rectal cancer
potential conflict of interest or those who will be dis- • Review and evaluate the current strategies for the
cussing any off-label, experimental, or investigational diagnosis, treatment, and management of obstructed
use of drugs or devices in their presentations are printed defecation syndrome
in this program. Also, all presenters must disclose to the • Review and evaluate the use of enhanced recovery
audience at the time of their presentation. If you would protocols for the treatment of colorectal diseases
like to see the actual signed disclosure forms, they are
available at the convention registration desk. • Understand the risks of conflict of interest, and
review ways to identify and avoid potential conflicts
in practice
Disclosures which are not listed in this program book
were not received at the time of printing and will be • Review current changes in policies affecting the Grad-
provided to meeting participants at the Convention. uate Medical Education environment
7
General Information
Educational Objectives (continued) Convention Registration
• Review the various energy devices used in colorectal The Convention Registration Desk is located in the
surgery, and understand their various applications Grand Ballroom Foyer and will be open from:
• Review the current technology of robotics and its Saturday, May 2 . . . . . . . . .6:00 am – 6:00 pm
application to colorectal surgery Sunday, May 3 . . . . . . . . . .6:00 am – 6:00 pm
• Understand the issues affecting end-of-life care Monday, May 4 . . . . . . . . .6:30 am – 4:00 pm
Tuesday, May 5 . . . . . . . . . .6:30 am – 4:00 pm
• Review current management of complex peri-anal Wednesday, May 6 . . . . . . .6:30 am – 2:30 pm
inflammatory bowel disease
• Review and evaluate the use of endo-luminal stenting
as a means to bridge patients to surgery, or provide Replacement Badges – $10.00 each
palliative relief for unresectable colorectal cancer
• Evaluate the follow-up options for patients that have Annual Dinner Dance Tickets
received surgical treatment of colorectal cancer
All registered ASCRS members and spouses receive an
• Review the current programs to expedite patient exchange ticket for the Annual ASCRS Dinner Dance
recovery and shorten hospital length of stay as part of their registration. These tickets must be
• Review the current updates on hereditary colorectal exchanged for assigned table seating by Noon,
cancer, and identify patients with potential HNPCC Wednesday, May 6.
and the role of genetic testing the care of patients Non-members and others who wish to purchase tickets
with HNPCC for the dinner/dance may do so at the Convention Reg-
• Evaluate the use of biologic mesh in the treatment of istration Desk. Please do so as early as possible in order
fistulas, hernias, and pelvic reconstruction to meet the ticket exchange deadline.
• Review angiogenesis and the impact of angiogenesis
inhibitors in the treatment of colorectal cancer Exhibits Showcase New Products
• Understand the current treatment options for patients A total of 75 technical and scientific exhibitors in 144
with incontinence and pelvic floor disorders booths will display their products and services in the
Great Hall throughout the Convention.
• Review and evaluate the options for the treatment of
metastatic colorectal cancer ASCRS appreciates the support of its exhibitors and
urges all registrants to visit the displays.
Goals Exhibit hours are:
The goals of these programs are to improve the preven- Monday, May 4 . . . . . . . . .9:00 am – 4:00 pm
tion, diagnosis and treatment of patients with diseases Tuesday, May 5 . . . . . . . . . .9:00 am – 4:30 pm
and disorders affecting the colon and rectum; and Wednesday, May 6 . . . . . . . . .9:00 – 11:00 am
improve the quality of patient care by maintaining,
developing and enhancing the knowledge, skills, profes- Index of Participants
sional performance and multi-disciplinary relationships The names of all program speakers, with page numbers
necessary to provide services for patients, the public and to indicate their scheduled appearances, are listed in the
the profession. back of this Program Book.
Target Audience Internet Café

The program is intended for the education of colon and Visit the “Internet Café” to surf the Internet and send
rectal surgeons as well as general surgeons and others and retrieve email. This high-tech area is located in the
involved in the treatment of diseases affecting the colon, Grand Ballroom Foyer and is complimentary to all
rectum and anus. meeting registrants from Sunday – Wednesday.
Supported by a grant from Covidien
8
General Information
New Members Speaker Ready Room
New members of the ASCRS (those elected at the 2008 The Speaker Ready Room, located in Room 216, is
Annual Meeting) will be identified by a special Society available to all program participants. Speakers are
decal affixed to their name badge. We encourage you to requested to take advantage of this opportunity prior to
introduce yourself and make our new members welcome. their presentation to review their slides.
Saturday . . . . . . . . . . . . . . .6:00 am - 6:30 pm
Numbered Abstracts Sunday . . . . . . . . . . . . . . . .6:00 am - 6:30 pm
All abstract presentations are numbered in the Program Monday . . . . . . . . . . . . . . . .6:00 am - 6:00 pm
Guide to correspond with abstracts listed in the back of Tuesday . . . . . . . . . . . . . . . .6:30 am - 6:30 pm
the book. Wednesday . . . . . . . . . . . . .6:30 am - 5:00 pm
Poster Displays AV Requirements for Speakers

All scientific posters will be on display in the Exhibit All presentations MUST be made using PowerPoint.
area in the Great Hall beginning at 9:00 am, Monday Please bring your presentation to the Speaker
and during all exhibit hours on Monday and Tuesday. Ready Room at least EIGHT hours (preferably 24
hrs.) prior to the start of the session in which you are
Recertification Examination speaking. Data projection equipment will be provided
in the meeting room. Laptops will NOT be permitted.
The American Board of Colon and Rectal Surgery will
conduct the Recertification Exam from 9:00 – 11:00 am
on Saturday in the Regency Ballroom 1. The purpose of Disclaimer
recertification is to help maintain and advance standards The primary purpose of the ASCRS Annual Meeting is
in the specialty. This exam is open to those who have educational. Information, as well as technologies, prod-
applied to the Board in advance of this meeting and met ucts and/or services discussed, are intended to inform
the qualifications. participants about the knowledge, techniques and expe-
riences of specialists who are willing to share such infor-
Scientific Sessions mation with colleagues. A diversity of professional
opinions exist in the specialty and the views of the
The Opening Session begins at 1:45 pm, Sunday, in the
American Society of Colon and Rectal Surgeons dis-
Grand Ballroom.
claims any and all liability for damages to any individual
attending this conference and for all claims which may
result from the use of information, technologies, prod-
ucts and/or services discussed at the conference.
Call for Abstracts

Posters
2010 ASCRS Annual Meeting
All posters are located in the Great Hall
May 15 – 19, 2010
Poster Display Hours
Program Chair: Matthew Mutch, MD
Monday 9:00 am – 4:00 pm Program Vice-Chair: Steven Hunt, MD
Tuesday 9:00 am - 4:30 pm
Hilton Minneapolis Hotel &
Poster Walk Arounds Minneapolis Convention Center
with Authors Present Minneapolis, MN
Monday 5:00 – 6:30 pm On-Line Submission Site Opens

September 15, 2009
Complimentary wine and cheese reception
and Closes November 18, 2009
while you discuss posters with authors
www.fascrs.org
9
General Information
Annual Named Lectures
Norman D. Nigro Research Lectureship Ernestine Hambrick Lectureship

Dr. Norman Nigro is recognized for his many contribu- This lectureship honors Dr. Ernestine Hambrick for her
tions to the care of patients with diseases of the colon dedication to patients with colon and rectal disorders,
and rectum; for his significant research in the preven- surgical students and trainees and the community at
tion of large bowel cancer and treatment of squamous large. The first woman to be board certified in colon
cell carcinoma of the anus and for his leadership role in and rectal surgery, Dr. Hambrick provided excellent
his chosen specialty and allied medical organizations. care to patients and mentored numerous students, resi-
Dr. Nigro has generously contributed many years of dents and young surgeons during her clinical career.
dedication and service to the specialty through his activ- After she retired from clinical practice, Dr. Hambrick
ities in the American Society of Colon and Rectal Sur- founded the STOP Foundation to promote screening
geons (ASCRS) and the American Board of Colon and and prevention of colon and rectal cancer. In addition,
Rectal Surgery (ABCRS). she has volunteered many hours working for the ASCRS
including serving as the Vice President.
Harry E. Bacon Lectureship

Harry Ellicott Bacon was Professor and Chairman of
the Department of Proctology at Temple University Awards
Hospital. His stellar contribution was the establishment
of the Journal Diseases of the Colon and Rectum, of which The following awards will be chosen at the 2009
he was Chief Editor. He was a Past President of the Annual Meeting and announced shortly after.
American Society of Colon and Rectal Surgeons and the Each recipient will be given a plaque and a $500 cash
American Board of Colon and Rectal Surgery. Dr. award from the regional society sponsoring the award.
Bacon was the founder of the International Society of Awards are given for the best basic science or clinical
University Colon and Rectal Surgeons. paper presented from the podium or as a poster.
As a researcher and teacher of over 100 residents, he was • The Harry E. Bacon Foundation Award
innovative in some operations that are forerunners of • The Michigan Society of Colon and Rectal
sphincter saving procedures for cancer of the rectum Surgeons Award
(pull-through operation) and inflammatory bowel
disease (ileoanal reservoir anastomosis). • The New Jersey Society of Colon and Rectal
Surgeons Award
• The New York Society of Colon and Rectal Surgeons
Award – A. W. Martin Marino, Sr., MD, Award
Parviz Kamangar
Humanities in Surgery Lectureship • The Northwest Society of Colon and Rectal
Surgeons Award
This unique lectureship is funded by Mr. Parviz
Kamangar, a grateful patient, to remind physicians • The Piedmont Society of Colon and Rectal Surgeons
and surgeons to place compassionate care at the Award
top of the list of priorities. • The Southern California Society of Colon and Rectal
Surgeons Award
10
Maintenance of Certification
The 2009 scientific offerings assist the physician with the six core competencies first adopted by the Accreditation Council
for Graduate Medical Education (ACGME) and the American Board of Medical Specialties. Attendees are encouraged to
select areas of interest from the program which will enhance their knowledge and improve the quality of patient care.
1 Patient Care – Provide care that is compassionate, 4 Professionalism – Demonstrate a commitment to

appropriate and effective treatment for health problems carrying out professional responsibilities, adherence to
and to promote health. ethical principles and sensitivity to diverse patient
populations.
2 Medical Knowledge – Demonstrate knowledge about
established and evolving biomedical, clinical and cognate 5 Systems-based Practice – Demonstrate awareness of
sciences and their application in patient care. and responsibility to larger context and systems of
healthcare. Be able to call on system resources to pro-
3 Interpersonal and Communication Skills – vide optimal care (e.g. coordinating care across sites or
Demonstrate skills that result in effective information serving as the primary case manager when care involves
exchange and teaming with patients, their families and multiple specialties, professions or sites).
professional associates (e.g. fostering a therapeutic
relationship that is ethically sound, uses effective 6 Practice-based Learning and Improvement –
listening skills with non-verbal and verbal communica- Able to investigate and evaluate their patient care prac-
tion; working as both a team member and at times as tices, appraise and assimilate scientific evidence and im-
a leader). prove their practice of medicine.
The ASCRS assists the American Board of Colon and Rectal Surgery with a 4-part process for
continuous learning:
Part I – Professional Standing Part IV – Practice Performance Assessment

Medical specialists must hold a valid, unrestricted medical They are evaluated in their clinical practice according to
license in at least one state or jurisdiction in the United specialty-specific standards for patient care. They are asked
States, its territories or Canada. to demonstrate that they can assess the quality of care they
provide compared to peers and national benchmarks and
then apply the best evidence or consensus recommendations
Part II – Lifelong Learning and Self-Assessment
to improve that care using follow-up assessments.
Physicians participate in educational and self-assessment
programs that meet specialty-specific standards that are set
by their member board.
Part III – Cognitive Expertise

Physicians demonstrate, through formalized examination,
that they have the fundamental, practice-related and prac-
tice environment-related knowledge to provide quality care
in their specialty.
11
Thanks to our Corporate Supporters
ASCRS and its Research Foundation are grateful to the following companies and organizations
for their generous support of the following projects and programs this year:
Adolor Corporation and Covidien

GlaxoSmithKline Co-supporter of the Saturday Hand Assist Laparoscopic
Co-supporter of Sunday’s luncheon symposium on Intestinal Surgery Workshop… Saturday’s Laparoscopic
Perioperative Considerations and the Monday symposium Colectomy Workshop… the Saturday Laparoscopic Colectomy
on Enhanced Recovery Protocols… sponsor of the Workshop… the Sunday symposium on Laparoscopic
Meeting Schedule Board… and the Advance Colorectal Surgery: Nuts, Bolts & New Tools for Your
Registration Brochure. Toolbox… Monday's symposium on Energy Devices in
Colon & Rectal Surgery… sponsor of the Lead Retrieval…
Internet Café… the October Executive Council
American Medical Systems Dinner… and an unrestricted grant in support of the
Research Foundation’s Meet the Challenge program.
Partial support of Sunday's breakfast symposium on
Prosthetics in Colorectal Surgery.
Applied Medical Co-supporter of the Monday breakfast symposium
on Lymph Nodes: Prognostic, Therapeutic and Quality
Co-supporter of the Saturday Hand Assist Laparoscopic
Implications.
Intestinal Surgery Workshop and the Sunday symposium
on Laparoscopic Colorectal Surgery: Nuts, Bolts & New Tools
for Your Toolbox… and partial support of the Monday
symposium on Rectal Cancer. Ethicon Endo-Surgery, Inc.,
a Johnson & Johnson Company
Supporter of Sunday's Simulation Colectomy Workshop…
Boston Scientific Endoscopy co-supporter of Saturday's Laparoscopic Colectomy
Supporter of the Tuesday breakfast symposium on Workshop… Saturday’s Hand Assist Laparoscopic Intestinal
Developments in Colonic Stenting. Surgery Workshop… the Sunday symposium on Laparo-
scopic Colorectal Surgery: Nuts, Bolts & New Tools for Your
Toolbox… Sunday’s symposium on Technological Advances
Centocor-Ortho Biotech Services, LLC in the Diagnosis and Treatment of Colorectal Diseases...
the Monday symposium on Energy Devices in Colon &
Partial support of Tuesday’s scientific session on
Rectal Surgery… Wednesday's ASCRS/SAGES Joint
Inflammatory Bowel Disease.
Symposium on NOTES… sponsor of the Abstracts on
Disk… “Save the Date” flyer… Executive Council
Dinner… Hotel Key Card… Pocket Program Guide…
ConvaTec Inc. Exhibit Aisle Markers… Banners in the Convention
Partial support of the Sunday Allied Health Program on Center… Janus Boards… and the 2009 – 2010 Member-
The Critical Role of Allied Health Professionals in the ship Directory… the Innovative Surgical Technologies
Management of Patients with Colorectal Disease. Research Grant in support of the ASCRS Research
Foundation… and an unrestricted grant in support of the
Research Foundation’s Meet the Challenge program.
Cook Medical
Partial support of Sunday’s breakfast symposium on
Prosthetics in Colorectal Surgery. Ethicon, Inc.
Co-supporter of Sunday's breakfast symposium on
Prosthetics in Colorectal Surgery.
12
Thanks to our Corporate Supporters
ASCRS and its Research Foundation are grateful to the following companies and organizations
for their generous support of the following projects and programs this year:
Ferndale Laboratories, Inc. Merck & Co., Inc.

Supporter of the Residents’ Reception on Tuesday. Co-supporter of Sunday's luncheon symposium on
Perioperative Considerations.
Genentech BioOncology
Partial support of the Wednesday symposium on Microline
Evaluation and Management of Metastatic Colon and Co-supporter of the Saturday Laparoscopic Colectomy
Rectal Cancer. Workshop.
Genzyme Biosurgery Myriad Genetic Laboratories, Inc.

Supporter of the Saturday Hand Assist Laparoscopic Supporter of the Tuesday dinner symposium on
Intestinal Surgery Workshop… Monday's symposium on Understanding Syndromes of Inherited Colorectal Cancer.
Enhanced Recovery Protocols… and an unrestricted grant
in support of the Research Foundation’s Meet the
Challenge program. Olympus America Inc.
Co-supporter of Saturday’s Laparoscopic Colectomy
Genzyme Corporation Workshop… the Sunday symposium on Laparoscopic
Partial support of the Tuesday dinner symposium on Colorectal Surgery: Nuts, Bolts & New Tools for Your
Understanding Syndromes of Inherited Colorectal Cancer. Toolbox… and Wednesday's ASCRS/SAGES Joint
Symposium on NOTES.

Co-supporter of Tuesday’s symposium on Robotics. Power Medical Interventions, Inc.
Co-supporter of Tuesday's symposium on Robotics.
Konsyl Pharmaceuticals, Inc.

Supporter of the Monday morning Residents’ Breakfast. Richard Wolf Medical Instruments
Corporation
Supporter of Saturday’s morning and afternoon sessions
Mederi Therapeutics, Inc. of Transanal Endoscopic Microsurgery Courses (TEM).
Co-supporter of the Sunday symposium on Technological
Advances in the Diagnosis and Treatment of Colorectal
Diseases. sanofi-aventis U.S.
Co-supporter of Sunday's luncheon symposium on
Perioperative Considerations… and Monday’s breakfast
Medtronic, Inc. symposium on Lymph Nodes: Prognostic, Therapeutic and
Supporter of Tuesday's symposium on Fecal Incontinence… Quality Implications.
and co-supporter of Sunday's symposium on Technologi-
cal Advances in the Diagnosis and Treatment of Colorectal
Diseases. Stryker Endoscopy
Co-supporter of the Saturday Hand Assist Laparoscopic
Intestinal Surgery Workshop.
13
Social Events / Special Programs
Admission to the following social events is limited to registered physicians and their registered spouses/guests.
Admission by Badge Only
Welcome Reception
Sunday
7:00 – 8:30 pm
Westin Diplomat
Diplomat Landing (outdoors)
Annual Dinner Dance

Wednesday
Reception: 7:00 – 8:00 pm
Dinner Dance: 8:00 – 10:30 pm
Westin Diplomat
Regency Ballroom
Admission by ticket only
Members – please exchange your tickets for seat assignments by Noon on Wednesday.
Non-Members, spouses, guests may purchase tickets for $75 at the Registration Desk before Noon on Wednesday.
Special Programs for Spouses and Guests

Spouses and guests interested in attending the ASCRS program can select from the following options.
Please register at the convention registration desk
Package #1 – ($100) Includes items A through E.
Package #2 – ($55) Includes items C through E only.
A. Annual Reception, 7:00-8:00 pm, Wednesday.
B. Annual Dinner Dance, 8:00-10:30 pm, Wednesday.
C. Welcome Reception, 7:00-8:30 pm, Sunday.
D. Hospitality Suite, 7:30-10:30 am, Sunday through Wednesday.
E. Admission to all scientific sessions and the exhibit area.
Spouse/Guest Hospitality Suite

7:30 – 10:30 am
Sunday through Wednesday
Aizia Restaurant
(Lobby Level)
Registered spouses/guests only please
14
On-Going Video Display
The following videos will be shown in the Diplomat Ballroom, Salon 1
Noon, Sunday through Wednesday.
STATION 1 STATION 4
Must See Videos Single Port/NOTES
Laparoscopic Very Low Stapling in Ileal Laparoscopic-assisted Natural Orifice Surgery: Trans-
Pouch Anal Anastomosis for Benign Disease (V-36) vaginal Sigmoidectomy and Rectocolpopexy (V-31)
S. Berdah, D. Birnbaum, Marseille, France J. Sanchez, B. Krieger, S. Rasheid, J. Frattini, J. Marcet,
Tampa, FL
Martius Procedure for Complex Rectal and
AnoVaginal Fistula (V-33) Single Access Laparoscopic Colectomy (V-23)
B. Gurland, M. Zutshi, T. Hull, Cleveland, OH D. Uematsu, Nagano, Japan
Transanal Hemorrhoidal Dearterialization – Procedure NOTES Transanal and Transgastric Endoscopic
for Hemorrhoids and Hemorrhoidal Prolapse (V-24) Colon Resection in a Live Porcine Model (V-37)
M. Page, Des Moines, IA P. Sylla, D. Sohn, S. Cizginer, Y. Konuk, B. Turner,
D. Rattner, Boston, MA
Laparoscopic Total Mesorectal Excision for
Rectal Cancer (V-27)
G. Kennedy, C. Heise, Madison, WI
STATION 2 STATION 5
Training Models Potpourri
Robotic Total Mesorectal Excision in Severely Laparoscopic Repair of Perineal Hernia (V-25)
Obese Female Patient (V-5) T. Francone, P. Marcello, Burlington, MA
L. Prasad, S. Marecik, J. Park, T. Edson, Park Ridge, IL
Anal Sphincteroplasty in a Man (V-10)
and Chicago, IL
A. Bastawrous, J. Blumetti, V. Chaudhry, J. Harrison,
Laparoscopic Protocolectomy with Robotic Intersphinc- J. Cintron, L. Prasad, Chicago, IL and Park Ridge, IL
teric Proctectomy for Rectal Cancer in Child’s B
Laparoscopic Rectopexy for Rectal Prolapse (V-12)
Cirrhotic Patient with Ulcerative Colitis (V-40)
M. Gedeon, V. Ho, J. Milsom, New York, NY
P. Bouchard, T. Young-Fadok, J. Heppell, J. Efron,
Phoenix, AZ
Robotic Right Colectomy (V-26)
S. Tsoraides, A. Cha, D. Crawford, Peoria, IL
STATION 3
Best Video
Robotics
Robotic-assisted Colorectal Surgery Training in Combined Laparoscopy and CO2 Colonoscopy

a Porcine Model: Rectopexy and Vessel Ligation (V-1) for Polyp Removal (V-13)
E. Haas, U. Gedalia, Houston, TX V. Ho, J. Yan, S. Stein, T. Sonoda, S. Lee, J. Milsom,
New York, NY
Acquiring Basic Skills for Robotic TME on
Pelvic Simulator (V-6)
S. Marecik, L. Prasad, J. Blumetti, B. Paris, Park Ridge,
IL and Chicago, IL
Transanal Single Port Low Anterior Resection (V-30)
A. Fajardo, S. Hunt, J. Fleshman, M. Mutch,
St. Louis, MO
15
Daily Schedule
REGISTRATION for physicians, spouses and exhibitors is located in the Grand Ballroom Foyer of the Westin
Diplomat Hotel from Saturday, May 2 through Wednesday, May 6.
SCIENTIFIC SESSIONS are located in the Grand Ballroom.
SPEAKER READY ROOM is located in Room 216.
POSTERS are located in the Great Hall (Exhibit Hall).
HOURS ROOM
Saturday, May 2
6:00 am – 6:00 pm Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom Foyer
6:00 am – 6:30 pm Speaker Ready Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .216
6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
6:30 – 9:00 am Transanal Endoscopic Microsurgery Course (Didactic Session) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 3
6:30 – 11:00 am Laparoscopic Colectomy Didactic Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom
8:40 – 9:00 am Laparoscopic Colectomy Break . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom Foyer
9:00 – 11:00 am ABCRS Recertification Exam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 1
9:00 am – Noon Transanal Endoscopic Microsurgery Lab A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 2
11:00 am – 4:00 pm Hand-Assist Laparoscopic Intestinal Surgery Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Off-Site (DaVinci Center)
11:00 am – 4:00 pm Laparoscopic Colectomy Workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Off-Site (DaVinci Center)
Noon – 1:00 pm Transanal Endoscopic Microsurgery Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 3
Noon – 1:30 pm Luncheon Symposium: Professionalism and Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom
1:00 – 4:00 pm Transanal Endoscopic Microsurgery Lab B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 2
2:00 – 3:30 pm Video Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom
3:30 – 4:00 pm Refreshment Break . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom Foyer
4:00 – 5:30 pm Symposium: Colorectal Screening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom
4:00 – 5:30 pm Standards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
4:00 – 5:30 pm TEM Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
4:00 – 6:00 pm Allied Health Program for the Physician: Key Components of a Successful
Colorectal Surgery Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom 3
6:30 – 8:00 pm Dinner Symposium: Simulation in Colon and Rectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom
Sunday, May 3
6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
6:30 – 8:00 am Breakfast Symposium: Prosthetics in Colorectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
6:30 – 10:00 am Allied Health Program for Nurses: The Critical Role of Allied Health
Professionals in the Management of Patients with Colorectal Disease . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
6:30 am – 3:30 pm Laparoscopic Colectomy Simulation Colectomy Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Off-Site (DaVinci Center)
7:00 – 8:30 am Research Foundation Board of Trustees Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
7:30 – 10:30 am Spouse / Guest Hospitality Suite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Aizia Restaurant
16
Daily Schedule
HOURS ROOM
Sunday, May 3 (continued)

8:00 – 10:00 am Symposium: Laparoscopic Colorectal Surgery: Nuts, Bolts and New Tools
for Your Toolbox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
8:30 – 10:00 am Symposium: Technological Advances in the Diagnosis and Treatment of
Colorectal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
9:00 – 10:00 am Self Assessment Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
9:00 am – Noon RF Research Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
9:30 – 11:30 am ACS Advisory Council . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317
10:00 – 10:30 am Refreshment Break . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom Foyer
D A I LY S C H E D U L E
10:30 am – Noon Core Subject Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
10:30 am – Noon International Council of Coloproctology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
11:00 am – Noon CME Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:30 pm Luncheon Symposium: Perioperative Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
Noon – 1:30 pm Young Surgeon’s Luncheon Symposium: Sculpting Your Career:
Career Pearls You Didn’t Learn in Fellowship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
Noon – 1:30 pm Public Relations Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 / 313
Noon – 1:30 pm ISUCRS Executive Board Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .320
Noon – 6:00 pm Video Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 1
1:45 – 2:30 pm Welcome & Opening Announcements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
2:30 – 3:30 pm Presidential Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
3:30 – 4:00 pm Refreshment Break . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom Foyer
4:00 – 4:30 pm Research Foundation Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
4:30 – 6:00 pm Symposium: Obstructed Defecation Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
4:30 – 6:00 pm Research Foundation Workshop: The Leading Edge – Update on the Latest in
Research and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
7:00 – 8:30 pm Welcome Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Landing
9:30 pm – Midnight E.P. Salvati Society Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
Monday, May 4
6:00 – 7:30 am Breakfast Symposium: Lymph Nodes: Prognostic, Therapeutic and Quality Implications . . . . . . . . . .Regency Ballroom
6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
6:30 am – 6:00 pm Video Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 1
6:30 – 7:30 am “Meet the Professor” Breakfasts
M-1 Parastomal Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
M-2 Coding and Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 4
M-3 Rectal Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 5
M-4 Anorectal Crohn’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
M-5 Uncomplicated Diverticular Disease: When Do You Really Need to Operate? . . . . . . . . . . . . . . . . . . .312 / 313
M-6 Clinical Trials Research: How to Get Started? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .314
continues on the following page …
17
Daily Schedule
HOURS ROOM
Monday, May 4 (continued)

6:30 – 7:30 am Regional Society Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
7:00 – 8:00 am Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
7:00 – 8:00 am Residents’ Breakfast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
7:30 – 10:00 am Symposium: Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
9:00 am – 4:00 pm Exhibit & Poster Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
10:00 – 10:30 am Refreshment Break in Exhibit Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
10:30 am – Noon Symposium: Enhanced Recovery Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
10:30 am – Noon Neoplasia I – Rectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
Noon – 12:30 pm Past Presidents’ & Spouses of the Past Presidents’ Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319 & 320
Noon – 1:00 pm Complimentary Box Lunch in Exhibit Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
Noon – 1:00 pm ASCRS Textbook Editorial Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302
Noon – 1:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:00 pm Quality Assessment & Safety Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
Noon – 1:00 pm Past Vice Presidents’ Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301
12:30 – 1:30 pm Past Presidents’ Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .320
12:30 – 1:30 pm Spouses of the Past Presidents’ Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .319
1:00 – 1:45 pm Norman Nigro Research Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
1:00 – 2:30 pm RF Fundraising Assistance Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
1:45 – 2:30 pm Harry E. Bacon Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
2:30 – 3:00 pm Traveling Fellows & Impact Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
2:30 – 3:30 pm Hospitality Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
3:00 – 3:30 pm Refreshment & Ice Cream Break in Exhibit Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
3:30 – 5:00 pm Symposium: Energy Devices in Colorectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
3:30 – 5:00 pm Benign I – Anorectal Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
4:00 – 6:00 pm DC&R Co-Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
5:00 – 6:30 pm Poster Walk-Arounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
6:30 – 8:00 pm Mount Sinai Medical Alumni Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Aizia Restaurant
6:30 – 8:30 pm Cleveland Clinic Alumni Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
6:30 – 8:30 pm Washington University Colorectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Suite
6:30 – 8:30 pm GA Colon & Rectal Surgical Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301
7:00 pm Colon & Rectal Clinic of Orlando . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
7:00 – 9:00 pm Mayo Clinic Alumni Dinner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .320
7:00 – 10:00 pm Colon & Rectal Associates Alumni . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
7:00 – 10:00 pm Lahey Clinic Alumni Dinner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Off-Site
Tuesday, May 5
6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

18
Daily Schedule
HOURS ROOM
Tuesday, May 5 (continued)

T-1 Quality Indicators in Colon and Rectal Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
T-2 Colorectal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 4
T-3 Rectal Intussusception / Solitary Rectal Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 5
T-4 Bowel Prep: Why or Why Not . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
T-5 Reconstruction after Rectal Resection (Straight/J-Pouch/Baker/Coloplasty) . . . . . . . . . . . . . . . . . . . . .312 / 313
T-6 Basic Science Research: How to Get Started? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .314
6:30 – 8:00 am Breakfast Symposium: Developments in Colonic Stenting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
6:30 – 8:00 am DC&R Editorial Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
7:00 – 8:00 am Residents Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
8:00 – 9:00 am Exhibitor’s Advisory Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
8:00 – 9:00 am Symposium: Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
8:00 – 9:00 am Outcomes I – Surgical Site Infections and Ileus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
9:00 – 10:00 am Symposium: Maintenance of Certification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
9:00 – 10:00 am Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
9:00 am – 4:30 pm Exhibit & Poster Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
10:30 – 11:15 am Ernestine Hambrick Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
11:15 am – Noon Parviz Kamangar Humanities in Surgery Lectureship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
11:30 am – 1:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:00 pm Complimentary Box Lunch in Exhibit Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
Noon – 1:00 pm CREST Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
Noon – 1:00 pm Socioeconomic Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
Noon – 1:00 pm Web Site Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
Noon – 1:30 pm Women in Colorectal Surgery Luncheon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
1:00 – 2:30 pm Symposium: End of Life Issues for Colon and Rectal Surgeons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
1:00 – 2:30 pm Neoplasia II – Staging and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
2:30 – 4:00 pm ASCRS / SAGES Symposium: Acquiring and Assessing Skills in Endoscopic Surgery . . . . . . . . . . . . . .Grand Ballroom
2:30 – 4:00 pm General Surgery Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
2:30 – 4:30 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
4:00 – 4:30 pm Refreshment & Cookie Break in Exhibit Hall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
4:30 – 6:00 pm ASCRS / International Foundation for Functional Gastrointestinal Disorders Symposium:
Fecal Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
4:30 – 6:00 pm Research Forum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
6:00 – 6:15 pm Research Foundation Young Researchers Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
6:00 – 7:00 pm Residents’ Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 4-5
7:00 – 8:30 pm Dinner Symposium: Understanding Syndromes of Inherited Colorectal Cancer . . . . . . . . . . . . . . . . . .Regency Ballroom
19
Daily Schedule
HOURS ROOM
Wednesday, May 6
6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205
W-1 Abdominal Catastrophe – Leaks and Other Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
W-2 Anal Diseases Associated with HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 4
W-3 Non-Healing Perineal Wound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 5
W-4 Physician Marketing and Referral Practice Building . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .303
W-5 Use of Physician Extenders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 / 313
W-6 Health Services Research: How to Get Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .314
7:00 – 8:00 am Membership Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
8:00 – 9:15 am Symposium: Post Treatment Follow-up of Patients with Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
8:00 – 9:15 am Benign II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
9:00 – 11:00 am Exhibit Hours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
9:15 – 10:30 am ASCRS / SSAT Symposium: Single Port Minimally Invasive Surgery / NOTES . . . . . . . . . . . . . . . . . .Grand Ballroom
9:15 – 10:30 am Neoplasia III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
11:00 am – Noon Symposium: Evaluation and Management of Metastatic Colon and Rectal Cancer . . . . . . . . . . . . . . . . . .Grand Ballroom
11:00 am – Noon Benign III – Diverticulitis, Colitis and Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
Noon – 1:30 pm Lunch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .On Own
Noon – 1:30 pm ASCRS Annual Business Meeting and State of the Society Address . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3-5
Noon – 3:30 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
1:30 – 2:15 pm Memorial Lectureship Honoring Dr. Alejandro F. Castro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
2:15 – 3:00 pm Mathews Oration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
3:00 – 3:30 pm Refreshment Break in Foyer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom Foyer
3:30 – 5:00 pm Video Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom
3:30 – 5:00 pm Outcomes II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
5:00 – 6:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
7:00 – 8:00 pm Annual Reception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grand Ballroom Foyer
8:00 – 10:30 pm Annual Dinner Dance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Regency Ballroom
20
ASCRS Committee Meetings
HOURS ROOM
Saturday, May 2
4:00 – 5:30 pm Standards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
4:00 – 5:30 pm TEM Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Sunday, May 3
7:00 – 8:30 am Research Foundation Board of Trustees . . . . . . . . . . . . . . . . . . . . . .303
9:00 – 10:00 am Self Assessment Committee . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
9:00 am – Noon Research Foundation Research Committee . . . . . . . . . . . . . . . . . . . .220
10:30 am – Noon ICCP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
11:00 am – Noon CME Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:30 pm Public Relations Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . .312-313
Monday, May 4
6:30 – 7:30 am Regional Society Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
7:00 – 8:00 am Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:00 pm ASCRS Textbook Editorial Board . . . . . . . . . . . . . . . . . . . . . . . . . . .302
Noon – 1:00 pm Quality Assessment & Safety Committee . . . . . . . . . . . . . . . . . . . . .303
1:00 – 3:30 pm Awards Committee (Posters) . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
1:00 – 2:30 pm Research Foundation Fundraising
Assistance Committee . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
2:30 – 3:30 pm Hospitality Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
4:00 – 6:00 pm DC&R Co-Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
Tuesday, May 5
6:30 – 8:00 am DC&R Editorial Board . . . . . . . . . . . . . . . . . . . . .Diplomat Ballroom 3
7:00 – 8:00 am Residents Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
10:00 – 11:30 am Awards Committee (Posters) . . . . . . . . . . . . . . . . . . . . . . . . . .Great Hall
11:30 am – 1:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Noon – 1:00 pm CREST Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202
Noon – 1:00 pm Socioeconomic Committee . . . . . . . . . . . . . . . . . .Diplomat Ballroom 2
Noon – 1:00 pm Website Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
2:30 – 4:30 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
6:00 – 6:15 pm Research Foundation Young Researchers
Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Atlantic Ballroom
Wednesday, May 6
7:00 – 8:00 am Membership Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .220
Noon – 3:30 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
5:00 – 6:00 pm Awards Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
21
ASCRS Past Presidents
1899-1900 Joseph M. Mathews 1936-1937 Marion C. Pruitt 1974-1975 Rupert B. Turnball

1900-1901 James P. Tuttle 1937-1938 Harry Z. Hibshman 1975-1976 Patrick H. Hanley
1901-1902 Thomas C. Martin 1938-1939 Dudley Smith 1976-1977 John R. Hill
1902-1903 Samuel T. Earle 1939-1940 Martin S. Kleckner 1977-1978 Alejandro F. Castro
1903-1904 William M. Beach 1940-1941 Clement J. Debere 1978-1979 Donald M. Gallagher
1904-1905 J. Rawson Pennington 1941-1942 Frederick B. Campbell 1979-1980 Stuart H.Q. Quan
1905-1906 Lewis H. Adler, Jr. 1942-1944 Homer I. Silvers 1980-1981 Malcolm C. Veidenheimer
1906-1907 Samuel G. Gant 1944-1946 William H. Daniel 1981-1982 Bertram A. Portin
1907-1908 A. Bennett Cooke 1946-1947 Joseph W. Ricketts 1982-1983 Eugene S. Sullivan
1908-1909 George B. Evans 1947-1948 George H. Thiele 1983-1984 Stanley M. Goldberg
1909-1910 Dwight H. Murray 1948-1949 Harry E. Bacon 1984-1985 A.W. Martin Marino, Jr.
1910-1911 George J. Cooke 1949-1950 Louis E. Moon 1985-1986 Eugene P. Salvati
1911-1912 John L. Jelks 1950-1951 Hoyt R. Allen 1986-1987 H. Whitney Boggs, Jr.
1912-1913 Louis J. Hirschman 1951-1952 Robert A. Scarborough 1987-1988 Frank J. Theuerkauf
1913-1914 Joseph M. Mathews 1952-1953 Newton D. Smith 1988-1989 Herand Abcarian
1914-1915 Louis J. Krause 1953-1954 W. Wendell Green 1989-1990 J. Byron Gathright, Jr.
1915-1916 T. Chittenden Hill 1954-1955 A.W. Martin Marino, Sr. 1990-1991 Peter A. Volpe
1916-1917 Alfred J. Zobel 1955-1956 Stuart T. Ross 1991-1992 Robert W. Beart, Jr.
1917-1919 Jerome M. Lynch 1956-1957 Rufus C. Alley 1992-1993 W. Patrick Mazier
1919-1920 Collier F. Martin 1957-1958 Julius E. Linn 1993-1994 Samuel B. Labow
1920-1921 Alois B. Graham 1958-1959 Karl Zimmerman 1994-1995 Philip H. Gordon
1921-1922 Granville S. Hanes 1959-1960 Hyrum R. Reichman 1995-1996 Victor W. Fazio
1922-1923 Emmett H. Terrell 1960-1961 Walter A. Fansler 1996-1997 David A. Rothenberger
1923-1924 Ralph W. Jackson 1961-1962 Merrill O. Hines 1997-1998 Ira J. Kodner
1924-1925 Frank C. Yeomans 1962-1963 Robert J. Rowe 1998-1999 Lee E. Smith
1925-1926 Descum C. McKenney 1963-1964 Robert A. Scarborough 1999-2000 H. Randolph Bailey
1926-1927 William H. Kiger 1964-1965 Garnet W. Ault 2000-2001 John M. MacKeigan
1927-1928 Louis A. Buie 1965-1966 Norman D. Nigro 2001-2002 Robert D. Fry
1928-1929 Edward G. Martin 1966-1967 Maus W. Stearns, Jr. 2002-2003 Richard P. Billingham
1929-1930 Walter A. Fansler 1967-1968 Raymond J. Jackman 2003-2004 David J. Schoetz, Jr.
1930-1931 Dudley Smith 1968-1969 Neil W. Swinton 2004-2005 Bruce G. Wolff
1931-1932 W. Oakley Hermance 1969-1970 James A. Ferguson 2005-2006 Ann C. Lowry
1932-1933 Curtice Rosser 1970-1971 Walter Birnbaum 2006-2007 Lester Rosen
1933-1934 Curtis C. Mechling 1971-1972 Andrew Jack McAdams 2007-2008 W. Douglas Wong
1934-1935 Louis A. Buie 1972-1973 John E. Ray
1935-1936 Frank G. Runyeon 1973-1974 John H. Remington
22
Saturday, May 2
Transanal Endoscopic Microsurgery

1 2 6 *
Didactic Session Only 6:30 – 9:00 am • Fee $50 (Open to All Registrants)
Lab A: 9:00 am – Noon (Limit: 10) • Lab B: 1:00 – 4:00 pm (Limit: 10)
Fee $500 (Includes Didactic and Lab) • Registration Required • Lunch Included for Lab Registrants Only
T
OLD OU
L ABS S
Didactic Session: Regency Ballroom 3
Lab A & B: Regency Ballroom 2
Supported by an educational grant from Richard Wolf Medical Instruments Corporation
Didactic lectures will include the history and development of TEM, preoperative assessment, indications for TEM in benign
and malignant lesions, getting started, surgical technique, complications, and results. The hands-on portion will include
training on bovine intestine progressing from an open trainer to a closed trainer with only endoscopic visualization. Partici-
pants will learn techniques for exposure, full and partial thickness rectal excisions, and suture closure of rectal defects.
Director: Charles Finne, MD, Minneapolis, MN
Assistant Director (Didactic): Dana Sands, MD, Weston, FL
Assistant Director (Lab): Peter Cataldo, MD, Burlington, VT
Disclosure: C. Finne: No Affiliation
Disclosure: D. Sands: No Affiliation
Disclosure: P. Cataldo: Richard Wolf Medical Instruments Co. – No remuneration (Speaker)
S AT U R D AY
6:30 am Continental Breakfast 8:15 am TEM for Cancer: Results
Bruce Orkin, MD, Washington, DC
7:00 am Welcome Remarks
Charles Finne, MD, Minneapolis, MN 8:30 am Technical Equipment Problems
and Solutions
7:05 am TEM Instruments and Positioning
Peter Cataldo, MD, Burlington, VT
Disclosure: No Affiliation 8:40 am Complications of TEM
Dana Sands, MD, Weston, FL
7:15 am TEM Video
8:50 am Comparison of TEM and
7:30 am TEM: Indications, Patient Preparation
Conventional Transanal Excision
Dana Sands, MD, Weston, FL
Charles Finne, MD, Minneapolis, MN
7:40 am Cancer Selection for Local Treatment
9:00 am Introduction to TEM Hands-on Lab
7:55 am TEM Coding and Billing
9:00 am – Noon Lab A
Mark Whiteford, MD, Portland, OR
Disclosure: Richard Wolf Medical Instruments – Research Sup- Noon – 1:00 pm Lunch for Lab Participants
port/Consulting Fee (Research/Consultant); Applied Medical –
Honorarium (Speaker); sanofi aventis – Honorarium (Speaker) 1:00 – 4:00 pm Lab B
8:00 am TEM for Benign Disease (Adenoma,

Carcinoid, GIST): Results
Objectives: At the conclusion of this session, participants should be able to: a) understand the indications, risks,
and benefits of TEM; b) understand patient selection for TEM in benign and malignant disease; and c) under-
stand the technique of TEM.
The American Society of Colon and Rectal Surgeons designates this educational activity for a maximum of
5 AMA PRA Category 1 Credit(s)™
* This session addresses MOC requirements as explained on page 11.

23
Saturday, May 2
Laparoscopic Colectomy
Didactic Session
1 2 3 *
6:30 - 11:00 am
Diplomat Ballroom
Continental Breakfast • Open to All Registrants
This didactic lecture session will cover the principles of laparoscopic and hand-assisted colectomy. Basic information
including positioning, equipment and case selection will be covered, followed by oncological outcomes. Techniques for
each type of bowel resection will be discussed. Concluding lectures will discuss more complex situations, including inflam-
matory disease, complications, conversion and reoperative surgery. There will also be information on perioperative care
strategies to maximize patient recovery.
Director: Conor Delaney, MD, Cleveland, OH

Assistant Director: Floriano Marchetti, MD, Miami, FL
Disclosure: C. Delaney: No Affiliation
Disclosure: F. Marchetti: Adolor – Honorarium (Speaker); Genzyme – Honorarium (Speaker)
6:30 am Introduction and Goals 8:25 am HALS Left/Sigmoid Colectomy

Kirk Ludwig, MD, Milwaukee, WI
6:35 am Case Selection, Equipment and
Disclosure: Covidien – Honorarium (Speaker); Applied Medical –
Room Set-up Honorarium (Speaker)
Christine Bartus, MD, New Britain, CT
Disclosure: No Affiliation 8:40 am Questions and Break (Diplomat Foyer)
6:50 am Cancer: Concerns and Outcomes 9:00 am Dealing with the Splenic Flexure and
Floriano Marchetti, MD, Miami, FL Middle Colic Vessels
Rebecca Hoedema, MD, Grand Rapids, MI
7:10 am Laparoscopic Right Hemicolectomy (I) Disclosure: No Affiliation
Helen MacRae, MD, Toronto, ON, Canada
Disclosure: No Affiliation 9:15 am Laparoscopic Rectal Dissection
John Marks, MD, Wynnewood, PA
7:25 am Laparoscopic Right Hemicolectomy (II) Disclosure: Covidien – Honorarium (Consultant/Speakers
Vincent Obias, MD, Washington, DC Bureau); Wolf – Honorarium (Consultant/Speakers Bureau);
Disclosure: No Affiliation Stryker – Honorarium (Consultant/Speakers Bureau);
Glaxo Smith Kline – Honorarium (Consultant); Zassi –
7:40 am HALS Right Hemicolectomy Honorarium (Consultant); Covidien – Grant/Research Support;
Harry Reynolds, Jr., MD, Cleveland, OH SurgiQuest – Honorarium (Scientific Advisory Board);
Disclosure: Covidien – Honorarium (Speaker/Course Instructor) SurgiQuest (Stockholder)
7:55 am Laparoscopic Left/Sigmoid Colectomy (I) 9:30 am HALS Rectal Dissection

Conor Delaney, MD, Cleveland, OH Paul Vignati, MD, Hartford, CT
Disclosure: No Affiliation
8:10 am Laparoscopic Left/Sigmoid Colectomy (II)
David Larson, MD, Rochester, MN
* This session addresses MOC requirements as explained on page 11. continues on the following page …
24
Saturday, May 2
Didactic Session (continued)
9:45 am Optimizing Peri-Operative Care 10:15 am Fistulas, Abscesses, and Inflammatory

Eric Weiss, MD, Weston, FL Conditions
Disclosure: Power Medical – Residency Program Support David Vargas, MD, Lexington, KY
(Resident Education); Ethicon Endosurgery – Residency Program Disclosure: Ethicon Endosurgery – Honorarium (Speaker);
Support (Resident Education); Covidien – Residency Program Covidien – Honorarium (Preceptor/Consultant); Applied Medical
Support (Resident Education) – Honorarium (Preceptor)
10:00 am Managing Complications, Reoperative 10:30 am Panel Discussion

Surgery and Conversion
Deborah Nagle, MD, Boston, MA
Objectives: At the conclusion of this session, participants should be able to: understand the techniques required
for performing laparoscopic colorectal resections; thus, improving surgical skills and safety.
4.5 AMA PRA Category 1 Credit(s)™
S AT U R D AY
25
Saturday, May 2
Hand-Assist Laparoscopic Intestinal Surgery Workshop

1 2 3 6 *
11:00 am - 4:00 pm
Fee $595 • Registration Required • Limit 21 • Lunch included
The didactic portion of this course will be held at 6:30 am, Saturday in the Diplomat Ballroom
and all course registrants are encouraged to attend.
Workshop Location: DaVinci Center
8850 NW 20 Street
Miami, FL 33172
Transportation will be provided
Supported by educational grants from:
Applied Medical
Covidien
Genzyme Biosurgery
Stryker Endoscopy
This workshop will involve hands-on training in the steps necessary for laparoscopic colorectal surgery. Anatomy will be
reviewed. The steps of each procedure will be performed by participants using cadaver models with the close supervision of
expert faculty.
Laparoscopic Colectomy Coordinator: Conor Delaney, MD, Cleveland, OH
Director: Paul Vignati, MD, Hartford, CT
Assistant Director: David Vargas, MD, Lexington, KY
Disclosure: P. Vignati: No Affiliation
Disclosure: D. Vargas: Ethicon Endosurgery – Honorarium (Speaker); Covidien – Honorarium
(Preceptor/Consultant); Applied Medical – Honorarium (Preceptor)
The course will emphasize:

Anatomy Required for Laparoscopic Methods of Bowel Mobilization and
Intestinal Resection Devascularization
Oncologic Principles of Laparoscopic Extracorporeal and Intracorporeal
Intestinal Resection Anastomosis
Faculty:
Christine Bartus, MD, New Britain, CT William Timmerman, MD, Richmond, VA
Disclosure: No Affiliation Disclosure: Ethicon Endosurgery – Honorarium (Speaker/ Consultant)
Harry Reynolds, Jr., MD, Cleveland, OH David Vargas, MD, Lexington, KY
Disclosure: Covidien – Honorarium (Speaker/Course Instructor) Paul Vignati, MD, Hartford, CT
Toyooki Sonoda, MD, New York, NY
Disclosure: Covidien – Honorarium (Speaker); Applied Medical – Honorarium
(Speaker, Proctor); Adolor – Honorarium (Consultant)
Objectives: At the conclusion of this session, participants should be able to: a) understand the basic techniques of
laparoscopic intestinal surgery; b) understand the anatomical approaches as they relate to laparoscopy; c) apply
laparoscopic techniques for dissection in correct anatomical planes to intestinal surgery; and d) understand the
sequence of steps necessary to perform the procedure safely and efficiently.

26
Saturday, May 2
Laparoscopic Colectomy Workshop

Straight Laparoscopic Cadaver Lab
1 2 3 6 *
11:00 am - 4:00 pm
Fee $595 • Registration Required • Limit 21 • Lunch included
The didactic portion of this course will be held at 6:30 am, Saturday in the Diplomat Ballroom
and all course registrants are encouraged to attend.
8850 NW 20 Street
Miami, FL 33172
Covidien
Microline
This course will feature hands-on training in the steps necessary for laparoscopic colorectal surgery. Anatomy will be
reviewed. The steps of each procedure will be performed by participants using cadaver models, with the close supervision
S AT U R D AY
of expert faculty.
Director: Conor Delaney, MD, Cleveland, OH
Assistant Director: Floriano Marchetti, MD, Miami, FL
Disclosure: F. Marchetti: Adolor – Honorarium (Speaker); Genzyme – Honorarium (Speaker)
The workshop will cover:

Laparoscopic Right Colectomy Laparoscopic Transverse Colectomy and
Laparoscopic Sigmoid Colectomy Anterior Resection (if time permits)
Faculty:
Conor Delaney, MD, Cleveland, OH Paul Neary, MD, FRCSI, Dublin, Ireland
Edward Lee, MD, Albany, NY
Disclosure: US Surgical – Honorarium (Instructor) Vincent Obias, MD, Washington, DC
Floriano Marchetti, MD, Miami, FL
Gino Trevisani, MD, Burlington, VT
Disclosure: Ethicon Endosurgery – Honorarium (Instructor)
Disclosure: Covidien – Honorarium (Consultant/Speakers Bureau); Wolf –
Honorarium (Consultant/Speakers Bureau); Stryker – Honorarium (Consul-
tant/Speakers Bureau); Glaxo Smith Kline – Honorarium (Consultant); Zassi –
Honorarium (Consultant); Covidien – Grant/Research Support; SurgiQuest –
Honorarium (Scientific Advisory Board); SurgiQuest (Stockholder)

27
Saturday, May 2
Lunch Symposium
Professionalism and Communication

1 3 4 *
12:00 - 1:30 pm
Diplomat Ballroom
Professionalism…
As professionals, surgeons practice commitment to patients by demonstrating respect, compassion, integrity, accountability,
and a penchant for excellence and on-going professional development. This session will discuss physician leadership in both
the academic and hospital environment.
Communication…
Effective surgeons must foster a therapeutic relationship between patients, families and professional associates based on
sound ethical practices. They must know when to listen and when to act; when to work as a team member and when to
lead. This symposium will address positive communication skills as it pertains to medical staff leaders, physician to physi-
cian, and physician to lay board members. It will also address negative behavior and communication; how it affects the
individual, his/her environment and its affect on quality.
Director: Guy Orangio, MD, Atlanta, GA

Assistant Director: Kerry Hammond, MD, Charleston, SC
Disclosure: G. Orangio: No Affiliation
Disclosure: K. Hammond: No Affiliation
Physician Leadership in Both the Academic Negative Behavior and Communication

and Hospital Environment Guy Orangio, MD, Atlanta, GA
Robert Fry, MD, Philadelphia, PA
Panel Discussion
Positive Communication Skills

Ann Lowry, MD, St. Paul, MN
Objectives: At the conclusion of this session, participants should understand the importance of professionalism
and good communication.

28
Saturday, May 2
Video Session
2:00 - 3:30 pm
Diplomat Ballroom
Videos of advanced colorectal procedures and teaching techniques submitted by the faculty will be presented with a period
for questions after the presentation.
Moderators: Bertram Chinn, MD, Edison, NJ and Petar Vukasin, MD, Glendale, CA
Disclosure: B. Chinn: No Affiliation
Disclosure: P. Vukasin: No Affiliation
2:00 pm Colonoscopic High Frequency 2:38 pm Discussion

Ultrasound as Useful Adjunct during
2:40 pm Laparoscopic Very Low Stapling
Routine Colonoscopy V-2
in Ileal Pouch Anal Anastomosis for
A. Haji, S. Papagrigoriadis, London, UK
Benign Disease V-36
S. Berdah, D. Birnbaum, Marseille, France
2:06 pm Discussion Disclosure: Ethicon Endo Surgery – Consulting Fee (Consultant,
Speaker)
2:08 pm Robotic Total Mesorectal Excision
in Obese Male Patient V-7 2:46 pm Discussion
L. Prasad, S. Marecik, J. Park, T. Edson, 2:48 pm Martius Procedure for Complex
S AT U R D AY
Park Ridge, IL and Chicago, IL Rectal and AnoVaginal Fistula V-33
B. Gurland, M. Zutshi, T. Hull, Cleveland, OH
2:14 pm Discussion Disclosure: No Affiliation
2:16 pm Combined Laparoscopy and CO2 2:54 pm Discussion

Colonoscopy for Polyp Removal V-13
2:56 pm Transanal Hemorrhoidal Dearterialization –
V. Ho, J. Yan. S. Stein, T. Sonoda, S. Lee,
Procedure for Hemorrhoids and
J. Milsom, New York, NY
Hemorrhoidal Prolapse V-24
(Voted Best Video by the ASCRS Awards Committee)
M. Page, Des Moines, IA
Disclosure: THD America – Honorarium (Trainer)
2:22 pm Discussion
3:02 pm Discussion
2:24 pm Restorative Procto Sigmoidectomy for
3:04 pm Laparoscopic Total Mesorectal
Giant Villous Tumor – A Combined
Excision for Rectal Cancer V-27
Laparoscopic and Perineal Approach V-17
G. Kennedy, C. Heise, Madison, WI
P. Reissman, A. Dagan, Jerusalem, Israel
2:30 pm Discussion 3:10 pm Discussion
2:32 pm Cleft Lift Treatment for Unhealed 3:12 pm Acquiring Basic Skills for Robotic
Pilonidal Disease V-39 TME on Pelvic Simulator V-6
Mark Brand, Chicago, IL S. Marecik, L. Prasad, J. Blumetti, B. Paris,
Disclosure: MISDER, LLC – Ownership Interest (Founder, Park Ridge, IL and Chicago, IL
Chairman of Board); AMI (Agency for Medical Innovations) – Disclosure: No Affiliation
Honorarium (Instructor); Ethicon EES – Honorarium (Instruc-
tor/Consultant); American Physicians Instit. for Adv. Prof.
3:18 pm Discussion
Studies – Honorarium (Instructor)
The American Society of Colon and Rectal Surgeons designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™
3:30 – 4:00 pm Refreshment Break in Foyer
29
Saturday, May 2
Symposium
Colorectal Screening
1 2 5 6 *
4:00 - 5:30 pm
Diplomat Ballroom
Colorectal cancer is a common cause of cancer related mortality in the United States. Detection and treatment of colorectal
adenomatous polyps can prevent development of cancer and early detection of cancers can improve survival. Multiple
modalities and schedules exist for detection of colorectal cancers and polyps, each with its own detection rate, limitations,
and risks.
While lack of patient awareness is a significant barrier to screening, physician factors have also been identified. The
National Cancer Institute’s National Surveys of Colorectal Cancer Screening Policies and Practices concluded in several
surveys: 1) Education of providers and system-level interventions are needed to improve the quality of screening implemen-
tation; 2) Strategies to improve colorectal cancer screening recommendations of primary care physicians may improve the
use of screening for millions of Americans; and 3) Physician awareness about colorectal screening is high. However,
knowledge gaps about the timing and frequency of screening and suboptimal screening delivery were evident.
Participants will learn of the prevalence of colorectal cancer; the different colorectal cancer screening options available; and
the economic impact of colorectal cancer screening on the U.S. healthcare system.
Existing Gaps
What is: A variety of tests are deemed acceptable for colorectal cancer screening, but through a lack of patient and physician
education, less than half of patients who meet the criteria undergo appropriate testing.
What Should Be: Physicians who regularly see patients who meet the criteria for colorectal screening should have a thorough
knowledge of appropriate screening schedules and should counsel patients about the benefits and limitations of the testing
alternatives in order to help patients make an informed decision as to what screening strategy they would like to pursue.
Director: Charles Whitlow, MD, New Orleans, LA

Assistant Director: Nadav Dujovny, MD, Grand Rapids, MI
Disclosure: C. Whitlow: No Affiliation
Disclosure: N. Dujovny: Myriad Genetics – Honorarium (Speaker)
4:00 pm Welcome/Introduction 4:45 pm CT Colonography

Perry Pickhardt, MD, Madison, WI
4:05 pm Indications and Economics of Screening
Disclosure: Medicsight – Consulting Fee (Consultant); Viatronix
Alan Herline, MD, Nashville, TN – Consulting Fee (Consultant); Covidien – Consulting Fee
Disclosure: Pathfinder Therapeutics – Stock (Founder) (Consultant); Fleet – Consulting Fee (Consultant); Philips –
Consulting Fee (Consultant); VirtuoCTC – Ownership
4:25 pm Colonoscopy Interest (Co-founder)
Steven Hunt, MD, St. Louis, MO
Disclosure: Karl Storz Endoscopy – Honorarium (Instructor); 5:05 pm Fecal DNA/Stool Testing
Ethicon Endosurgery – Honorarium (Instructor); Applied Kerry Hammond, MD, Charleston, SC
Medical – Honorarium (Instructor); Adolor/GSK – Honorarium Disclosure: No Affiliation
(Instructor); Covidien – Honorarium (Instructor); Richard Wolf
– Honorarium (Speaker) 5:20 pm Panel Discussion
Objectives: At the conclusion of this session, participants should be able to: a) identify appropriate patients for
colorectal cancer screening; b) counsel patients about acceptable options for colorectal cancer screening; c) rec-
ognize the impact of screening on the incidence and survival of colorectal cancer; and d) integrate best available
evidence in making recommendations for colorectal cancer screening intervals.

30
Saturday, May 2
Allied Health Program for the Physician
Key Components of a
Successful Colorectal Surgery Practice
3 4 *
4:00 - 6:00 pm
Regency Ballroom 3
Because the U.S. population has become more diverse, the healthcare workforce must be mindful of the changing needs
of the patient population. Patients desire providers who address their diverse needs including gender and cultural issues.
The workforce needed to address these needs in colorectal surgery includes physician and non-physician care givers.
This workshop will address issues of patient, physician, and non-physician diversity and how attention to these issues can
enhance patient care. In addition, physicians looking to join a practice and physicians looking to hire and retain partners
will have the opportunity to discuss strategies that are more likely to yield long term successful partnerships.
Director: Charles Littlejohn, MD, Stamford, CT

Assistant Director: Kirsten Bass Wilkins, MD, Edison, NJ
Disclosure: C. Littlejohn: No Affiliation
Disclosure: K. Wilkins: Glaxo-Smith Kline/Adolor – Honorarium (Speaker)
Diversity in Colorectal Practice: Creating and Building a Partnership:

4:00 pm Why is Diversity an Important Part 4:45 pm Young Partner Perspective
S AT U R D AY
of Practice? Daniel Herzig, MD, Portland, OR
Guy Orangio, MD, Atlanta, GA Disclosure: No Affiliation
5:00 pm A Senior Partner’s Perspective
4:15 pm Colorectal Surgery: Does Gender Matter? Donald Colvin, MD, Fairfax, VA
Patricia Roberts, MD, Burlington, MA Disclosure: Covidien – Honorarium (Speaker)
5:15 pm Panel Discussion
4:30 pm My Associate Is Not a MD
Kelly Tyler, MD, Springfield, MA
Objectives: At the conclusion of this session, participants should be able to understand: a) the diversity of the
current patient population; b) the gender and/or cultural diversity of the current physician workforce and the
impact on patient care and referral patterns; c) how the current physician and patient demographics can affect
resident recruitment, d) staff recruitment and partner recruitment; e) how a colorectal surgeon identifies the need
for other healthcare providers in their practice; f) the role of non-physician health care providers in enhancing
patient care; g) a new partner’s clinical goals when joining a private or academic practice; h) a new partner’s and
senior partner’s monetary goals; i) how a senior partner provides a practice environment that maximizes the
retention of a new partner; and j) the practice philosophy of senior partners and how this affects their decision
regarding partnership or tenure; and factors to consider when buying into a practice.

31
Saturday, May 2
Dinner Symposium
Simulation in Colon and Rectal Surgery

2 3 5 *
6:30 - 8:00 pm
Diplomat Ballroom
The use of simulation in medical education has grown exponentially over the last decade. With currently available simula-
tions, programs can be developed for many types of skills, including crisis resource management, discrete technical skills,
early laparoscopic skills, advanced laparoscopic operations, and endoscopic skills. Many of these programs have direct
applicability to the colon and rectal surgeon in practice, as well as to residents in training.
The educational theory and rationale for using simulation-based education for surgical training will be reviewed. Participants
will have a better understanding of the types of simulations available and how to integrate them into a residency program.
Director: Helen MacRae, MD, Toronto, ON, Canada

Assistant Director: Jonathan Efron, MD, Phoenix, AZ
Disclosure: H. MacRae: No Affiliation
Disclosure: J. Efron: Covidien – Honorarium (Speaker)
6:30 pm Welcome/Introductions 7:05 pm Team Training and Crisis Resource

Helen MacRae, MD, Toronto, ON, Canada Management
Jonathan Efron, MD, Phoenix, AZ Jonathan Efron, MD, Phoenix, AZ
6:35 pm The Integration of Simulation into Patient 7:20 pm Developing (and paying for) Simulation
Safety Initiatives Based Training
Mika Sinanan, MD, PhD, Seattle, WA Helen MacRae, MD, Toronto, ON, Canada
Disclosure: Cancerfacts.com – Honorarium (Paper Review and
Editing Website Content) 7:35 pm Panel Discussion
6:50 pm Simulators for Laparoscopic and

Endoscopy Training
Conor Delaney, MD, PhD, Cleveland, OH
Objectives: At the conclusion of this session, participants should be able to: a) recognize the deficiencies of the
current model of surgical training; b) understand the types of simulations available for use by colon and rectal
surgery programs; c) discuss methods to fund simulation programs; d) describe how simulators can be used to en-
hance surgical and colon and rectal resident training, as well as to improve continuing professional development;
and e) and describe how simulation based training can be integrated into residency programs.

32
Sunday, May 3
Breakfast Symposium
Prosthetics in Colorectal Surgery

1 2 *
6:30 - 8:00 am
Regency Ballroom
American Medical Systems
Cook Medical
Ethicon, Inc.
This symposium will provide attendees with an overview of the current commercially available products and the basic
science of their mechanical properties and absorption. A series of short lectures will highlight their use in surgery for anal
and rectovaginal fistulas, the treatment and prevention of parastomal hernias, in rectocele repairs and their use in total
pelvic floor reconstruction.
Director: Theodore Saclarides, MD, Chicago, IL

Assistant Director: Megan Cavanaugh, MD, Portland, OR
Disclosure: T. Saclarides: Richard Wolf Medical – Honorarium (Instructor); Ethicon Endosurgery – Honorarium (Instructor)
Disclosure: M. Cavanaugh: Cook Medical – Travel Expenses (Research Meeting); Genzyme – No Remuneration (Speakers’ Bureau)
6:30 am The Basic Science of Bioprosthetics 7:10 am Rectocele Surgery

Megan Cavanaugh, MD, Portland, OR Sharon Gregorcyk, MD, Dallas, TX
6:40 am Overview of Commercially Available
Products 7:20 am Total Pelvic Floor Reconstruction
Theodore Saclarides, MD, Chicago, IL Janice Rafferty, MD, Cincinnati, OH
Disclosure: American Medical Systems – No Remuneration
6:50 am Anal and Rectovaginal Fistula Plugs (Consultant)
Alex Ky, MD, New York, NY
Disclosure: Ethicon – Honorarium (Preceptor) 7:30 am Panel Discussion
7:00 am Parastomal Hernias - Treatment

and Prevention
S U N D AY
Objectives: At the conclusion of this session, participants should be able to: a) understand how biologic meshes
differ from their permanent mesh counterparts; b) describe which products are commercially available and select
the appropriate product for a given clinical scenario; c) discuss outcome and product utility with patients regard-
ing the use of bioprosthetics for anal and rectovaginal fistulas; d) discuss whether biologic mesh products can be
used to prevent hernia formation; e) enumerate the various ways that biologic meshes can be used in the repair of
parastomal hernias and relate clinical results noted thus far; f) describe the use of biologic mesh products in rec-
tocele surgery; and g) describe the use of bioprosthetics in total pelvic floor reconstruction.

33
Sunday, May 3
Allied Health Program for Nurses
The Critical Role of Allied Health Professionals in the

Management of Patients with Colorectal Disease
1 2 5 *
6:30 - 10:00 am
Diplomat Ballroom 3
Continental Breakfast
Partial support by an educational grant from ConvaTec Inc.
The American Society of Colon and Rectal Surgeons recognizes the valuable contributions that Allied Health professionals
have made to this field. This is the fourth symposium at the annual meeting dedicated to allied health professionals. The
topics that will be covered include care of the stoma, pre- and post-operative concerns for the complicated stoma patient,
management of difficult wounds, telephone triage, fiscal impact of an allied professional on daily practice, and dealing with
the difficult patient.
Director: Feza Remzi, MD, Cleveland, OH
Assistant Director: Heidi Chua, MD, Rochester, MN
Disclosure: F. Remzi: Covidien – Honorarium (Advisory Board)
Disclosure: H. Chua: No Affiliation
6:30 am Continental Breakfast 8:25 am Bridging the Gap: A Model for Nurse and
Physician Collaboration in Colorectal
7:00 am Stomas: Surgeons’ View
Surgery–The Role of a Wound Ostomy
James Wu, MD, PhD, Beachwood, OH
and Skin Care Nurse
Sara Hallam, RN, BSN, CWOCN,
7:25 am Stomas: Preoperative Teaching, Marking Cleveland, OH
and Postoperative Management of Disclosure: No Affiliation
Complex Stomas
8:50 am Panel Discussion
Paula Erwin-Toth , MSN, RN, ET, CWOCN,
CNS, Cleveland, OH 9:00 am The Economics of Adding the Providers to
Disclosure: Convatec – Honorarium (Speaker); Coloplast – a Practice
Honorarium (Speaker); Convatec – No Remuneration Joshua Dorsey, MHA, Cleveland, OH
(Professional Advisory Board); Coloplast – No Remuneration Disclosure: No Affiliation
(Professional Advisory Board)
9:25 am Managing the Difficult Patient
Vicki Rumpler, RN, BSN, Cleveland, OH
8:00 am Complex Abdominal and Perineal Wounds: Disclosure: No Affiliation
When is it Time to Call the Plastic Surgeon
and What Can Be Done About It?
Armand R. Lucas, MD, Cleveland, OH
Objectives: At the conclusion of this session, participants should be able to: a) identify challenges related to pre
and postoperative management of complicated stoma patient; b) demonstrate the proper marking on a colorectal
surgery patient for a colostomy and ileostomy; c) discuss patient education related to the care of ileostomy and
colostomy; d) discuss the complications and appropriate treatment in the care of an ileostomy and colostomy
stoma; e) identify a non-healing wound in the perineal, perianal, abdominal regions; f) discuss the management
methods for interacting with the difficult colorectal patient; and g) demonstrate the impact of allied health pro-
fessional to daily practice.

34
Sunday, May 3
Simulation Colectomy Only
1 2 6 *
6:30 am – 3:30 pm
Fee $595 • Registration Required • Limit 30 • Lunch Included
Course Registrants are encouraged to attend the Laparoscopic Colectomy Didactic Session
6:30 – 11:00 am, Saturday in the Diplomat Ballroom (see page 24).
8850 NW 20 Street
Miami, FL 33172
The Simulators used in this course are designed for right-handed dominant surgeons.
Supported by an educational grant from Ethicon Endo-Surgery, Inc., a Johnson and Johnson Company
This Simulation Laboratory will involve hands-on training in the steps necessary for laparoscopic colorectal surgery.
Anatomy will be reviewed. The steps of each procedure will be performed by participants using simulated models, with the
close supervision of expert faculty. Both straight laparoscopic and hand-assisted laparoscopic procedures will be taught
depending on the wishes of the participant.
Directors: Conor Delaney, MD, Cleveland, OH and Paul Neary, MD, Dublin, Ireland
Disclosure: P. Neary: No Affiliation
Faculty:
Conor Delaney, MD, PhD, Cleveland, OH David Maron, MD, MBA, Philadelphia, PA
Disclosure: SurgRx – Honorarium (Consultant)
Morris Franklin, MD, San Antonio, TX
Disclosure: Gore – Honorarium (Speaker); Cook – Honorarium (Speaker); Deborah Nagle, MD, Boston, MA
S U N D AY
Covidien – Honorarium (Speaker and Instructor); Ethicon – Honorarium Disclosure: No Affiliation
(Speaker & Instructor); Atrium – No Remuneration (Speaker)
Paul Neary, MD, Dublin, Ireland
Charles Heise, MD, Madison, WI
Disclosure: No Affiliation Harry Reynolds, Jr., MD, Cleveland, OH
Disclosure: Covidien – Honorarium (Speaker/Course Instructor)
Rebecca Hoedema, MD, Grand Rapids, MI
Disclosure: No Affiliation David Vargas, MD, Lexington, KY
Disclosure: Ethicon Endosurgery – Honorarium (Speaker); Covidien – Honorar-
Floriano Marchetti, MD, Miami, FL ium (Preceptor/Consultant); Applied Medical – Honorarium (Preceptor)
Disclosure: Adolor – Honorarium (Speaker); Genzyme – Honorarium (Speaker)

35
Sunday, May 3
Symposium
Laparoscopic Colorectal Surgery:

Nuts, Bolts and New Tools for Your Toolbox
1 2 6 *
8:00 - 10:00 am
Grand Ballroom
Applied Medical
Covidien
This symposium will showcase experienced laparoscopic colorectal surgeon educators in a fast paced format. Faculty will
share their surgical pearls, tips, and tricks in short videos and discuss and defend their techniques. A wide range of topics
spanning from fundamentals of laparoscopic colectomy, to proctectomy and reoperative laparoscopic colorectal surgery will
be demonstrated.
Director: Mark Whiteford, MD, Portland, OR

Assistant Director: Bradley Davis, MD, Cincinnati, OH
Disclosure: M. Whiteford: Richard Wolf Medical Instruments – Research Support/Consulting Fee (Research/
Consultant); Applied Medical – Honorarium (Speaker); Sanofi Aventis – Honorarium (Speaker)
Disclosure: B. Davis: Ethicon Endo Surgery – Honoraria (Instructor)
8:00 am Introduction 8:16 am Controlling the Out-of-Control:

Mark Whiteford, MD, Portland, OR Hemorrhage
Sharon Stein, MD, New York, NY
8:02 am OR Set up and Patient Positioning
Disclosure: Covidien – Honorarium (Speaker); Olympus –
Jon Vogel, MD, Cleveland, OH Honorarium (Speaker)
Disclosure: Applied Medical, Inc. – Honorarium (Speaker/Course
Instructor) 8:19 am Panel Discussion
8:05 am Right Colon Vascular Control Using
Mechanical Devices: Clips and on Staplers 8:31 am Hepatic Flexure: Antegrade Starting at
Robin Boushey, MD, Ottawa, ON, Canada Ascending Colon
Disclosure: Covidien Canada – Research Funding and Honorar- Bradford Sklow, MD, Salt Lake City, UT
ium (Speaker/Teacher of Laparoscopic Course); Storz Canada - Disclosure: W.L.Gore – Honorarium (Consultant); Applied Med-
Research Funding and Honorarium (Speaker/Teacher of Laparo- ical – Honorarium (Instructor)
scopic Course); Applied Medical – Honorarium (Speaker/Teacher
of Laparoscopic Course) 8:34 am Hepatic Flexure: Retrograde Starting at the
Transverse Colon
8:09 am Left Colon Vascular Control Using Energy
Kirk Ludwig, MD, Milwaukee, WI
Devices: Ultrasonic and Bipolar Devices
Disclosure: Covidien – Honorarium (Speaker); Applied Medical –
Alan Herline, MD, Nashville, TN Honorarium (Speaker)
Disclosure: Pathfinder Therapeutics – Stock (Founder)
8:37 am Splenic Flexure: Retrograde Starting at
8:13 am Left Ureter Hide and Seek Descending Colon
David Rivadeneira, MD, Smithtown, NY Tonia Young-Fadok, MD, Phoenix, AZ
Disclosure: Applied Medical – Honorarium (Instructor for Lap Disclosure: No Affiliation
Course); Covidien – Honorarium (Speaker/Instructor); TranS 1
– Honorarium (Consultant for Course)
36
Sunday, May 3
Laparoscopic Colorectal Surgery:

Nuts, Bolts and New Tools for Your Toolbox (Continued)
8:40 am Splenic Flexure: Antegrade Starting at 9:14 am Laparoscopic TME: Restoring Continuity
Transverse Colon Bradley Champagne, MD, Cleveland, OH
John Marks, MD, Wynnewood, PA Disclosure: Covidien – Honorarium (Speaker); GSK Glaxo –
Disclosure: Covidien – Honorarium (Consultant/Speakers Honorarium (Speaker)
Bureau); Wolf – Honorarium (Consultant/Speakers Bureau);
Stryker – Honorarium (Consultant/Speakers Bureau); 9:18 am Panel Discussion
Glaxo Smith Kline – Honorarium (Consultant); Zassi – Mark Whiteford, MD, Portland, OR
Honorarium (Consultant); Covidien – Grant/Research Support;
SurgiQuest – Honorarium (Scientific Advisory Board); 9:30 am Laparoscopic Management of Small Bowel
SurgiQuest (Stockholder) Obstruction
Bradley Davis, MD, Cincinnati, OH 9:33 am Laparoscopic Parastomal Hernia Repair
Jonathan Efron, MD, Phoenix, AZ
8:55 am Retracting the Uterus:Transabdominal Disclosure: Covidien – Honorarium (Speaker)
Techniques
Nadav Dujovny, MD, Grand Rapids, MI 9:36 am Laparoscopic Assisted Colonoscopic
Disclosure: Myriad Genetics – Honorarium (Speaker) Polypectomy
Sang Lee, MD, New York, NY
8:58 am Laparoscopic TME: Dissection and Disclosure: Covidien – Honorarium (Speaker/Consultant); Power
Mobilization Medical – Honorarium (Speaker); Olympus - Course Support
David Jayne, MD, Leeds, United Kingdom (Course Director); Applied Medical – Course Support (Course
Disclosure: No Affiliation Director); TranS1 – Honorarium (Consultant)
9:02 am Laparoscopic TME: The Ideal First Assistant 9:40 am Laparoscopic Resection-Rectopexy
George Chang, MD, Houston, TX for Prolapse
Disclosure: Covidien – Honorarium (Speaker) Madhulika Varma, MD, San Francisco, CA
9:06 am Laparoscopic TME: Deep Pelvic Exposure,
Dissection and Division 9:44 am Laparoscopic Rectopexy with Mesh
Eric Weiss, MD, Weston, FL Bradley Davis, MD, Cincinnati, OH
Disclosure: Power Medical – Residency Program Support (Resi-
dent Education); Ethicon Endosurgery – Residency Program Sup-
Bradley Davis, MD, Cincinnati, OH
S U N D AY
port (Resident Education); Covidien – Residency Program
Support (Resident Education)
9:10 am Laparoscopic TME: How the Robot Makes

it Better
Sonia Ramamoorthy, MD, San Diego, CA
Disclosure: Covidien – Honorarium (Course Faculty); Applied
Medical – Honorarium (Course Director); Apollo Endo – No
Remuneration (Consultant)
Objectives: At the conclusion of this session, participants should be able to: a) understand various methods of
colon mobilization and vascular control; b) understand the special challenges and techniques associated with
pelvic dissection; and c) have a better understanding of fundamentals of reoperative intestinal surgery.
10:00 – 10:30 am Refreshment Break in Grand Ballroom Foyer
37
Sunday, May 3
Symposium
Technological Advances in the Diagnosis and

Treatment of Colorectal Diseases
2 6 *
8:30 - 10:00 am
Regency Ballroom
Mederi Therapeutics, Inc.
Medtronic, Inc.
Technologic advances alter the way we diagnose and treat colorectal diseases. This symposium will address new technology
in staple-line reinforcement technology, the results of sacral nerve stimulation for incontinence, the use of doppler-guided
hemorrhoidal artery ligation, and advances in endoscopy and polypectomy.
Director: Martin Weiser, MD, New York, NY
Assistant Director: Karim Alavi, MD, Worcester, MA
Disclosure: M. Weiser: Applied Medical – Honorarium (Speaker); Power Medical – Honorarium
(Speaker); Diagnocure – Honorarium (Speaker, Consultant)
Disclosure: K. Alavi: No Affiliation
8:30 am The SECCA Procedure for Fecal 9:15 am Use of Sacral Nerve Stimulation for Fecal
Incontinence Incontinence
Jonathan Efron, MD, Phoenix, AZ Steven Wexner, MD, Weston, FL
Disclosure: Covidien – Honorarium (Speaker) Dr. Wexner will present the results of a 120-patient
prospective multi-center study which was co-authored
8:45 am Advances in Colonoscopic Technology and by: J. Coller, Lahey Clinic, Burlington, MA; G.
Endoscopic Polypectomy Devroede, Universite de Sherbrooke, Eastman,
Sang Lee, MD, New York, NY Quebec; T. Hull, Cleveland Clinic, Cleveland, OH; A.
Disclosure: Covidien – Honorarium (Speaker/Consultant); Power F. Mellgren, University of Minnesota, Minneapolis,
Medical – Honorarium (Speaker); Olympus - Course Support MN and R. McCallum, KU Medical Center, Kansas,
(Course Director); Applied Medical – Course Support (Course MO. (Details of study are also included in Poster 59)
Director); TranS1 – Honorarium (Consultant)
The IRB approved study was supported and funded by
9:00 am Advances in Staple Line Reinforcement Medtronics
Technology Disclosure: Medtronics – No Remuneration (Institutional Support
for IRB Study – Investigator); Simendo – Consulting Fee
Bradley Champagne, MD, Cleveland, OH (Consultant)
Disclosure: Covidien – Honorarium (Speaker); GSK Glaxo –
Honorarium (Speaker) 9:30 am Improving Hemorrhoidectomy with
Doppler-Guided Hemorrhoidal Artery
Ligation
Marc Brand, MD, Chicago, IL
Disclosure: MISDER, LLC – Ownership Interest (Founder,
Chairman of Board); AMI (Agency for Medical Innovations) –
Honorarium (Instructor); Ethicon EES – Honorarium (Instruc-
tor/Consultant); American Physicians Instit. for Adv. Prof.
Studies – Honorarium (Instructor)
Objectives: At the conclusion of this session, participants should be able to: understand the recent developments
in staple line reinforcement technology, the efficacy of sacral nerve stimulation for incontinence, understand the
use of doppler guided vessel ligation for hemorrhoidal disease, and appreciate the advances in endoscopy.
38
Sunday, May 3
Core Subject Update

2 *
10:30 am - 12:00 pm
Grand Ballroom
The Core Subject Update - one of the highlights of the meeting - was developed by ABCRS and ASCRS to assist in the
education and recertification of colon and rectal surgeons. Core subjects have been restructured to include 24 topics rotat-
ing on a four year cycle. Speakers give a 15 minute evidence-based review focused on current concepts and controversies
followed by a 3-minute question period. A written précis based on each talk is available on the ASCRS website. Questions
developed from each presentation are included in the ABCRS recertification question bank.
Director: W. Donald Buie, MD, Calgary, AB Canada

10:30 am Fistulas/Abscess 11:21 am Questions from the Audience

Bradley Champagne, MD, Cleveland, OH
11:24 am Diverticulitis
Honorarium (Speaker) M. Shane McNevin, MD, Spokane, WA
10:45 am Questions from the Audience
11:39 am Questions from the Audience
10:48 am Fecal Incontinence
Andreas Kaiser, MD, Los Angeles, CA 11:42 am Colon Cancer (Controversies in
Disclosure: Ethicon (Consultantship); Cook Medical – Honorar- Surgical/Medical Therapy)
ium (Consultantship); McGraw-Hill – Royalties (Author) Howard Ross, MD, Red Bank, NJ
Disclosure: Covidien – Honorarium (Speaker); Electrocore –
11:03 am Questions from the Audience Consulting Fees (Consulting); Applied Medical – Honorarium
(Speaker)
11:06 am Other Colitidies
Farshid Araghizadeh, MD, Dallas, TX 11:57 am Questions from the Audience
Disclosure: Genzyme Biosurgery – Honorarium (Speaker)
Objectives: At the conclusion of this session, participants should be able to: a) understand an evidence-based
S U N D AY
approach to the management of anorectal fistula disease and become familiar with less invasive approaches to the
treatment of anorectal fistula; b) understand the epidemiology, etiologies and impact of fecal incontinence as well
as the workup, differentiate between various treatment modalities for fecal incontinence; c) discuss the etiology,
presentation and treatment of colitidies not associated with IBD, such as infectious and non-infectious colitidies,
collagenous colitis, solitary rectal ulcer syndrome, medication related colitis and other more rare colitidies; d) un-
derstand the pathophysiology of acute diverticulitis, the evolving indications for surgery and the evolving options
for surgical procedures; e) understand the most recent trials of adjuvant therapy for colon cancer, the mechanisms
of action of emerging agents in adjuvant therapy for colon cancer and gain an awareness of growing controver-
sies/emerging treatment paradigms in colon cancer.

39
Sunday, May 3
Young Surgeons’ Lunch Symposium
Sculpting Your Career:

Career Pearls You Didn't Learn In Fellowship
3 4 5 *
12:00 – 1:30 pm
Diplomat Ballroom 3
The focus of this symposium is to help young surgeons understand elements outside of medicine which are not learned in
training. Participants will learn: a) how to bill and code cases; b) data collection; c) publishing; d) importance of networking;
and e) other important factors to achieve a vibrant, active and dynamic career.
Director: Bradley Champagne, MD, Cleveland, OH

Assistant Director: Sharon Stein, MD, New York, NY
Disclosure: B. Champagne: Covidien – Honorarium (Speaker); GSK Glaxo – Honorarium (Speaker)
Disclosure: S. Stein: Covidien – Honorarium (Speaker); Olympus – Honorarium (Speaker)
12:00 pm Introduction 1:00 pm Private: Making a Difference from Outside

Bradley Champagne, MD, Cleveland, OH the University
12:05 pm Speaking: Getting Your Audience to Listen
Disclosure: Richard Wolf Medical Instruments – Research
to You? Support/Consulting Fee (Research/Consultant); Applied Medical
Tim Baker, Cleveland, OH – Honorarium (Speaker); sanofi aventis – Honorarium (Speaker)
1:10 pm Politicing: Impacting Organizations on a
12:20 pm Coding: Making the Most of the Work That National Level
You Do? Patricia Roberts, MD, Burlington, MA
Guy Orangio, MD, Atlanta, GA Disclosure: No Affiliation
1:20 pm Review of Young Surgeon’s Survey
12:35 pm Collecting: Creating, Maintaining and and Datashare
Storing Your Data? Sharon Stein, MD, New York, NY
Jonah Stulberg, MPH, Cleveland, OH
Disclosure: Ethicon Endo-Surgery – Salary (Employee/Research
Fellow)
12:50 pm Publishing: Balancing Academics

and Clinical?
Martin Weiser, MD, New York, NY
Disclosure: Applied Medical – Honorarium (Speaker); Power
Medical – Honorarium (Speaker); Diagnocure – Honorarium
(Speaker, Consultant)
Objectives: At the conclusion of this session, participants should be able to: a) understand how to appropriately
bill and code for cases and patients early in practice; b) understand the importance and best approach to becom-
ing active in ASCRS; c) recognize the critical steps in transitioning from fellowship into both academic and pri-
vate practice; d) learn how to create a user-friendly database that is appropriate for your practice; and e) learn
presentation pearls that are effective in the community and on the national stage.

40
Sunday, May 3
Lunch Symposium
Perioperative Considerations
1 2 6 *
12:00 - 1:30 pm
Regency Ballroom
Merck & Co., Inc.
sanofi-aventis U.S.
With increasing scrutiny of surgical practices and emphasis on standardization of practice parameters to enhance outcomes,
it is imperative that practicing physicians have a thorough understanding of the measures they can employ to reduce varia-
tion and improve safety. In an effort to create transparency in outcomes data, regulatory agencies and even community
hospitals are publicizing length of stay, re-admissions, and complication rates as well as other data to highlight the “quality”
of care they provide their patients. Additionally, as pay for performance is integrated into hospital and physician reimburse-
ment, failure to adhere to care guidelines will not only impact an institution’s designation as a center of excellence, but its
financial bottom line as well.
Participants will be educated on the most recent recommendations (SCIP & NSQIP) to reduce surgical site infections; deep
vein thrombosis, post-op ileus and anastomotic leak, as well as the role bowel preparation may play in these complications.
Director: Michael Spencer, MD, St. Paul, MN

Assistant Director: Alex Ky, MD, New York, NY
Disclosure: M. Spencer: No Affiliation
Disclosure: A. Ky: Ethicon – Honorarium (Preceptor)
12:00 pm Bowel Prep 12:45 pm Anastomotic Protection

Jon Hourigan, MD, Lexington, KY Michael Spencer, MD, St. Paul, MN
Disclosure: Applied Medical – Honorarium (Instructor)
1:00 pm Post-Operative Ileus
12:15 pm Deep Vein Thrombosis Thomas Read, MD, Burlington, MA
Martin Luchtefeld, MD, Grand Rapids, MI Disclosure: No Affiliation
S U N D AY
12:30 pm Surgical Site Infection
Karim Alavi, MD, Worcester, MA
Objectives: At the conclusion of this session, participants should be able to: a) understand the role of bowel
prep, appropriate antibiotic prophylaxis and anastomotic protection in reducing post operative infections and
anastomotic leaks; b) understand the pathophysiology of ileus and DVT and mechanism to reduce of each; and c)
understand importance of integrating practice guidelines into their practice to reduce variation in outcomes.

41
Sunday, May 3
Welcome and Opening Announcements
1:45 pm
Grand Ballroom
Anthony Senagore, MD, Grand Rapids, MI Robin Boushey, MD, Ottawa, ON, Canada
President, ASCRS Awards Chair
C. Neal Ellis, MD, Mobile, AL Dana Sands, MD, Weston, FL
Program Chair Local Arrangements Chair
James Merlino, MD, Cleveland, OH
Program Vice-Chair
Presidential Address Research Foundation Update

2:30 - 3:30 pm 4:00 - 4:30 pm
Grand Ballroom Grand Ballroom
It is the Unknown Unknowns José Guillem, MD
that Really Matter President, ASCRS Research Foundation
New York, NY
Anthony J. Senagore, MD, MS,
MBA, FACS, FASCRS Dr. Guillem will present an overview
Vice President, Research & of recent activities of the Research
Medical Education, Spectrum Health Foundation including: fund raising
Professor of Surgery, efforts, the fostering of interactions
Michigan State University/CHM with the National Institutes of Health
Grand Rapids, MI and the development of broader fund-
Disclosure: Deltex Medical - Unrestricted Educational Grant; Tranzyme
ing opportunities for those who conduct clinical and basic
Pharma -Consulting Fee (Consultant/Advisor) research on diseases of the colon, rectum and anus.
42
Sunday, May 3
Research Foundation Workshop
The Leading Edge - Update on the Latest

in Research and Development
4:30 - 6:00 pm
Regency Ballroom
This session will include presentations from recipients of Limited Project Grants and Career Development Awards who
will discuss their studies and present a chronological description of their academic career including current research inter-
est. Speakers will give presentations of what they have done and where they are going. There will be a question period after
the presentations.
Director: José Guillem, MD, New York, NY

Faculty includes:
Clifford Ko, MD, Los Angeles, CA Lisa Poritz, MD, Hershey, PA
Disclosure: No Affiliation Disclosure: No Affiliation
Kelli Bullard Dunn, MD, Buffalo, NY Larissa Temple, MD, New York, NY
Emina Huang, MD, Gainesville, FL

Objectives: At the conclusion of this session, participants should be able to: a) appreciate the impact the ASCRS
Research Foundation has had on helping launch successful academic careers for colorectal surgeons and b) appre-
ciate the degree of time and effort and commitment that is required to conduct leading edge research.
S U N D AY
43
Sunday, May 3
Symposium
Obstructed Defecation Syndrome

1 2 *
4:30 - 6:00 pm
Grand Ballroom
This symposium will provide a comprehensive review of the evaluation and treatment of obstructive defecation syndrome.
Discussion of treatment will include use of less invasive options such as biofeedback therapy and sacral stimulation as well
as the use of the STARR procedure, biomaterials and mesh.
Existing Gaps
What is: Functional bowel disorders are a common condition in which an incomplete understanding of the disease process,
appropriate testing available, and treatment options result in patients being misdiagnosed and inadequately treated.
What Should Be: Physicians who regularly see patients with functional bowel disorders should have a thorough knowledge of
appropriate testing. They should also be able to counsel patients about the benefits and limitations of the available treat-
ment alternatives in order to aid patients in making an informed decision about their care.
Director: Madhulika Varma, MD, San Francisco, CA
Assistant Director: Brooke Gurland, MD, Cleveland, OH
Disclosure: M. Varma: No Affiliation
Disclosure: B. Gurland: No Affiliation
4:30 pm The Role of Anorectal Physiology Testing 5:15 pm Treatment of Functional Abnormalities:
Brooke Gurland, MD, Cleveland, OH Sacral Nerve Stimulation
Soren Laurberg, MD, Aarhus, Denmark
4:45 pm The Role of Radiographic Imaging Disclosure: Medtronic – Honorarium (Member of Advisory Board)
Jennifer Kemp, MD, Denver, CO
Disclosure: No Affiliation 5:30 pm Treatment of Anatomical Abnormalities:
STARR, Biomaterials, Rectocele Repair
5:00 pm Treatment of Functional Abnormalities: Anders Mellgren, MD, PhD, Minneapolis, MN
Biofeedback Disclosure: Ethicon Endosurgery – Research Support (Consul-
Kevin Olden, MD, Little Rock, AR tant); American Medical Systems – Research Support (Consul-
Disclosure: No Affiliation tant); Q-Med Scandinavia – Research Support (Consultant);
Medtronic – Research Support (Consultant); Carbon Medical –
Research Support (Consultant)

Objectives: At the conclusion of this session, participants should be able to: a) identify the signs and symptoms of
obstructive defecation syndrome; b) understand the role of anorectal physiology and radiographic imaging to con-
firm the diagnosis; c) recognize the importance of addressing the functional aspects of obstructive defecation; and d)
discuss the advantages/disadvantages of correcting anatomical abnormalities associated with obstructive defecation.
Welcome Reception
7:00 - 8:30 pm
Diplomat Landing (outdoors)
After a long day of scientific sessions, plan to unwind at the festive Welcome Reception.
This fun-filled event will be held at the Westin Diplomat Resort and will feature entertainment,
hors d’oeuvres and cocktails. It’s the perfect place to catch up with old friends and make new acquaintances.
You’ll also have an opportunity to bid on terrific items at the Research Foundation’s Silent Auction.
44
Monday, May 4
Breakfast Symposium
Lymph Nodes:
Prognostic, Therapeutic and Quality Implications
2 6 *
6:00 - 7:30 am
Regency Ballroom
sanofi-aventis U.S.
Approximately 85% of patients with colorectal cancer will present with potentially curable disease that is treated by surgical
resection. Surgical treatment should include resection of the affected segment of bowel and en bloc resection of the associ-
ated draining lymph nodes to the level of the origin of the primary blood supply to that segment of the bowel. A complete
evaluation of the lymph node basin is important for accurately identifying lymph node involvement with colon cancer
and for complete resection of disease. Because of the high risk for recurrence of colon cancer, adjuvant chemotherapy is
recommended for patients with lymph node metastases (Stage III). Thus, adequate lymph node staging of patients with
colon cancer is important for determining prognosis and planning further treatment.
The 1990 Working Party Report to the World Congresses of Gastroenterology recommended evaluation of at least 12
lymph nodes, a recommendation that was subsequently reiterated by a National Cancer Institute sponsored panel of experts
to ensure adequate sampling. Numerous observational studies, particularly in Stage II colorectal cancer have found an associ-
ation between survival and node number. However, a population-based analysis found that only 37% of patients with colon
cancer receive adequate lymph node evaluation. Reasons for low population rates of “adequate” node sampling may include
patient-, tumor-, surgeon-, and/or pathologist-related variables. The two potentially modifiable influences are the complete-
ness of lymph node evaluation by examining pathologists and the adequacy of the surgical resection.
The number of lymph nodes recovered from a patient with colon cancer has been identified as a potentially important meas-
ure of the quality of cancer care by many organizations, including the American College of Surgeons, the American Society
of Clinical Oncology, the National Comprehensive Cancer Network, the National Quality Forum, health insurance
providers, and others. However, it is not universally accepted that examining more lymph nodes will lead to better outcomes
or improved staging accuracy as a means to improved survival. It is important that surgeons understand the implications of
quality benchmarks, methods to ensure adequate staging in their patients, and are aware of the controversies in this area.
Existing Gaps
What is: Many surgeons do not fully understand the relationship between lymph node evaluation and outcome in patients with
colon and rectal cancer. Additionally, many surgeons are concerned about quality benchmarking based on nodal recovery.
What Should Be: Surgeons should understand the importance of adequate nodal staging of colon and rectal cancer patients,
understand the implications of quality benchmarks for lymph node harvest and be aware of the controversies in this area.
Director: Nancy Baxter, MD, PhD, Toronto, ON, Canada

Assistant Director: George Chang, MD, Houston, TX
Disclosure: N. Baxter: No Affiliation
Disclosure: G. Chang: Covidien – Honorarium (Speaker)
M O N D AY
6:00 am Welcome 6:20 am Lymph Node Recovery: What is the Role of

Nancy Baxter, MD, PhD, Toronto, ON, Canada the Surgeon?
George Chang, MD, Houston, TX Elin Sigurdson, MD, PhD, Philadelphia, PA
Disclosure: Sanonfi – Honorarium (Speaker)
6:05 am Context and Controversy
Clifford Ko, MD, Los Angeles, CA
45
Monday, May 4
Lymph Nodes:
Prognostic, Therapeutic and Quality Implications
(continued)
6:35 am Lymph Node Recovery: What is the Role of 7:05 am Panel Discussion
the Pathologist?
Mariana Berho, MD, Weston, FL
6:50 am Strategies for Quality Improvement

Neil Hyman, MD, Burlington, VT
Objectives: At the conclusion of this session, participants should be able to: a) discuss the data comparing lymph
node harvest with survival and understand the difference between association and causation; b) understand the
factors which can affect lymph node harvest; c) describe techniques to improve identification of lymph nodes; and
d) discuss lymph node evaluation as a quality indicator in colon and rectal surgery.
46
Monday, May 4
Meet the Professor Breakfasts
6:30 - 7:30 am
Limit: 30 per breakfast • Fee $35 • Registration Required • Continental Breakfast
Registrants are encouraged to bring problems and questions to this informal discussion.
Code Subject/Faculty Room Code Subject/Faculty Room

M-1 Parastomal Hernia Diplomat Ballroom 2 M-4 Anorectal Crohn’s Disease Room 303
O L D OUT
S
Jonathan Efron, MD, Phoenix, AZ Walter Koltun, MD, Hershey, PA
Bruce Orkin, MD, Washington, DC Scott Strong, MD, Cleveland, OH
Disclosure: J. Efron: Covidien – Honorarium (Speaker) Disclosure: W. Koltun: No Affiliation
Disclosure: B. Orkin: No Affiliation Disclosure: S. Strong: No Affiliation
M-2 Coding and M-5 Uncomplicated Diverticular
O L D OUT
S
Reimbursement Diplomat Ballroom 4 Disease: When Do You Really
David Margolin, MD, New Orleans, LA Need to Operate? Room 312/313
Guy Orangio, MD, Atlanta, GA David Larson, MD, Rochester, MN
Disclosure: D. Margolin: No Affiliation Clifford Simmang, MD, Dallas, TX
Disclosure: G. Orangio: No Affiliation Disclosure: D. Larson: No Affiliation
Disclosure: C. Simmang: - Ethicon Endorsurgery – Honorarium
M-3 Rectal Prolapse Diplomat Ballroom 5 (Speaker); Stryker – Honorarium (Consultant)
Anders Mellgren, MD, PhD, Minneapolis, MN
Michael Stamos, MD, Orange, CA M-6 Clinical Trials Research:
Disclosure: A. Mellgren: Ethicon Endosurgery – Research Sup- How to Get Started? Room 314
port (Consultant); American Medical Systems – Research Support Alessandro Fichera, MD, Chicago, IL
(Consultant); Q-Med Scandinavia – Research Support (Consul- Julio Garcia-Aguilar, MD, PhD, Duarte, CA
tant); Medtronic – Research Support (Consultant); Carbon Med-
ical – Research Support (Consultant) Disclosure: A. Fichera: No Affiliation
Disclosure: M. Stamos: Ethicon – Fellow Grant Support (In- Disclosure: J. Garcia-Aguilar: No Affiliation
structor); Covidien – Mini Fellowship Support (Instructor);
Glaxo – Honorarium (Advisor/Speaker); Valleylab/Covidien En-
ergy – Honorarium (Speaker/Advisor)
Residents' Breakfast
7:00 - 8:00 am
Diplomat Ballroom 3
Colon and Rectal Surgery: A Specialty on
the Rise
W. Douglas Wong, MD, FACS
M O N D AY
Chief, Colorectal Service

Memorial Sloan-Kettering Cancer Center
Professor of Surgery, Cornell University Medical
College, New York, NY
Disclosure: Power Medical Interventions – Stock
Introduction: Eugene Foley, MD
Residents Only • Registration Required
Supported by a grant from Konsyl Pharmaceuticals, Inc.
47
Monday, May 4
Symposium
Rectal Cancer
1 2 5 *
7:30 - 10:00 am
Grand Ballroom
Partial support by an educational grant from Applied Medical
The management of patients with rectal cancer requires a multidisciplinary approach with an experienced expert team to
assure optimal care. Total mesorectal excision has been associated with a decrease in the rate of local failure after surgery.
Pathologic analysis, particularly of the radial margin, provides important prognostic information that enables better
allocation of postoperative care. The data shows that preoperative chemoradiotherapy is more beneficial and has less
toxicity for patients with resectable rectal cancer than postoperative chemoradiotherapy. Surgical quality assurance is a
central issue in the treatment of rectal cancer and has led to substantial improvements in sphincter preservation, local
control and overall survival.
Existing Gaps
What is: Receipt of recommended chemotherapy is 48 percent for Stage II rectal cancer, and 66 percent for Stage III rectal
cancer. Receipt of recommended radiation therapy was 52 percent for Stage II rectal cancer and 66 percent for Stage III
rectal cancer.
What Should Be: All patients with rectal cancer without co-morbidities which preclude multimodality therapy, should receive
treatment in accordance with established guidelines.
Director: Anthony Senagore, MD, Grand Rapids, MI

Assistant Director: Najjia Mahmoud, MD, Philadelphia, PA
Disclosure: A. Senagore: Deltex Medical - Unrestricted Educational Grant; Tranzyme Pharma -
Consulting Fee (Consultant/Advisor)
Disclosure: N. Mahmoud: Merck – Honorarium (Consultant); Wyeth – Honorarium (Consultant);
Adolor – Honorarium (Consultant)
7:30 am Clinical Staging of Rectal Cancer 8:15 am Pathological Assessment of TME Specimens
Michael Stamos, MD, Orange, CA Mariana Berho, MD, Weston, FL
Disclosure: Ethicon – Fellow Grant Support (Instructor); Disclosure: No Affiliation
Covidien – Mini Fellowship Support (Instructor); Glaxo –
Honorarium (Advisor/Speaker); Valleylab/Covidien Energy – 8:30 am Quality Measures and Economic
Honorarium (Speaker/Advisor) Implications of Management Options
for Rectal Cancer
7:45 am Pre-operative Imaging Before Total
Anthony Senagore, MD, Grand Rapids, MI
Mesorectal Excision for Rectal Cancer
Gina Brown, MBBS MD MRCP FRCR, 8:45 am Open Total Mesorectal Excision
London, United Kingdom Professor R. J. Heald, OBE, MChir, FRCS,
Disclosure: No Affiliation Basingstoke, United Kingdom
8:00 am Choosing Optimal Radiation for Rectal
Cancer Management 9:00 am Laparoscopic TME
Bruce Minsky, MD, Chicago, IL Conor Delaney, MD, Cleveland, OH
Disclosure: sanofi-aventis – Honorarium (Speaker, Advisory Disclosure: No Affiliation
Board); Genentech – Honorarium (Speaker); Bristol Myers
Squibb – Honorarium (Speaker); Roche – Honorarium (Speaker)
48
Monday, May 4
Rectal Cancer (continued)
9:15 am The Role of Abdominoperineal Excision in 9:45 am Discussion

the Surgical Management of Rectal Cancer
Torbjörn Holm, MD, PhD, Stockholm, Sweden
Disclosure: Covidien – Honorarium (Speaker)
9:30 am Dealing with Local Recurrence in

Rectal Cancer
Heidi Nelson, MD, Rochester, MN
Objectives: At the conclusion of this session, participants should be able to: a) discuss the recommended treat-
ment of rectal cancer; b) describe the recommended preoperative evaluation and treatment of rectal cancer; c)
discuss the surgical aspects of optimal surgical management of rectal cancer; and d) discuss the role of minimally
invasive surgery in the management of rectal cancer.
10:00 – 10:30 am Refreshment Break in Exhibit Hall
M O N D AY
49
Monday, May 4
Symposium Parallel Session: 1-A
Enhanced Recovery Protocols

1 2 6 *
10:30 am - 12:00 pm
Grand Ballroom
Genzyme Biosurgery
A number of trials contrasting clinical results in enhanced-recovery protocols versus traditional care clearly show that such
protocols indeed enhance recovery by shortening hospital stay and improving patient satisfaction. Another recent survey
has revealed that best clinical practice in perioperative care, based on previously published high-grade evidence, is only
partially in use in daily clinical practice. Evidence supporting avoidance of intraoperative fluid excess, prevention of intra-
abdominal adhesions and the use of the oral opioid antagonist alvimopan to limit postoperative gastrointestinal paralysis has
emerged. There is strong evidence on how to enhance recovery after colorectal surgery, but many interventions are not
utilized in daily practice. Further evidence has emerged supporting several perioperative treatments and successful experi-
ences of enhanced-recovery programs have now been reported from several centers.
Participants will learn techniques to enhance recovery after colon and rectal resection, the impact of enhanced recovery
protocols on patients, and the benefits of these enhanced recovery protocols for the health care system.
Existing Gaps
What is: Postoperative hospital stay after colonic resection is usually 6 to 12 days. Additionally patient satisfaction is poor
because of postoperative morbidity.
What Should Be: Functional recovery in 3 days after colorectal resection should be achieved in daily practice with subsequent
improvement in patient satisfaction.
Director: Philip Cole, MD, Shreveport, LA
Assistant Director: Rebecca Hoedema, MD, Grand Rapids, MI
Disclosure: P. Cole: No Affiliation
Disclosure: R. Hoedema: No Affiliation
10:30 am Introduction 11:05 am Fluid Management

Philip Cole, MD, Shreveport, LA Dan Metcalf, MD, Duluth, MN
Rebecca Hoedema, MD, Grand Rapids, MI Disclosure: No Affiliation
10:35 am Prevention of Ileus 11:20 am Bowel Prep-or Not

David Beck, MD, New Orleans, LA Gary Dunn, MD, Shreveport, LA
Disclosure: Genzyme – Research Support, Honorarium (Investi- Disclosure: No Affiliation
gator, Advisory Board); Life Cell – Research Support (Investiga-
tor); Sapphire – Research Support (Investigator); Ethicon – 11:35 am Economics
Honorarium (Course Director) Bradley Champagne, MD, Cleveland, OH
10:50 am Prevention of Adhesions Honorarium (Speaker)
Matthew Mutch, MD, St. Louis, MO
Disclosure: Applied Medical – Honorarium (Teaching); Ethicon – 11:50 am Panel Discussion
Honorarium (Teaching); Covidien – Honorarium (Teaching);
Johnson and Johnson – Grant (Research); Applied Medical –
Stock (Teaching)
Objectives: At the conclusion of this session, participants should be able to: a) describe methods to prevent post-
operative ileus; b) discuss techniques to optimize fluid management; c) describe techniques to prevent postopera-
tive adhesions; d) discuss the value of enhanced recovery protocols to the patient and health care system.

50
Monday, May 4
Scientific Session Parallel Session: 1-B
Neoplasia I
Rectal Cancer
1 2 6 *
10:30 am - 12:00 pm
Atlantic Ballroom
Moderators: W. Donald Buie, MD, Calgary, AB, Canada and David Levien, MD, Baltimore, MD
Disclosure: W. Buie: No Affiliation
Disclosure: D. Levien: No Affiliation
10:30 am Neoadjuvant Therapy for Rectal Cancer: 11:00 am Neoadjuvant High Dose-Rate Endorectal
Does The Interval Between Chemoradia- Brachytherapy in the Era of Total
tion and Surgery Matter? S1 Mesorectal Excision for Patients with
L. F. Lobato, D. Geisler, A. da Luz Moreira, Rectal Cancer: Ten Year Follow-Up S4
V. W. Fazio, Cleveland, OH A. S. Liberman, C. Richard, K. Waschke,
Disclosure: L. Lobato: No Affiliation G. Artho, J. Parent, G. Bourdon, B. Stein,
Disclosure: D. Geisler: No Affiliation P. Charlebois, F. Letellier, D. Anderson,
S. Devic, T. Vuong, Montreal, Quebec, Canada
10:37 am Discussion
Disclosure: A. Liberman: No Affiliation
10:40 am Can We Increase the Rates of Complete Disclosure: T. Vuong: No Affiliation
Response for Distal Rectal Cancer? The study was sponsored by Nucletron, who supplied the equip-
ment. The NCIC (National Cancer Institute of Canada) provided
Results of a Prospective Study Using
a research grant for the patients who had lower 1/3 rectal tumors.
Additional Chemotherapy During the
Resting Period of Neoadjuvant CRT S2 11:07 am Discussion
R. O. Perez, A. Habr-Gama, W. Nadalin,
11:10 am Transanal Endoscopic Microsurgery
J. Sabbaga, P. Aguilar, I. Proscurshim,
Resection of Rectal Tumors:
J. Gama-Rodrigues, Sao Paulo, Brazil
Outcomes and Recommendations S5
Disclosure: R. Perez: No Affiliation
B. M. Tsai, C. O. Finne, J. Nordenstam,
Disclosure: A. Habr-Gama: No Affiliation
D. Christoforidis, R. D. Madoff, A. F. Mellgren,
10:47 am Discussion Minneapolis, MN; Lausanne, Switzerland
Disclosure: B. Tsai: No Affiliation
10:50 am Complete Remission After Neoadjuvant Disclosure: A. Mellgren: Ethicon Endosurgery – Research Support
Radiochemotherapy in Rectal Cancer: (Consultant); American Medical Systems – Research Support
Radical Surgery Or "Wait and See"? S3 (Consultant); Q-Med Scandinavia – Research Support (Consul-
H. P. Kessler, S. Merkel, W. Hohenberger, tant); Medtronic – Research Support (Consultant); Carbon
Medical – Research Support (Consultant)
Erlangen, Germany
Disclosure: H. Kessler: No Affiliation 11:17 am Discussion
Disclosure: W. Hohenberger: No Affiliation
11:20 am Can MRI After Chemoradiation for Rectal
10:57 am Discussion Cancer Select Patients with a Good
Response for Local Excision? S6
G. L. Beets, S. M. Engelen, M. J. Lahaye,
M O N D AY
G. Lammering, R. Jansen, R. M. van Dam,

J. W. Leijtens, J. Konsten, C. J. van de Velde,
R. G. Beets-Tan, Maastricht, Netherlands;
Roermond, Netherlands; Venlo, Netherlands;
Leiden, Netherlands
Disclosure: G. Beets: No Affiliation
Disclosure: R. Beets-Tan: No Affiliation
Off-Label: MR contrast agent USPIO: company filed for FDA
approval: Guerbet, France
51
Monday, May 4
Neoplasia I
Rectal Cancer (Continued)
11:27 am Discussion 11:47 am Discussion

11:30 am Salvage Treatment of Recurrences After 11:50 am Risk Factors for Anastomotic Leakage
Transanal Endoscopic Microsurgery S7 Following Preoperative Radiotherapy
F. T. Ferenschild, I. M. Dawson, Combined with Low Anterior Resection-
G. W. Tetteroo, J. H. de Wilt, E. J. de Graaf, The Indication of Defunctioning Stoma S9
Rotterdam, Zuid-Holland, Netherlands L. Wang, J. Gu, Beijing, China
Disclosure: F. Ferenschild: No Affiliation M. Li will present
Disclosure: E. de Graaf: No Affiliation Disclosure: L. Wang: No Affiliation
Disclosure: J. Gu: No Affiliation
11:37 am Discussion
Disclosure: M. Li: No Affiliation
11:40 am Short and Long-Term Results in Rectal
11:57 am Discussion
Cancer by Laparoscopic Approach. Our
Experience in More than 450 Cases S8
S. Delgado, A. Ibarzabal, N. Salgado,
F. Higuera, J. Maurel, A. Lacy, Barcelona, Spain
A. Lacy will present
Disclosure: S. Delgado: No Affiliation
Disclosure: A. Lacy: No Affiliation
Objectives: At the conclusion of this session, participants should be able to: (1) analyze the impact of the interval
between completion of neoadjuvant chemoradiation and surgery on tumor downstaging, oncologic outcomes and
perioperative morbidity/mortality; (2) analyze the impact of the addition of chemotherapy during the resting
period after CRT on complete response rates for distal rectal cancer; (3) analyze the chance of durable tumor
remission after neoadjvant radiochemotherapy in rectal cancer; understand the role of surgery in different stages
of rectal cancer; (4) understand the rationale for using brachytherapy as a neoadjuvant radiotherapy modality in
rectal cancer treatment; (5) differentiate outcomes of transanal endoscopic microsurgery in benign and malignant
rectal tumors; identify situations in which TEM may be useful; (6) understand that local excision after a good
response to chemoradiation for rectal cancer is still investigational; developments in MR technique and lymph
node specific MR contrast agents could produce tools that help in selecting patients for this controversial
approach; (7) know the basic principles and indications of transanal endoscopic microsurgery (TEM); manage
local recurrences after TEM for pT1 rectal cancer; (8) analyze the feasibility of laparoscopic surgery in rectal
cancer; compare the long term results with open surgery; and (9) know that anastomosis higher than 4cm to anal
verge was comparably safe and defunctioning stoma can be selective.
Noon - 1:00 pm
Complimentary Box Lunch

in Exhibit Hall
52
Monday, May 4
Norman Nigro
Research Lectureship
1:00 - 1:45 pm
Grand Ballroom
Conflict of Interest
Interactions Between Physician
Researchers and Industry 4 *
Erin Reilly Lewis

Counsel, Baker & Daniels
Indianapolis, IN
Disclosure: Baxter Healthcare - Spouse, Cory
Lewis (Salaried Employee); Althea Technologies -
Spouse, Cory Lewis (Salaried Employee)
Harry E. Bacon
Lectureship
1:45 - 2:30 pm
Grand Ballroom
Challenges and Opportunities
Facing American Graduate
Medical Education in 2009 4 *
Thomas J. Nasca, MD, MACP
Chief Executive Officer
Accreditation Council for
Graduate Medical Education
Chicago, IL
Professor of Medicine,
Jefferson Medical College
Philadelphia, PA
M O N D AY

53
Monday, May 4
Traveling Fellows and Impact Paper
2:30 - 3:00 pm
Grand Ballroom
Moderator: W. Donald Buie, MD, Calgary, AB, Canada
2:30 pm The Robert W. Beart, MD 2008 Impact Paper of the Year Award
Sacral Nerve Stimulation is More Effective than Optimal Medical Therapy for Severe Fecal Inconti-
nence: A Randomized, Controlled Study
Joe J. Tjandra, Miranda K.Y. Chan, Chung H. Yeh, Carolyn Murray-Greene, Melbourne, Australia
Resident / Fellow Presentations

Moderator: Graham Newstead, MBBS, Sydney, NSW, Australia
2:40 pm ASCRS International Scholarship Winner 2:50 pm British Traveling Fellow

A Snapshot of Colorectal Practice in a Systematic Reviews and Meta-Analyses
Teaching Hospital in South India in Coloproctology - Balancing Wider
Benjamin Perakath, MB BS Application with Considered Interpretation
Vellore, India Andrew Renehan, PhD, FRCS, FDS
Disclosure: No Affiliation HEFCE Senior Lecturer in Cancer Studies
and Surgery, Honorary Consultant,
2:45 pm ASCRS International Scholarship Winner
University of Manchester, Christie Hospital
Systematic Review and Meta-analysis of NHS Foundation Trust
Randomized Controlled Trials Comparing Disclosure: No Affiliation
Stapled Haemorrhoidopexy with Conven-
tional Haemorrhoidectomy 2:55 pm Mark Killingback Prize Winner
Shao Wanjin, MD Long-term Follow-up of Anterior Anal
Nanjing, People’s Republic of China Sphincter Repair – Patterns and Predictors
Disclosure: No Affiliation of Failure
Mr. Michael Weston Warner, FRACS, MRCS
(Eng), MB, ChB
Colorectal Surgeon Royal Perth Hospital,
Western Australia
3:00 – 3:30 pm Refreshment & Ice Cream Break in Exhibit Hall
54
Monday, May 4
Scientific Session Parallel Session: 2-A
Benign I
Anorectal Conditions
1 2 6 *
3:30 - 5:00 pm
Atlantic Ballroom
Moderators: Robin Boushey, MD, Ottawa, ON, Canada and David Rivadeneira, MD, Smithtown, NY
Disclosure: R. Boushey: Covidien Canada – Research Funding and Honorarium (Speaker/Teacher of Laparoscopic Course); Storz Canada -
Research Funding and Honorarium (Speaker/Teacher of Laparoscopic Course); Applied Medical – Honorarium (Speaker/Teacher of
Laparoscopic Course)
Disclosure: D. Rivadeneira: Applied Medical – Honorarium (Instructor for Lap Course); Covidien – Honorarium (Speaker/Instructor);
TranS 1 – Honorarium (Consultant for Course)
3:30 pm A Prospective Analysis of Clinician 4:00 pm The Ligation of Intersphincteric Fistula

Accuracy in the Diagnosis of Benign Tract for Fistula-in-Ano: Sphincter
Anorectal Pathology: Comparison Across Saving Technique S13
Specialties and Years of Experience S10 A. Shanwani, M. N. Azmi, N. Amri, Kelantan,
A. Grucela, H. Salinas, S. Khaitov, Malaysia; Pahang, Malaysia
R. M. Steinhagen, S. R. Gorfine, Disclosure: A. Shanwani: No Affiliation
D. B. Chessin, New York, NY Disclosure: M. Azmi: No Affiliation
Disclosure: A. Grucela: No Affiliation
4:07 pm Discussion
Disclosure: D. Chessin: No Affiliation
4:10 pm Follow-Up of Collagen Plug for
3:37 pm Discussion
Anorectal Fistulas S14
3:40 pm Modified Hanley Procedure for S. Khaitov, E. C. Ly, E. Steinhagen, A. J. Ky,
Management of Complex Horseshoe New York, NY
Fistulae S11 Disclosure: S. Khaitov: No Affiliation
A. M. Kaiser, L. Browder, S. Sweet, Los Disclosure: A. Ky: Ethicon – Honorarium (Preceptor)
Angeles, CA
4:17 pm Discussion
Disclosure: Presenting and Senior Author: A. Kaiser: Ethicon –
(Consultantship); Cook Medical – Honorarium (Consultantship); 4:20 pm Trans Anal Open Hemorrhoidopexy S15
McGraw-Hill – Royalties (Author) B. Govaert, F. Pakravan, C. Helmes,
3:47 pm Discussion C. G. Baeten, Maastricht, Netherlands;
Dusseldorf, Germany
3:50 pm Ligation of the Intersphincteric Fistula Disclosure: B. Govaert: No Affiliation
Tract: An Effective New Technique for Disclosure: C. Baeten: No Affiliation
Complex Fistulae S12
J. I. Bleier, H. Moloo, S. Goldberg, 4:27 pm Discussion
Philadelphia, PA; Ottawa, Ontario, Canada; 4:30 pm Transanal Hemorrhoidal Dearterialization:
Minneapolis, MN An Effective Mini-Invasive Therapeutic
Disclosure: J. Bleier: No Affiliation Approach to Hemorrhoids S16
Disclosure: S. Goldberg: No Affiliation C. Ratto, A. Parello, L. Donisi, F. Litta, G. B.
M O N D AY
3:57 pm Discussion Doglietto, Rome, Italy

Disclosure: Presenting and Senior Author: C. Ratto: THD –
Honorarium (Scientific Contributor, Trainer, Speaker)
4:37 pm Discussion
55
Monday, May 4
Benign I
Anorectal Conditions (continued)
4:40 pm Patient Satisfaction and Outcomes 4:50 pm Chronic Anal Fissure: The High-Dose
Following Stapled Transanal Rectal Botox Experience S18
Resection for Obstructive Defecation J. Park, S. M. Barone, J. C. Reilly, L. Kondylis,
Syndrome S17 P. D. Kondylis, Erie, PA
N. Bhoot, E. Haas, T. B. Pickron, Houston, TX Disclosure: J. Park: No Affiliation
Disclosure: N. Bhoot: No Affiliation Disclosure: P. Kondylis: No Affiliation
Disclosure: E. Haas: No Affiliation
4:57 pm Discussion
4:47 pm Discussion
Objectives: At the conclusion of this session, participants should be able to: (10) discuss the ability of medical
clinicians to accurately diagnose common anorectal pathology; understand the need to develop educational pro-
grams for medical professionals in the accurate diagnosis of common anorectal pathology; (11) assess the value of
a Hanley technique in the treatment of complex horseshoe fistulae; (12) understand the clinical difficulties in
dealing with transsphincteric fistula; familiar with surgical options for dealing with trans-sphincteric fistula; (13)
know the new technique for treatment of fistula-in-ano; (14) assess the efficacy of the Surgisis Plug and under-
stand how to put it in with better results; (15) familiar with a simple and safe haemorrhoidopexy procedure to
treat third degree haemorrhoids with good results; (16) correctly use the Transanal Hemorrhoidal Dearterializa-
tion (THD) in the treatment of various degrees of hemorrhoids; evaluate safety and effectiveness of THD ther-
apy; (17) learn patient satisfaction and outcomes following Stapled Transanal Rectal Resection (STARR
procedure) for obstructive defecation syndrome; and (18) discuss the role of Botox in the treatment of chronic
anal fissure; discuss the healing and recurrence rates of anal fissure after Botox injection; discuss some factors af-
fecting recurrence and healing after Botox injection for anal fissure.
56
Monday, May 4
Symposium Parallel Session: 2-B
Energy Devices in Colorectal Surgery

2 6 *
3:30 - 5:00 pm
Grand Ballroom
Covidien
Minimally invasive technique is now an acceptable, and for many conditions, the preferred surgical approach. The difficulty
with traditional means of dissection and hemostasis has created a need for technologies to accomplish these tasks. Current
options include monopolar cautery, bipolar cautery, ultrasound energy and most recently, nanotechnology. These technolo-
gies are not interchangeable with different scientific basis and capabilities. Confusion exists over the role each of these
technologies fills in minimally invasive surgery. Participants will learn the mode of action, safety, and efficacy of the available
energy-based devices in colon and rectal surgery.
Existing Gaps
What is: There is confusion regarding the different modes of action, capabilities, efficacy and safety of the various technolo-
gies available to dissect and achieve hemostasis in colon and rectal surgery.
What Should Be: Surgeons should understand the mode of action, the advantages and disadvantages of available technologies
and select the modality that best fulfills their needs during colorectal surgical procedures.
Director: James Fleshman, MD, St. Louis, MO
Assistant Director: Dana Sands, MD, Weston, FL
Disclosure: J. Fleshman: Ethicon – Research Grant (Researcher); Lifecell – Research Grant (Researcher); Applied Medical – Honoraria,
Research Grant (Lecturer, Researcher); Sapphire Therapeutics – Honoraria, Research Grant (Consultant, Researcher); Innocoll – Research
Grant, Honoraria (Researcher, Consultant); SurgRX – Owns Stock
Disclosure: D. Sands: No Affiliation
Monopolar Energy Ultrasound Energy

David Maron, MD, MBA, Philadelphia, PA Alessandro Fichera, MD, Chicago, IL
Disclosure: SurgRx – Honorarium (Consultant) Disclosure: No Affiliation
Bipolar Energy Nanotechnology

George Chang, MD, Houston, TX David Margolin, MD, New Orleans, LA
Disclosure: Covidien – Honorarium (Speaker) Disclosure: No Affiliation
Objectives: At the conclusion of this session, participants should be able to: a) describe the available technologies for dissection and hemo-
stasis in colon and rectal surgery; b) discuss the mode of action of the different technologies for dissection and hemostasis in minimally in-
vasive surgery; c) understand the capabilities of the technologies available for dissection and hemostasis in minimally invasive surgery; and
d) discuss the costs, efficacy and safety of the different technologies available.
Poster Walk-Arounds with Wine and Cheese

M O N D AY
5:00 - 6:30 pm
Great Hall
Relax and enjoy a glass of wine while you talk to poster authors. This is an opportunity to
pose questions and engage in discussions with the authors and other attendees in an
informal setting. Wine and cheese will be served. Authors are required to be at their poster.

57
Tuesday, May 5
6:30 - 7:30 am

T-1 Quality Indicators in Colon T-5 Reconstruction after Rectal
O L D OUT O L D OUT
S
and Rectal Surgery Diplomat Ballroom 2 Resection (Straight/J-Pouch/
Neil Hyman, MD, Burlington, VT S Baker/Coloplasty) Room 312/313
Clifford Ko, MD, Los Angeles, CA Matthew Mutch, MD, St. Louis, MO
Disclosure: N. Hyman: No Affiliation Eric Weiss, MD, Weston, FL
Disclosure: C. Ko: No Affiliation Disclosure: M. Mutch: Applied Medical – Honorarium
(Teaching); Ethicon – Honorarium (Teaching); Covidien –
T-2 Colorectal Trauma Diplomat Ballroom 4 Honorarium (Teaching); Johnson and Johnson – Grant
John Eggenberger, MD, Detroit, MI (Research); Applied Medical – Stock (Teaching)
Scott Steele, MD, Fort Lewis, WA Disclosure: E. Weiss: Power Medical – Residency Program
Disclosure: J. Eggenberger: No Affiliation Support (Resident Education); Ethicon Endosurgery – Residency
Program Support (Resident Education); Covidien – Residency
Disclosure: S. Steele: Ethicon Endosurgery – Honoraria
Program Support (Resident Education)
(Speaking and Teaching); Genzyme Biosurgery – Honoraria
(Speaking and Teaching) T-6 Basic Science Research:
T-3 Rectal Intussusception / How to Get Started? Room 314
L D OUT
Emina Huang, MD, Gainesville, FL
S O
Solitary Rectal Ulcer Diplomat Ballroom 5
Joseph Gallagher, MD, Orlando, FL Lisa Poritz, MD, Hershey, PA
Tracy Hull, MD, Cleveland, OH Disclosure: E. Huang: No Affiliation
Disclosure: J. Gallagher: Ethicon Endo-Surgery, Inc. – Disclosure: L. Poritz: No Affiliation
Honorarium (Speaker/STARR Course); Entereg Inc. –
Honorarium (Speaker)
Disclosure: T. Hull: No Affiliation
T-4 Bowel Prep: Why or Why Not Room 303

C. Neal Ellis, MD, Mobile, AL
Jan Rakinic, MD, Springfield, IL
Disclosure: C. Ellis: No Affiliation
Disclosure: J. Rakinic: No Affiliation
58
Tuesday, May 5
Breakfast Symposium
Developments in Colonic Stenting
T U E S D AY
1 2 6 *
6:30 - 8:00 am
Regency Ballroom
Supported by an educational grant from Boston Scientific Endoscopy
Acute colonic obstruction due to malignancy is often a surgical emergency. Surgical decompression with colostomy with or
without resection and eventual re-anastomosis has traditionally been the treatment of choice. These procedures have been
associated with a significant morbidity and mortality rate. Preoperative colonic stenting is effective for decompressing the
obstructed colon and may allow for surgery to be performed on an elective basis. The role for preoperative stenting in the
emergent management of acute malignant colonic obstruction has been supported by cost-effectiveness analysis studies and
several pooled analyses that demonstrate efficacy and safety.
Participants will learn the technique for placement of colonic stents, the impact of colonic stents on patients and the bene-
fits for the healthcare system.
Existing Gaps
What is: The most widely used approach for the management of acute left-sided colorectal obstruction is emergent surgery
which is associated with a high morbidity and mortality rate and frequently requires a “temporary” stoma which becomes
permanent in up to 60% of patients.
What Should Be: Placement of self expanding metallic stents should be the first step in the management of acute left sided
colonic obstruction.
Director: Michael Stamos, MD, Orange, CA

Disclosure: M. Stamos: Ethicon – Fellow Grant Support (Instructor); Covidien – Mini Fellowship
Support (Instructor); Glaxo – Honorarium (Advisor/Speaker); Valleylab/Covidien Energy – Honorarium
(Speaker/Advisor)
6:30 am Surgical Options 7:15 am Economics of Stenting

Terry Hicks, MD, New Orleans, LA Mark Welton, MD, Stanford, CA
Disclosure: No Affiliation Disclosure: Genzyme Biosurgical – Honorarium (Advisory
Board); Genzyme Biosurgical – Honorarium (Speaker)
6:45 am Endoluminal Treatment as a
“Bridge to Surgery” 7:30 am Video Session
Michael Hellinger, MD, Miami Beach, FL 7:45 am Panel Discussion
7:00 am Colonic Stenting as Definitive

Palliative Therapy
Maher Abbas, MD, Los Angeles, CA
Disclosure: Raven Technologies – Research Grant (Principal
Investigator)
Objectives: At the conclusion of this session, participants should be able to: a) discuss the management of acute
left-sided colonic obstruction; b) describe the techniques for placing a colonic stent; c) discuss the safety and effi-
cacy of colonic stents; d) describe the complications associated with colonic stents.

59
Tuesday, May 5
Robotics
2 6 *
8:00 - 9:00 am
Grand Ballroom
Power Medical Interventions, Inc.
Robotic assisted surgery is the latest technologic advance in minimally invasive surgery. Frustration with the limitations of
laparoscopic instrumentation and optics encouraged the development of robotic-assisted surgery. The focus in the surgical
robotic industry have been directed at restoring three-dimensional optics, developing intuitive controls and transforming the
procedure into an ergonomically comfortable experience. Currently available robotics feature three-dimensional stereoscopic
vision and depth perception. Instrument controls are no longer inverse and instead, electronically translate natural hand and
wrist motions whereby adding two additional degrees of freedom (pitch and yaw). The surgeon sits comfortably at a remote
console that features a neutral body position, arm and head rests. Taken together, the robot may have a reduced learning
curve and allow for more precise dissection, less difficulty with laparoscopic suturing, and knot tying. Robotics may be espe-
cially applicable for procedures requiring precise dissection and suturing in confined spaces such as total mesorectal excision
for rectal cancer, rectopexy for prolapse, or pelvic floor reconstruction. This symposium will focus on: current results from
ongoing randomized trials in Korea and the UK, the US experience, economic considerations and future applications.
Existing Gaps
What is: Most colon and rectal surgeons do not know the role of robotics in colon and rectal surgery.
What Should Be: Most colon and rectal surgeons should understand the capabilities and applications of robotics in colon and
rectal surgery.
Director: Leela Prasad, MD, Park Ridge, IL
Assistant Director: Sonia Ramamoorthy, MD, San Diego, CA
Disclosure: L. Prasad: No Affiliation
Disclosure: S. Ramamoorthy: Covidien – Honorarium (Course Faculty); Applied Medical – Honorarium (Course Director);
Apollo Endo – No Remuneration (Consultant)
8:00 am Welcome and Introductions 8:20 am US Experience/Training and Simulation

Leela Prasad, MD, Park Ridge, IL Slawomir Marecik, MD, Park Ridge, IL
8:05 am Korean Experience: Results of a Prospective
Randomized Control-Trial Robotic vs. 8:30 am Pro: Robotics
Open for Rectal Cancer Herand Abcarian, MD, Chicago, IL
Seon-Hahn Kim, MD, Seoul, South Korea Disclosure: No Affiliation
8:35 am Con: Robotics
8:12 am UK Experience: Results of a Prospective Anthony Senagore, MD, Grand Rapids, MI
Randomized Trial-Lap vs. Robotic Disclosure: Deltex Medical - Unrestricted Educational Grant;
David Jayne, MD, Leeds, United Kingdom Tranzyme Pharma - Consulting Fee (Consultant/Advisor)
Disclosure: No Affiliation 8:45 am Panel Discussion
Objectives: At the conclusion of this session, participants should be able to: a) discuss the available robotic tech-
nology and instruments available for use in colon and rectal surgery; b) describe the unique capabilities of robot-
ics in colon and rectal surgery; and c) describe the current application of robotic technology to colorectal surgery.

60
Tuesday, May 5
Outcomes I
T U E S D AY
Surgical Site Infections and Ileus
2 6 *
8:00 - 9:00 am
Atlantic Ballroom
Moderators: Christopher Mantyh, MD, Durham, NC and Arden Morris, MD, Ann Arbor, MI
Disclosure: C. Mantyh: No Affiliation
Disclosure: A. Morris: No Affiliation
8:00 am Validation of Risk Index Category as a 8:20 am Does Absolute Glycemic Response or the
Predictor of Surgical Site Infection in Variability of Glycemic Response Affect
Colorectal Patients S19 Surgical Site Infection Rates? S21
C. Pastor, J. H. Baek, M. G. Varma, E. Kim, A. Mahmood, K. El-Badawi, T. Asgeirsson,
L. A. Indorf, L. Gibbs, J. Garcia-Aguilar, M. Luchtefeld, D. Kim, R. Hoedema,
Duarte, CA; San Francisco, CA N. Dujovny, H. Slay, A. J. Senagore, Grand
Disclosure: C. Pastor: No Affiliation Rapids, MI
Disclosure: J. Garcia-Aguilar: No Affiliation Disclosure: A. Mahmood: No Affiliation
Disclosure: A. Senagore: Deltex Medical - Unrestricted Educa-
8:07 am Discussion tional Grant; Tranzyme Pharma - Consulting Fee (Consul-
tant/Advisor)
8:10 am An Increase in Compliance with SCIP
Measures Does Not Prevent Surgical 8:27 am Discussion
Site Infection in Colorectal Surgery S20
C. Pastor, A. Artinyan, J. H. Baek, M. G. Varma, 8:30 am Does SCIP Compliance Make Surgical
E. Kim, L. A. Indorf, L. Gibbs, J. Garcia- Site Infection a Never Event? S22
Aguilar, Duarte, CA; San Francisco, CA K. El-Badawi, A. Mahmood, T. Asgeirsson, M.
Disclosure: C. Pastor: No Affiliation Luchtefeld, D. Kim, R. Hoedema, H. Slay, N.
Disclosure: J. Garcia-Aguilar: No Affiliation Dujovny, A. J. Senagore, Grand Rapids, MI
Disclosure: K. El-Badawi: No Affiliation
8:17 am Discussion Disclosure: A. Senagore: Deltex Medical - Unrestricted Educa-
tional Grant; Tranzyme Pharma - Consulting Fee (Consul-
tant/Advisor)
8:37 am Discussion
61
Tuesday, May 5
Outcomes I
Surgical Site Infections and Ileus
(continued)
8:40 am Factors Associated with Perineal Wound 8:50 am The Morbidity of Clostridium Difficile
Complications After Abdominoperineal Infection Following Elective Colonic
Resection for Cancer of the Rectum S23 Resection-Results from a National
G. El-Gazzaz, R. P. Kiran, I. C. Lavery, Population Database S24
Cleveland, OH K. Lesperance, M. Spencer, S. R. Steele,
Disclosure: G. El-Gazzaz: No Affiliation Tacoma, WA; Rochester, MN
Disclosure: I. Lavery: No Affiliation Disclosure: K. Lesperance: No Affiliation
Disclosure: S. Steele: Ethicon Endosurgery – Honoraria (Speak-
8:47 am Discussion ing and Teaching); Genzyme Biosurgery – Honoraria (Speaking
and Teaching)
8:57 am Discussion
Objectives: At the conclusion of this session, participants should be able to: (19) validate potential predictors of
surgical wound infection after colon and rectal surgery; (20) analyze the impact of SCIP (Surgical Care Improve-
ment Project) health care practices to prevent surgical site infection after elective colorectal resections; (21) un-
derstand the importance of decreasing surgical site infections; critically analyze the role of the glycemic response
in relation to the development of surgical site infections realizing the numerous other factors that can contribute
to this problem; (22) understand the components of the Surgical Care Improvement Project; analyze how these
components, and other potential factors, impact development of surgical site infections; recognize the impor-
tance of careful assessment of care measures before implementation, and the possible clinical and economical re-
sults of such implementation; (23) understand the risk factors for perineal wound complications after APR for
rectal cancer; the effect of preoperative neoadjuvant therapy on perineal wound healing; and (24) understand out-
comes associated with pseudomembranous colitis in patients who have undergone colonic resection and factors
associated with its occurrence.
The American Society of Colon and Rectal Surgeons designates this educational activity for a maximum of 1 AMA
PRA Category 1 Credit(s)™
62
Tuesday, May 5
Maintenance of Certification
T U E S D AY
4 *
9:00 - 10:00 am
Grand Ballroom
This symposium will provide a review of the current components of Maintenance of Certification as well as the ideological
framework that lead to its development. A comparison to the Canadian system will be provided in addition to the details of
current requirements for the American Board of Colon and Rectal Surgery.
Director: Martin Luchtefeld, MD, Grand Rapids, MI

9:00 am Current Status of Maintenance 9:30 am An Overview of MOC and a Look Into
of Certification the Future
Martin Luchtefeld, MD, Grand Rapids, MI Kevin B. Weiss, MD, MPH, Evanston, IL
9:15 am Maintenance of Certification:
The Canadian Way 9:45 am Panel Discussion moderated by
W. Donald Buie, MD, Calgary, AB, Canada Martin Luchtefeld, MD
Disclosure: No Affiliation Panelists: Drs. W. Donald Buie, David Schoetz
and Kevin Weiss
Disclosure: D. Schoetz: Seminars in Colon and Rectal Surgery –
Honorarium (Editor-in-Chief)
Objectives: At the conclusion of this session, participants should be able to: a) describe the basic principles that
led to the transition from re-certification to Maintenance of Certification; b) plan for participation in the Mainte-
nance of Certification process by better understanding the requirements set forth by the ABCRS; and c) describe
the key components of Maintenance of Certification.

63
Tuesday, May 5
Inflammatory Bowel Disease

1 2 6 *
9:00 - 10:00 am
Atlantic Ballroom
Supported by an educational grant from Centocor-Ortho Biotech Services, LLC
Moderators: Scott Strong, MD, Cleveland, OH and Kirsten Bass Wilkins, MD, Edison, NJ
Disclosure: S. Strong: No Affiliation
Disclosure: K. Wilkins: Glaxo-Smith Kline/Adolor – Honorarium (Speaker)
9:00 am Technical Complications After Ileal 9:30 am Gender-Specific Differences in Pelvic

Pouch-Anal Anastomosis May Be Organ Function After Proctectomy for
Misinterpreted as Crohn's Disease S25 Inflammatory Bowel Disease S28
K. A. Garrett, F. Remzi, H. T. Kirat, B. Shen, M. G. Varma, S. L. Hart, J. Lee, J. Wang,
V. W. Fazio, R. P. Kiran,Cleveland, OH A. DelRosario, K. DelRosario, San Francisco,
Disclosure: K. Garrett: No Affiliation CA; Toronto, Ontario, Canada
Disclosure: R. Kiran: No Affiliation Disclosure: Presenting and Senior Author: M. Varma:
No Affiliation
9:07 am Discussion
9:37 am Discussion
9:10 am A Prospective Analysis of the Outcome
of Ileal Pouch-Anal Anastomosis in 9:40 am Outcome and Long-Term Function of
Inflammatory Bowel Disease Patients Restorative Proctocolectomy for Crohn's
with Backwash Ileitis S26 Disease: Comparison to Patients with
E. White, Z. Murrell, P. Fleshner, Los Ulcerative Colitis S29
Angeles, CA A. Grucela, J. J. Bauer, S. R. Gorfine,
Disclosure: E. White: No Affiliation D. B. Chessin, New York, NY
Disclosure: P. Fleshner: No Affiliation Disclosure: A. Grucela: No Affiliation
Disclosure: D. Chessin: No Affiliation
9:17 am Discussion
9:47 am Discussion
9:20 am Preservation of the Kock Pouch is
High in Long-Term Follow-Up S27
S. Forbes, S. Cowie, B. O'Conner, C. Victor,
Z. Cohen, R. McLeod, Toronto, Ontario,
Canada
Disclosure: S. Forbes: No Affiliation
Disclosure: R. McLeod: Ethicon Endosurgery - Research Grant
(Research)
9:27 am Discussion

64
Tuesday, May 5
Inflammatory Bowel Disease
T U E S D AY
(continued)
9:50 am Healthcare Resource Utilization and

Associated Costs Before and After Surgery
for Ulcerative Colitis: A Population-Based
Study in Olmsted County, Minnesota S30
S. D. Holubar, R. R. Cima, B. G. Wolff,
K. Long, E. Barnitt, E. V. Loftus,
J. H. Pemberton, Rochester, MN
Disclosure: S. Holubar: No Affiliation
Disclosure: J. Pemberton: No Affiliation
9:57 am Discussion
Objectives: At the conclusion of this session, participants should be able to: (25) understand the importance of
distinguishing between surgical complications following IPAA and Crohn's disease; (26) assess the prognostic sig-
nificance of backwash ileitis on the outcome of ileal pouch-anal anastomosis in patients with inflammatory bowel
disease; (27) understand the long term outcome of patients with a kock pouch; (28) appreciate the gender specific
diffences in outcome for patients with inflammatory bowel disease who undergo proctectomy; (29) discuss the
outcome and long-term function for patients undergoing restorative proctocolectomy for Crohn's disease; com-
pare the long-term functional outcome between patients with Crohn's disease and ulcerative colitis undergoing a
restorative proctocolectomy; and (30) describe healthcare resource utilization before and after surgery for ulcera-
tive colitis; discuss differences in healthcare resource utilization between different surgical procedures for ulcera-
tive colitis.
The American Society of Colon and Rectal Surgeons designates this educational activity for a maximum of 1 AMA
PRA Category 1 Credit(s)™
65
Tuesday, May 5
Ernestine Hambrick Parviz Kamangar
Lectureship Humanities in Surgery Lectureship
10:30 - 11:15 am 11:15 am - 12:00 pm
Grand Ballroom Grand Ballroom
Innovative Management of Emotional Management
Rectal Cancer 1 2 * and the Ethics of Medical
Decision Making 1 3 4 *
Angelita Habr-Gama, MD
Professor of Surgery Chris Feudtner, MD, PhD, MPH
University of Sao Paulo School Director, Department of Medical Ethics,
of Medicine Steven D. Handler Endowed Chair in
Sao Paulo, Brazil Medical Ethics, Director of Research &
Disclosure: No Affiliation Attending Physician PACT (Palliative
Care Team) & Integrated Care Service (ICS) General Pedi-
atrics, Children’s Hospital of Philadelphia, Philadelphia, PA
Noon - 1:00 pm
Complimentary Box Lunch in Exhibit Hall
Women in Colorectal Surgery Luncheon

Noon – 1:30 pm • Fee $42 • Registration Required
Diplomat Ballroom 3
The Women’s Luncheon offers an opportunity for women to renew friendships and make
new contacts. Female surgeons, residents and medical students attending the Annual Meet-
ing are welcome. Trainees are particularly encouraged to attend as the luncheon provides an
opportunity to meet experienced colon and rectal surgeons from a variety of settings.

66
Tuesday, May 5
End of Life Issues for Colon and Rectal Surgeons
T U E S D AY
1 3 4 5 *
1:00 - 2:30 pm
Grand Ballroom
Patients with advanced gastrointestinal cancer develop many symptoms as the disease progresses. The most common are
pain, nausea, vomiting, anorexia, constipation and intestinal obstruction. Appropriate prevention and management of gas-
trointestinal (GI) symptoms involves understanding their pathophysiology and severity. This knowledge, combined with
information about drugs and their administration, as well as the importance of anchoring all care plans, can lead to effective
symptom management and excellence in overall care.
You will learn about the problems which can arise in patients with terminal illnesses and the management of these problems.
Existing Gaps
What is: Patients with terminal colon and rectal cancer are not always receiving effective management of their gastrointesti-
nal symptoms.
What Should Be: Patients with terminal colon and rectal cancer should receive effective management of gastrointestinal
symptoms with an improvement in the quality of life of these patients.
Director: Richard Billingham, MD, Seattle, WA

Assistant Director: Kelli Bullard Dunn, MD, Buffalo, NY
Disclosure: R. Billingham: No Affiliation
Disclosure: K. Bullard-Dunn: No Affiliation
1:00 pm Surgical Issues: 1:45 pm When to Involve an Ethics Consultant or

Palliative Surgery in the Terminal Patient Ethics Committee
H. Randolph Bailey, MD, Houston, TX Lachlan Forrow, MD, Boston, MA
Disclosure: Merck Inc. – Honorarium (Speaker); Adolor/GSK – Disclosure: No Affiliation
Honorarium (Speaker)
2:00 pm Medicolegal Considerations in
1:15 pm “Comfort Care”: Palliative Care
Symptom Management at End of Life Deborah Nagle, MD, Boston, MA
Scott Steele, MD, Fort Lewis, WA Disclosure: No Affiliation
Disclosure: Ethicon Endosurgery – Honoraria (Speaking and
Teaching); Genzyme Biosurgery – Honoraria (Speaking and 2:15 pm Discussion
Teaching)
1:30 pm Ethical Considerations:

The Surgeon’s Role in the Care of the
Terminal Patient
Arden Morris, MD, Ann Arbor, MI
Objectives: At the conclusion of this session, participants should be able to: a) describe the management of pain
in patients with terminal colon and rectal cancer; b) describe the etiology and management of anorexia in patients
with terminal colon and rectal cancer; c) describe the etiology and management of nausea and vomiting in pa-
tients with terminal colon and rectal cancer; d) describe the etiology and management of constipation in patients
with terminal colon and rectal cancer; and e) describe the etiology and management of intestinal obstruction in
patients with terminal colon and rectal cancer.

67
Tuesday, May 5
Neoplasia II
Staging and Prognosis
2 6 *
1:00 - 2:30 pm
Atlantic Ballroom
Moderators: James Fleshman, MD, St. Louis, MO and Najjia Mahmoud, MD, Philadelphia, PA
Disclosure: J. Fleshman: Ethicon – Research Grant (Researcher); Lifecell – Research Grant (Researcher); Applied Medical – Honoraria,
Research Grant (Lecturer, Researcher); Sapphire Therapeutics – Honoraria, Research Grant (Consultant, Researcher); Innocoll – Research
Grant, Honoraria (Researcher, Consultant); SurgRX – Owns Stock
Disclosure: N. Mahmoud: Merck – Honorarium (Consultant); Wyeth – Honorarium (Consultant); Adolor – Honorarium (Consultant)
1:00 pm Gene Signature Predicts Early 1:37 pm Discussion

Stage Rectal Cancer Recurrence:
1:40 pm Gene Expression Signature and the
A Step Toward Individualized
Prediction of Lymph Node Metastasis in
Treatment Decisions S31
Colorectal Cancer By DNA Microarray S35
M. F. Kalady, J. A. Sanchez, K. DeJulius,
T. Watanabe, T. Kobunai, Tokyo, Japan
I. C. Lavery, J. M. Church, H. Ishwaran,
Disclosure: Presenting and Senior Author: T. Watanabe:
Cleveland, OH Yakuruto Honsha Co. Ltd – Honorarium (Speaker); Chugai
Funded by the ASCRS Research Foundation Pharmaceutical Co. Ltd – Honorarium (Speaker); Taiho
Disclosure: Presenting and Senior Author: M. Kalady: No Pharmaceutical Co.Ltd –Honorarium (Speaker)
Affiliation
1:47 pm Discussion
1:07 pm Discussion
1:50 pm Comparison of Cancer Testis Antigen
1:10 pm Effects of TNFon P53 and PUMA in Expression in Colorectal Cancer With
Colorectal Cancer S32 or Without Liver Metastasis S36
D. M. Pastor, R. B. Irby, L. S. Poritz, G. Z. Chen, J. Gu, Beijing, China
Hershey, PA Disclosure: G. Chen: No Affiliation
Funded by the ASCRS Research Foundation Disclosure: J. Gu: No Affiliation
Disclosure: D. Pastor: No Affiliation 1:57 pm Discussion
Disclosure: L Poritz: No Affiliation
2:00 pm Ex Vivo Sentinel Lymph Node Mapping
1:17 pm Discussion in Patients Undergoing Proctectomy
1:20 pm SIRT1 and eIF4E in Colon Cancer for Rectal Cancer S37
Outcome S33 K. R. Finan, E. Bailey, M. Mutch, E. H. Birn-
M. H. Smith, W. Pruitt, K. Pruitt, P. A. Cole, baum, J. L. Lewis, J. W. Fleshman, St. Louis,
Q. Chu, B. D. Li, Shreveport, LA MO
Disclosure: M. Smith: No Affiliation Disclosure: K. Finan: No Affiliation
Disclosure: B. Li: No Affiliation Disclosure: J. Fleshman: Ethicon – Research Grant (Researcher);
Lifecell – Research Grant (Researcher); Applied Medical –
1:27 pm Discussion Honoraria, Research Grant (Lecturer, Researcher); Sapphire
Therapeutics – Honoraria, Research Grant (Consultant,
1:30 pm The Truth About Advanced Stage Researcher); Innocoll – Research Grant, Honoraria (Researcher,
Colorectal Cancer: What the Primary Consultant); SurgRX – Owns Stock
Lesions Don't Tell You S34
2:07 pm Discussion
C. Messick, J. M. Church, X. Liu, M. F. Kalady,
Cleveland, OH
Disclosure: C. Messick: No Affiliation
Disclosure: M. Kalady: No Affiliation
68
Tuesday, May 5
Neoplasia II
T U E S D AY
Staging and Prognosis
(continued)
2:10 pm Injecting Methlyene Blue into the 2:20 pm Research Evaluation of Distribution and
Inferior Mesenteric Artery Assures Metastases Pattern of Lymph Nodes in
an Adequate Nodal Harvest and Mesorectum Following TME Procedure
Eliminates Pathologist Variability in by Modified Fat Clearing Technique S39
Rectal Cancer Nodal Staging S38 J. Gu, F. Y. Yao, L. Wang, Beijing, China
T. G. Kerwel, J. Spatz, M. Anthuber, Disclosure: Presenting and Senior Author: J. Gu: No Affiliation
K. Wunsch, H. Arnholdt, B. Markl, Augsburg,
2:27 pm Discussion
Germany
Disclosure: T. Kerwel: No Affiliation
Disclosure: B. Markl: No Affiliation
2:17 pm Discussion
Objectives: At the conclusion of this session, participants should be able to: (31) recognize the influence of indi-
vidual gene expression patterns on rectal cancer recurrence; appreciate the possibility of individualizing patient
care based on tumor gene expression; (32) examine the effect of TNFon p53 and PUMA; analyze the potential
role of TNF in inflammatory bowel disease-associated carcinogenesis; (33) comprehend the basic science under-
lying current SIRT1 and eIF4E research and its clinical implications; analyze the difference in clinical outcomes
of colon cancer patients who express SIRT1 and eIF4E; (34) recognize that genetic and epigenetic differences be-
tween primary tumors and lymph node metastases exist; understand clinical implications of genetic and epige-
netic differences between primary tumors and lymph nodes as they relate to treatment decisions and outcomes;
(35) develop a plan of management for an individual who are at high risk of lymph node metastasis; (36) know
features of CTA genes in predicting liver metastasis of CRC; (37) identify the role of SLN mapping in rectal can-
cer; identify the affect of neoadjuvant treatment in nodal harvest in rectal cancer; (38) implement ex-vivo methyl-
ene blue injection of the inferior mesenteric artery as a method to improve the lymph node harvest and eliminate
pathologist variability in rectal cancer staging; and (39) know how fat clearance greatly increased lymph nodes re-
trieval especially for small lymph nodes.
69
Tuesday, May 5
ASCRS/SAGES Symposium Parallel Session: 6-A
Acquiring and Assessing Skills in Endoscopic Surgery

1 2 *
2:30 - 4:00 pm
Grand Ballroom
A validated curriculum is needed to teach and assess the essential and unique skills needed to perform endoscopic surgery.
The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is in the process of developing a curriculum
for endoscopic surgery which includes a validated tool to objectively and reliably assess these technical skills. When
completed, this curriculum will provide a validated educational strategy to educate surgeons in flexible endoscopic surgery.
Participants will learn about the metrics available for skills assessment in endoscopic surgery.
Existing Gaps
What is: Currently case volumes during training are being used as a surrogate for competency in endoscopic surgery.
What Should Be: A curriculum with validated metrics should be used to reliably and objectively assess competency in
endoscopic surgery.
Director: Steven Wexner, MD, Weston, FL

Assistant Director: Maher Abbas, MD, Los Angeles, CA
Disclosure: S. Wexner: Medtronics – No Remuneration (Institutional Support for IRB Study – Investigator); Simendo –
Consulting Fee (Consultant)
Disclosure: M. Abbas: Raven Technologies – Research Grant (Principal Investigator)
2:30 pm Using Validated Clinical Measures to 3:15 pm Fundamentals of Endoscopic Surgery

Assess Endoscopic Skills Acquired Jeffrey Marks, MD, Cleveland, OH
Through Simulation Disclosure: WL Gore – Honoraria (Consultant); Olympus -
Gerald Fried, MD, Montreal, Canada Honoraria (Consultant); Covidien - Honoraria (Consultant);
Neoguide Systems – Honoraria (Advisory Board); Apollo
Disclosure: WL Gore – Honorarium (Speaker); Covidien –
Endosurgery – Honoraria (Advisory Board)
Research Grant (Principal Investigator); Ethicon Endosurgery –
Research Grant (Co-principal Investigator); Olympus Endoscopy 3:30 pm The Role of Simulation in Endoscopic
– Equipment Grant (Principal Investigator)
Surgery
2:45 pm Models for Learning Endoscopic and Shawn Tsuda, MD, Las Vegas, NV
Flexible Endoscopic Skills Disclosure: No Affiliation
Brian Dunkin, MD, Houston, TX
3:00 pm Learning and Maintaining Skills in

Colonoscopy
Eric Weiss, MD, Weston, FL
Disclosure: Power Medical – Residency Program Support
(Resident Education); Ethicon Endosurgery – Residency Program
Support (Resident Education); Covidien – Residency Program
Support (Resident Education)
Objectives: At the conclusion of this session, participants should be able to: a) describe the available methods of
assessment of endoscopic surgery; b) discuss the metrics which can be measured to determine competency in
endoscopic surgery; and c) discuss a validated curriculum for endoscopic surgery.
4:00 – 4:30 pm Refreshment & Cookie Break in Exhibit Hall

70
Tuesday, May 5
General Surgery Forum
T U E S D AY
2 6 *
2:30 - 4:00 pm
Atlantic Ballroom
Moderators: Charles Friel, MD, Charlottesville, VA and Traci Hedrick, MD, Charlottesville, VA
Disclosure: C. Friel: No Affiliation
Disclosure: T. Hedrick: No Affiliation
2:30 pm Single Port Access Colon Surgery - 20 3:07 pm Invited Discussant

Laparoscopic Colon Procedures Performed Yosef Nasseri, MD, Los Angeles, CA
through a Single Port of Entry GSF-1 Disclosure: No Affiliation
E. R. Podolsky, P. G. Curcillo, Philadelphia, PA
3:10 pm Discussion from the Floor
Disclosure: E. Podolsky: No Affiliation
Disclosure: P. Curcillo: Ethicon – Honorarium (Speaker); 3:15 pm Non-cutting Setons for Progressive
Olympus – Honorarium (Speaker); Storz – Honorarium Migration of Complex Fistula Tracts:
(Speaker) A New Spin on an Old Technique GSF-4
2:37 pm Invited Discussant G. Subhas, A. Gupta, S. Balaraman,
Timothy Ridolfi, MD, Milwaukee, WI V. K. Mittal, R. Pearlman, Southfield, MI
Disclosure: No Affiliation Disclosure: G. Subhas: No Affiliation
Disclosure: R. Pearlman: No Affiliation
3:22 pm Invited Discussant
2:45 pm Implementation of Institution-Wide Tiffany Fancher, MD, Waterbury, CT
Fast Track Pathway Leads to Decrease Disclosure: No Affiliation
in Post-Colectomy Length of Stay GSF-2
V. Y. Poylin, E. R. Woods, D. Nagle, 3:25 pm Discussion from the Floor
Boston, MA 3:30 pm Surgical Treatment at the End of Life
Disclosure: V. Poylin: No Affiliation for Patients with Colorectal Cancer:
Disclosure: D. Nagle: No Affiliation Does Hospice Care Decrease Use? GSF-5
2:52 pm Invited Discussant R. R. Cannom, R. W. Beart, G. T. Ault,
Jaime Sanchez, MD, Tampa, FL A. M. Kaiser, A. McElrath-Garza, P. Vukasin,
Disclosure: No Affiliation D. A. Etzioni, Los Angeles, CA
Disclosure: R. Cannom: No Affiliation
2:55 pm Discussion from the Floor Disclosure: D. Etzioni: No Affiliation
3:00 pm Predictors of Fulminant Colitis and 3:37 pm Invited Discussant
Mortality in Patients with Clostridium Renee Huang, MD, Albany, NY
Difficile Infection GSF-3 Disclosure: No Affiliation
N. J. Umoh, I. Sucandy, H. Dancea, L. Choi,
L. Esolen, M. Olson, Danville, PA 3:40 pm Discussion from the Floor
Disclosure: N. Umoh: No Affiliation
Disclosure: M. Olson: No Affiliation
71
Tuesday, May 5
General Surgery Forum

(continued)
3:45 pm Laparoscopic Total Colectomy: 3:52 pm Invited Discussant:
A Single Institution's Experience GSF-6 Mark Sun, MD, Worcester, MA
N. Bertelson, T. J. Saclarides, F. Abarca, M. I. Disclosure: No Affiliation
Brand, Chicago, IL
Disclosure: N. Bertelson: No Affiliation
Disclosure: M. Brand: MISDER, LLC – Ownership Interest
(Founder, Chairman of Board); AMI (Agency for Medical Inno-
vations) – Honorarium (Instructor); Ethicon EES – Honorarium
(Instructor/Consultant); American Physicians Instit.for Adv.
Prof. Studies – Honorarium (Instructor)
Objectives: At the conclusion of this session, participants should be able to: (1) understand Single Port Access
Surgery with particular attention to its applicability to colon surgery; (2) understand and analyze outcomes of im-
plementation of institution-wide fast track pathway; (3) identify predictors of fulminant colitis among patients
presenting with Clostridium difficile infection; be informed on factors that are positively or negatively associated
with mortality among patients with severe Clostridium difficile colitis; (4) know an alternative technique of treat-
ing complex anal fistulas; this technique is very cost effective and would be very helpful for developing countries;
(5) discuss the impact of regional hospice use on rates of surgical procedures at the end of life; and (6) understand
complexity of laparoscopic total colectomy; critically appraise the utility of this procedure for a given patient.
4:00 – 4:30 pm Refreshment & Cookie Break in Exhibit Hall
72
Tuesday, May 5
Scientific Session Parallel Session: 7-A
Research Forum
T U E S D AY
2 *
4:30 - 6:00 pm
Atlantic Ballroom
Moderators: Matthew Kalady, MD, Cleveland, OH and Harvey Moore, III, MD, New York, NY
Disclosure: H. Moore: No Affiliation
4:30 pm Low Voltage Electrical Stimulation 5:06 pm Discussion

Causes Cytokine Expression in the
5:09 pm Metabolic Profiling of Human Colorectal
Anal Sphincter RF-4
Cancer Using High-Resolution Magic
L. B. Salcedo, L. Lian, M. Damaser,
Angle Spinning Nuclear Magnetic
P. Zaszczurynski, M. Zutshi, Cleveland, OH
Resonance Spectroscopy and Gas
Disclosure: L. Salcedo: No Affiliation
Chromatography Mass Spectrometry RF-1
Disclosure: M. Zutshi: No Affiliation
P. Koh, E. Chan, M. Mal, K. W. Eu,
4:37 pm Invited Discussant A. Blackshall, H. Keun, Singapore, Singapore;
David Shibata, MD, Tampa, FL London, United Kingdom
Disclosure: No Affiliation Disclosure: P. Koh: No Affiliation
Disclosure: E. Chan: No Affiliation
4:40 pm Discussion
4:43 pm Single Nucleotide Polymorphism of
Alan Herline, MD, Nashville, TN
Thymidylate Synthase Gene for
Disclosure: Pathfinder Therapeutics – Stock (Founder)
Predicting Tumor Response to
Preoperative Chemoradiation 5:19 pm Discussion
Therapy in Rectal Cancer RF-2
5:22 pm The Effects of Pelvic Autonomic
H. Hur, J. S. Kim, N. K. Kim, B. S. Min,
Denervation on Rectal Motility in
S. K. Sohn, C. H. Cho, Seoul, South Korea
the Rat RF-5
Disclosure: H. Hur: No Affiliation
T. J. Ridolfi, T. Takahashi, L. Kosinski,
Disclosure: N. Kim: No Affiliation
K. A. Ludwig, Milwaukee, WI
4:50 pm Invited Discussant Disclosure: T. Ridolfi: No Affiliation
Amir Bastawrous, MD, Chicago, IL Disclosure: K. Ludwig: Covidien – Honorarium (Speaker);
Disclosure: No Affiliation Applied Medical – Honorarium (Speaker)
4:53 pm Discussion 5:29 pm Invited Discussant

Rocco Ricciardi, MD, Burlington, MA
4:56 pm Sulfur-Containing Amino Acid, Disclosure: No Affiliation
Methionine, has a Prokinetic Effect
on Human Colon in Vitro RF-3 5:32 pm Discussion
K. J. Park, E. Choe, J. S. Moon, Seoul,
South Korea
Disclosure: Presenting and Senior Author: J. Park:
No Affiliation

Alessandro Fichera, MD, Chicago, IL
73
Tuesday, May 5
Research Forum
(continued)
5:35 pm Postoperative Intra-Abdominal 5:48 pm Diagnostic Accuracy of MRI in
Infection Increases Inflammatory Assessing Tumor Invasion Within
Response and Angiogenesis after Pelvic Compartments in Recurrent
Surgery for Colorectal Cancer RF-6 and Locally Advanced Rectal Cancer RF-7
S. Alonso, M. Pera, M. Pascual, D. Pares, P. Georgiou, G. Brown, V. Constantinides,
S. Salvans, M. Gil, R. Courtier, X. Mayol, A. Antoniou, R. J. Nicholls, P. P. Tekkis,
L. Grande, Barcelona, Spain London, United Kingdom
Disclosure: S. Alonso: No Affiliation Disclosure: P. Georgiou: No Affiliation
Disclosure: M. Pera: No Affiliation Disclosure: P. Tekkis: No Affiliation
5:42 pm Invited Discussant 5:55 pm Invited Discussant

Christopher Mantyh, MD, Durham, NC Daniel Herzig, MD, Portland, OR
5:45 pm Discussion 5:58 pm Discussion
Objectives: At the conclusion of this session, participants should be able to: (1) appreciate complementary tech-
niques and emerging research tools with a strong potential for enhancing prognostication of colorectal cancers;
(2) correlate TS gene polymorphism with tumor response after preoperative CRT in rectal cancer; (3) determine
whether methionine, a specific blocker of stretch-dependent K+ channels in mouse causing depolarization and
enhanced spontaneous contractions, has any effect on human colon in vitro; (4) understand cytokines and the re-
lationship between cell signalling and low grade injury; (5) understand how pelvic autonomic denervation and
stimulation effects rectal motility in the rat; (6) understand the differences in the local and systemic angiogenic
response in patients with peritoneal infection after surgery for colorectal cancer and the possible influence of
these differences on long-term tumor recurrence; and (7) identify the diagnostic accuracy of MRI in detecting
local intrapelvic spread of recurrent and locally advanced primary rectal cancer. The strengths and weakness of
MRI are discussed for each intra-pelvic compartment.
74
Tuesday, May 5
ASCRS/International Foundation for Functional Gastrointestinal Disorders Symposium
Fecal Incontinence
T U E S D AY
1 2 6 *
4:30 - 6:00 pm Parallel Session: 7-B

Grand Ballroom
Supported by an educational grant from Medtronic, Inc.
Many physicians are unaware that fecal incontinence is often correctable. Because of embarrassment, patients with fecal
incontinence generally do not report this condition to a physician until the symptoms are psychologically and physically
incapacitating. In the elderly population, incontinence is the second most common cause of institutionalization and millions
are affected. Economic costs associated with managing and treating incontinence are substantial. Physicians who are familiar
with the evaluation and management of fecal incontinence encourage more patients to seek medical attention. Participants
will learn the causes and prevalence of fecal incontinence, the impact this condition has on patients quality of life and the
techniques to manage it.
Existing Gaps
What is: Many patients with potentially correctable fecal incontinence are not treated because the patient and/or their
physician is unaware of the options for the treatment of fecal incontinence.
What Should Be: With appropriate and relevant diagnostic tests, medical treatment and/or surgical correction, patients with
fecal incontinence will receive appropriate treatment.
Director: Ann Lowry, MD, St. Paul, MN
Assistant Director: Massarat Zutshi, MD, Cleveland, OH
Disclosure: A. Lowry: No Affiliation; Off-label: Sacral Nerve Stimulation for Fecal Incontinence by Medtronic
Disclosure: M. Zutshi: No Affiliation
4:30 pm Medical Management of Fecal Incontinence 5:15 pm Sacral Nerve Stimulation: Is it the Magic
Satish Rao, MD, Iowa City, IA Treatment for Fecal Incontinence?
Disclosure: No Affiliation Soren Laurberg, MD, Aarhus, Denmark
Disclosure: Medtronic – Honorarium (Member of Advisory
4:45 pm Biofeedback in Treating Fecal Incontinence Board)
Steve Heymen, PhD, Chapel Hill, NC
Disclosure: No Affiliation 5:30 pm Panel Discussion
5:00 pm Sphincterplasty: Does it Have a Role in

the Future?
Massarat Zutshi, MD, Cleveland, OH
Objectives: At the conclusion of this session, participants should be able to: a) describe the pathophysiology of
fecal incontinence; b) discuss the technique and outcomes of biofeedback for the management of fecal inconti-
nence; c) discuss the technique and outcomes of sphincteroplasty for the management of fecal incontinence; d)
discuss the technique and outcomes of sacral nerve stimulation for the management of fecal incontinence; and e)
discuss the technique and outcomes of the artificial bowel sphincter for the management of fecal incontinence.
Residents’ Reception
6:00 - 7:00 pm • Diplomat Ballroom 4-5
Supported by a grant from Ferndale Laboratories, Inc.
Open to general surgery residents and colorectal program directors.
General Surgery residents will have an opportunity to meet colorectal program directors.

75
Tuesday, May 5
Dinner Symposium
Understanding Syndromes of Inherited Colorectal Cancer

1 2 5 *
7:00 - 8:30 pm
Regency Ballroom
Supported by an educational grant from Myriad Genetic Laboratories, Inc.
Partial support by an educational grant from Genzyme Corporation
Hereditary colorectal cancer plays a role in as many as 7,500 newly diagnosed colorectal cancers in the United States each
year. Patients with hereditary colorectal cancer and their families have special needs based on the dominant transmission of
risk, and there are special opportunities for cancer prevention. A recent survey showed that colorectal surgeons can expect
to see an average of 2 patients with familial adenomatous polyposis and 4 patients with Lynch Syndrome each year. As
knowledge and technology have advanced, changes in the clinical approach to high risk patients and their relatives have oc-
curred. For these reasons, it is important that colorectal surgeons understand the genetics of hereditary colorectal cancer
and the application of genetic knowledge for patient care.
Existing Gaps
What is: Patients with Lynch Syndrome and Familial Colorectal Cancer Type X are often under-diagnosed and do not re-
ceive appropriate genetic counseling, surveillance or treatment. Patients with Hereditary Polyposis sometimes receive inap-
propriate surgery at inappropriate times.
What Should Be: Patients with Lynch Syndrome are recognized routinely based on family history, cancer phenotype and can-
cer genetics. Patients with hereditary polyposis are managed by surgery and endoscopy. All patients with hereditary col-
orectal cancer should undergo genetic testing, which if informative, should be offered to at risk family members.
Director: James Church, MD, Cleveland, OH

Disclosure: Myriad Genetics – Honorarium (Speaker/Consultant); Salix Pharmaceuticals – Honorarium (Speaker/Consultant); Cleveland
Clinic/Cologene Software – Salary (Employee); Pfizer – Research Support (Research Participant)
7:00 pm The Genetics Behind the Syndromes: 7:30 pm When to Refer Patients for Genetic
A Simple Explanation of Why Colorectal Counseling and Testing for a
Cancer Runs in Families Germline Mutation
James Church, MD, Cleveland, OH Brandie Leach, MS, CGC, Cleveland, OH
7:10 pm The Polyposis Syndromes: Definitions,
Diagnoses and Basic Clinical Management 7:40 pm Panel Discussion of Cases
Paul Wise, MD, Nashville, TN
8:10 pm Cases from the Audience
7:20 pm The Non Polyposis Syndromes: Recogniz-

ing Hereditary Non Polyposis Colorectal
Cancer When it is Sitting in Front of You
Matthew Kalady, MD, Cleveland, OH
Objectives: At the conclusion of this session, participants should be able to: a) describe ways to diagnose patients
with hereditary colorectal cancer; b) discuss the optimal work-up of affected patients and their relatives; c) de-
scribe techniques to prevent colorectal cancer and cancer in other organs; and d) discuss the genetic basis of the
syndromes of hereditary colorectal cancer.

76
Wednesday, May 6
6:30 - 7:30 am

W-1 Abdominal Catastrophe – Grant/Research Support; SurgiQuest – Honorarium (Scientific
OUT
W E D N E S D AY
SOLD
Leaks and Other Advisory Board); SurgiQuest (Stockholder)
Emergencies Diplomat Ballroom 2 W-4 Physician Marketing and
H. Randolph Bailey, MD, Houston, TX Referral Practice Building Room 303
Terry Hicks, MD, New Orleans, LA William Sardella, MD, Hartford, CT
Disclosure: H. Bailey: Merck Inc. – Honorarium (Speaker); Theodore Eisenstat, MD, Edison, NJ
Adolor/GSK – Honorarium (Speaker)
Disclosure: W. Sardella: No Affiliation
Disclosure: T. Hicks: No Affiliation
Disclosure: T. Eisenstat: No Affiliation
W-2 Anal Diseases Associated
O U T Bard Cosman, MD, San Diego, CA
W-5 Use of Physician Extenders Room 312/313
SOLD
with HIV Diplomat Ballroom 4 Philip Cole, MD, Shreveport, LA
Eric Dozois, MD, Rochester, MN
Mark Welton, MD, Stanford, CA Disclosure: P. Cole: No Affiliation
Disclosure: B. Cosman: No Affiliation
Disclosure: E. Dozois: No Affiliation
Disclosure: M. Welton: Genzyme Biosurgical – Honorarium (Ad-
visory Board); Genzyme Biosurgical – Honorarium (Speaker)
W-6 Health Services Research:
W-3 Non-Healing Perineal
How to Get Started Room 314
Wound Diplomat Ballroom 5
Nancy Baxter, MD, PhD, Toronto, ON, Canada
James Edlund, MD, Fort Wayne, IN
Arden Morris, MD, Ann Arbor, MI
Disclosure: N. Baxter: No Affiliation
Disclosure: J. Edlund: No Affiliation
Disclosure: A. Morris: No Affiliation
Disclosure: J. Marks: Covidien – Honorarium
(Consultant/Speakers Bureau); Wolf – Honorarium (Consul-
tant/Speakers Bureau); Stryker – Honorarium
(Consultant/Speakers Bureau); Glaxo Smith Kline – Honorar-
ium (Consultant); Zassi – Honorarium (Consultant); Covidien –
77
Wednesday, May 6
Post Treatment Follow-up of

Patients with Colorectal Cancer
1 2 5 *
8:00 - 9:15 am
Grand Ballroom
This course will provide a comprehensive review of recommended follow-up regimens of patients operated on for colorectal
cancer. There are multiple recommended regimens for the follow-up of colon and rectal cancer promoted by various medical
oncologic groups, including the American Society of Colon and Rectal Surgeons. However, there is no universally accepted
or practiced follow-up pattern. After completion of the course, attendees should understand the evidence supporting the var-
ious follow-up strategies suggested. Regimens will be reviewed, then the evidence supporting endoscopic, radiographic and
biochemical regimens will be analyzed. The surgeon’s and medical oncologist’s perspective will be examined. A panel discus-
sion will complete the session with an emphasis on practical problems encountered by the practicing colorectal surgeon.
Existing Gaps
What is: There remains significant controversy among different providers regarding the most appropriate follow-up for
patients who have been treated for colorectal cancer.
What Should Be: There should be defined, evidence-based standards in place to follow patients with a history of colorectal
cancer in the post-treatment period. These standards should assist clinicians in deciding what additional follow-up is neces-
sary when routine testing reveals suspicious findings.
Director: Harry Reynolds, Jr., MD, Cleveland, OH

Assistant Director: James Merlino, MD, Cleveland, OH
Disclosure: H. Reynolds: Covidien – Honorarium (Speaker/Course Instructor)
Disclosure: J. Merlino: No Affiliation
8:00 am Challenges and Controversies: Review of 8:35 am Imaging Modalities in Follow-up: What
Recommended Follow-up Should We Be Ordering and How Do We
Harry Reynolds, Jr., MD, Cleveland, OH Approach the “Positive Scan”
Alexander Heriot, MD, Melbourne, Australia
8:05 am Receipt of Guideline-Recommended
Follow-up in Current Practice:
How are We Doing? 8:50 am The Medical Oncologists’ Perspective on
Gregory Cooper, MD, Cleveland, OH Follow-up: What is the Role of CEA and is
Disclosure: Takeda – Honorarium (Speaker); Viro Pharma – There Anything New on the Horizon?
Honorarium (Speaker) Smitha Krishnamurthi, MD, Cleveland, OH
Disclosure: Imclone Systems, Inc – Research Funding (Investiga-
8:20 am The Colorectal Surgeons View of
tor); Genentech - Research Funding (Investigator); sanofi aventis -
Endoscopic Follow-up Research Funding (Investigator); EMD Merck Serono - Research
David Margolin, MD, New Orleans, LA Funding (Investigator); Merck - Research Funding (Investigator);
Disclosure: No Affiliation Bristol Myers Squibb - Research Funding (Investigator)
9:05 am Practical Cases for the Experts:

Panel Discussion
Objectives: At the conclusion of this session, participants should be able to: a) discuss the controversies currently
facing clinicians when deciding the most appropriate follow-up course for patients who have been treated for col-
orectal malignancies; b) review the recommended endoscopic follow-up frequency; c) discuss the importance and
role of CEA levels, and other biological markers in the follow-up of patients; and d) discuss the controversies and
actions necessary for follow-up of patients with positive post-treatment imaging.
78
Wednesday, May 6
Benign II
2 6 *
8:00 - 9:15 am
Atlantic Ballroom
Moderators: Alessandro Fichera, MD, Chicago, IL and David Maron, MD, MBA, Philadelphia, PA
Disclosure: A. Fichera: No Affiliation
Disclosure: D. Maron: SurgRx – Honorarium (Consultant)
W E D N E S D AY
8:00 am Sacral Nerve Stimulation for 8:30 am Predictive Factors for Subchronic Test
Constipation: Loss of Efficacy and Stimulation Outcome in Sacral Nerve
Re-Operations S40 Modulation for the Treatment of Fecal
Y. Maeda, L. Lundby, S. Buntzen, S. Laurberg, Incontinence S43
Aarhus, Denmark B. Govaert, W. G. van Gemert, C. G. Baeten,
Disclosure: Y. Maeda: No Affiliation Maastricht, Netherlands
Disclosure: S. Laurberg: Medtronic – Honorarium (Member of Disclosure: B. Govaert: No Affiliation
Advisory Board) Disclosure: C. Baeten: No Affiliation; Off-Label: Interstim treat-
ment for Fecal Incontinence by Medtronic
8:07 am Discussion
8:37 am Discussion
8:10 am Electrically Stimulated Gracilis
Neosphincter Construction for End 8:40 am What Is Optimal Treatment of Rectal
Stage Fecal Incontinence: Evaluation Prolapse in Elderly Patients: Altemeier
of Long-Term Functional Outcome S41 Procedure vs. Laparoscopic Rectopexy? S44
J. Murphy, D. J. Boyle, C. Bhan, J. Saunders, S. W. Lee, O. Oliveira, M. Gedeon,
N. S. Williams, Whitechapel, London, United D. L. Feingold, T. Sonoda, S. L. Stein,
Kingdom K. J. Trencheva, A. Li, J. W. Milsom, New
Disclosure: J. Murphy: No Affiliation York, NY
Disclosure: N. Williams: No Affiliation Disclosure: Presenting and Senior Author: S. Lee: Covidien –
Honorarium (Speaker/Consultant); Power Medical – Honorar-
8:17 am Discussion ium (Speaker); Olympus - Course Support (Course Director);
Applied Medical – Course Support (Course Director); TranS1 –
8:20 am Sacral Nerve Stimulation is a Valid Honorarium (Consultant)
Therapy in Fecal Incontinent Patients
with Sphincter Lesion, When 8:47 am Discussion
Compared to Sphincter Repair S42 8:50 am The Role of Aminocaproic Acid in the
C. Ratto, A. Parello, L. Donisi, F. Litta, G. B. Management of Massive Lower
Doglietto, Rome, Italy Gastrointestinal Hemorrhage S45
Disclosure: Presenting and Senior Author: C. Ratto: THD – G. Dunn, S. Clark, P. Cole, Shreveport, LA
Honorarium (Scientific Contributor, Trainer, Speaker); Off-
Disclosure: G. Dunn: No Affiliation
Label: Interstim therapy for Fecal Incontinence by Medtronic
8:27 am Discussion
8:57 am Discussion
79
Wednesday, May 6
Benign II
(continued)
9:00 am Mesenteric Embolization: A Safe and 9:07 am Discussion

Efficacious Treatment Modality of
Lower Gastrointestinal Hemorrhage S46
P. Rider, D. Beck, A. Timmcke, T. Hicks,
C. Whitlow, D. Margolin, New Orleans, LA
Disclosure: P. Rider: No Affiliation
Disclosure: D. Margolin: No Affiliation
Objectives: At the conclusion of this session, participants should be able to: (40) evaluate the outcome of SNS
for constipation and future research direction; (41) appreciate the utility of ESGN construction for restoration of
gastrointestinal continuity in patients motivated to avoid permanent stoma formation; (42) select treatment for
fecal incontinence in presence of sphincter lesion, betweeen Sphincteroplasty and Sacral Nerve Stimulation; (43)
use patient charecteristics to predict outcome in Sacral Nerve Stimulation therapy for fecal incontinence; (44)
compare advantages in postoperative outcomes of elderly patients (pts) (> 70 yr) undergoing Altemeier procedure
(ALT) vs. laparoscopic rectopexy (RPX) for full-thickness rectal prolapse(RP); (45) understand the role of
aminocaproic acid in the management of massive lower gastrointestinal hemorrhage; and (46) understand role of
utilization and the efficacy mesenteric embolization in treatment of lower gastrointestinal bleeding.
80
Wednesday, May 6
ASCRS/SSAT Symposium Parallel Session: 9-A
Single Port Minimally Invasive Surgery / NOTES

2 *
9:15 - 10:30 am
Grand Ballroom
Laparoscopic surgery to treat colon and rectal diseases has been a major improvement from traditional open surgery in
W E D N E S D AY
terms of less pain, better cosmesis, and shortened length of hospitalization. Despite smaller incisions, however, patients
continue to suffer from incisional pain, postoperative ileus causing delay in discharge, and wound complications such as
infections and hernias. Laparoscopy, thus, should not be viewed as the pinnacle of our surgical progress, but a step toward
achieving this goal. What lies in our future as the next step in high-tech surgical innovation? Currently, the role of
NOTES, or natural orifice translumenal endoscopic surgery, is being investigated as a method of performing operations
without an abdominal incision; if successful and safe, this would eliminate painful abdominal wounds and associated wound
complications, and would lessen the overall trauma that our surgical procedures inflict. Single port laparoscopic surgery
has begun to be utilized for intestinal surgery as well; it is unclear if this represents a clear improvement over current
laparoscopic techniques, but some of the technological innovations needed for this surgical approach may ultimately
assist in the development of NOTES techniques as well. Finally, endolumenal surgery, or intestinal operations performed
from within the intestine itself using endoscopes, holds promise as a potential method of performing complex intestinal
resections in the future. Participants will learn the current state and potential future of high-tech surgery which includes:
NOTES, single port laparoscopy and endoluminal surgery to treat colon and rectal diseases.
Existing Gaps
What is: Even after laparoscopic bowel resection, patients continue to suffer from postoperative pain, ileus, and wound
complications.
What Should Be: Technological innovations in surgery should eventually lead to elimination of abdominal wounds that
would curtail these shortcomings of current laparoscopic surgery.
Director: Toyooki Sonoda, MD, New York, NY
Assistant Director: David Larson, MD, Rochester, MN
Disclosure: T. Sonoda: Covidien – Honorarium (Speaker); Applied Medical – Honorarium (Speaker, Proctor); Adolor – Honorarium (Consultant)
Disclosure: D. Larson: No Affiliation
9:15 am Introduction 9:50 am Single Port Laparoscopy – Here to Stay?

Feza Remzi, MD, Cleveland, OH
9:20 am NOTES in Colorectal Surgery – Disclosure: No Affiliation
Experimental Models
Mark Whiteford, MD, Portland, OR 10:05 am Endoluminal Surgery: Combined
Disclosure: Richard Wolf Medical Instruments – Research Support/ Laparoscopy and Endoscopy
Consulting Fee (Research/Consultant); Applied Medical – Hono- Sang Lee, MD, New York NY
rarium (Speaker); Sanofi Aventis – Honorarium (Speaker)
Disclosure: Covidien – Honorarium (Speaker/Consultant); Power
Medical – Honorarium (Speaker); Olympus - Course Support
9:35 am NOTES Colectomy: Current Experience (Course Director); Applied Medical – Course Support (Course
in Humans Director); TranS1 – Honorarium (Consultant)
Antonio Lacy, MD, Barcelona, Spain
Disclosure: No Affiliation 10:20 am Panel Discussion
Objectives: At the conclusion of this session, participants should be able to: a) describe the current status of NOTES in colon and rectal
surgery; b) describe the current status of single port laparoscopy in colon and rectal surgery; c) discuss endolumenal surgery and its applica-
tions in colon and rectal surgery; and d) discuss how these three surgical innovations could influence the future of colon and rectal surgery.

81
Wednesday, May 6
Neoplasia III
1 2 6 *
9:15 - 10:30 am
Atlantic Ballroom
Moderators: Philip Cole, MD, Shreveport, LA and Robert Akbari, MD, Towson, MD
Disclosure: R. Akbari: No Affiliation
9:15 am Effect of Race On Colon Cancer Care 9:45 am Palliative Resection of the Primary
in the Department of Defense Health Lesion in Stage IV Rectal Cancer
Care System S47 Prolongs Survival S50
L. J. Hofmann, S. Lee, B. E. Waddell, C. Cellini, S. Hunt, A. Lin, E. Birnbaum,
K. G. Davis, El Paso, TX J. Fleshman, M. Mutch, St. Louis, MO
Disclosure: L. Hofmann: No Affiliation Disclosure: C. Cellini: No Affiliation
Disclosure: K. Davis: No Affiliation Disclosure: M. Mutch: Applied Medical – Honorarium (Teach-
ing); Ethicon – Honorarium (Teaching); Covidien – Honorarum
9:22 am Discussion (Teaching); Johnson and Johnson – Grant (Research); Applied
Medical – Stock (Teaching)
9:25 am Evaluating the Age Distribution of
Patients with Colorectal Cancer: Are 9:52 am Discussion
the U.S. Preventative Services Task
9:55 am Combined Radiological and Endoscopic
force Guidelines for Colorectal Cancer
Approach has a Higher Success Rate in
Screening Appropriate? S48
Colonic Stenting S51
J. K. Shellnut, H. J. Wasvary, Royal Oak , MI
N. Wong, A. Venkatasubramaniam, S. Plusa,
Disclosure: J. Shellnut: No Affiliation
H. Gallagher, J. Hanson, F. Bergin,
Disclosure: H. Wasvary: No Affiliation
D. Richardson, J. Graham, Newcastle upon
9:32 am Discussion Tyne, United Kingdom
Disclosure: N. Wong: No Affiliation
9:35 am Downstaging Following CRT for Locally
Disclosure: J. Graham: No Affiliation
Advanced Rectal Cancer: Is There More
(Tumor) than Meets the Eye? S49 10:02 am Discussion
E. D. Mignanelli, L. F. Lobato, L. Stocchi,
I. C. Lavery, D. Dietz, Cleveland, OH
Disclosure: E. Mignanelli: No Affiliation
Disclosure: D. Dietz: No Affiliation
9:42 am Discussion
82
Wednesday, May 6
Neoplasia III
(continued)
10:05 am Is the Phenotype Mixed or Mistaken? 10:15 am Sentinel Node Biopsy in Squamous-Cell
Hyperplastic Polyposis Syndrome and Carcinoma of the Anal Canal S53
Hereditary Non Polyposis Colorectal P. De Nardi, M. Carvello, P. Passoni,
Cancer S52 C. Canevari, N. Slim, C. Staudacher, Milano,
A. M. Jarrar, J. M. Church, S. Fay, M. F. Kalady, Italy
Cleveland, OH Disclosure: P. De Nardi: No Affiliation
Disclosure: A. Jarrar: No Affiliation Disclosure: C. Staudacher: No Affiliation
W E D N E S D AY
10:22 am Discussion
10:12 am Discussion
Objectives: At the conclusion of this session, participants should be able to: (47) analyze the differences in colon
cancer rates, stage at diagnosis, and treatments for black and white patients in an equal access health care system;
(48) understand the 2008 U.S. Preventative Services Task force Recommendations for Colorectal Cancer Screen-
ing; understand the changes in age at diagnosis distribution for colorectal cancer over time at the authors' institu-
tion; understand how the 2008 USPSTF recommendations for colorectal cancer screening are called into
question by the study's findings; (49) discuss the rate of pCR post chemoradiotherpay for rectal cancer. Discuss
the prevalence of metastatic lymph nodes in patients with a complete mural response to chemoradiotherapy; (50)
analyze the differences in survival and predictors of resectability of patients presenting with rectal cancer and
liver metastases; (51) learn safe practice in stenting of colonic obstruction; (52) appreciate a newly noticed poten-
tial overlap between Hereditary Nonpolyposis Colorectal Cancer (HNPCC) and Hyperplastic Polyposis (HPS)
Syndrome; appreciate the possibility that HPS may be under diagnosed, and that a subset of HNPCC and hered-
itary colon cancer is misdiagnosed; and (53) select patients with carcinoma of the anal canal for inguinal sentinel
node biopsy; realize the possible benefits of this technique; develop an individualized treatment for patients with
carcinoma of the anal canal.
83
Wednesday, May 6
Evaluation and Management of

Metastatic Colon and Rectal Cancer
1 2 5 6 *
11:00 am - 12:00 pm
Grand Ballroom
Partial support from an educational grant from Genentech BioOncology
A number of recent advances have radically altered the way in which patients with metastatic colorectal cancer are treated.
Many new chemotherapeutic drugs have been introduced and found more effective than traditional 5FU/leucovrin therapy
alone in the systemic treatment of metastatic colorectal cancer. Additionally, the use of aggressive resective and other
targeted therapies for metastatic disease in the liver have grown over the last decade. These advances in systemic and liver
directed therapies have started a renaissance in interest and investigation in the treatment of metastatic colorectal cancer,
and for the first time in many decades, hold promise to provide meaningful improvement in clinical outcomes for patients
with this disease. The composite affect of these advances has led to the improvement of overall care for patients with
metastatic colorectal cancer, and a reduction in the sense of futility that has accompanied this diagnosis in the past. It is im-
portant for surgeons and other practitioners who care for patients with metastatic colorectal cancer to continue to closely
follow the evolution of changes in treatment of this disease. Participants will learn about the recent changes and advance-
ments in the treatment of patients with metastatic colorectal cancer to improve patient care in this clinical scenario.
Existing Gaps
What is: Traditionally, the treatment options available to patients with metastatic colorectal cancer have been quite limited,
having minimal overall impact on cancer progression and survival in most patients. This fact has led to a sense of futility on
the part of practitioners caring for these patients.
What Should Be: Advances in chemotherapeutic and liver targeted therapies will continue to improve cancer outcomes in
patients with metastatic colorectal cancer and should be increasingly understood and utilized.
Director: Eugene Foley, MD, Madison, WI
Assistant Director: Rocco Ricciardi, MD, MPH, Burlington, MA
Disclosure: E. Foley: No Affiliation
Disclosure: R. Ricciardi: No Affiliation
11:00 am Novel Chemotherapeutic Agents in the 11:40 am Putting it All Together: Case Presentations
Systemic Treatment of Metastatic and Creation of Individualized Treatment
Colorectal Cancer Plans
Kyle Holen, MD, Madison, WI Eugene Foley, MD, Madison, WI
Disclosure: Sanofi-Aventis – Research Funds (Principal Investi- Kyle Holen, MD, Madison, WI
gator); BMS – Research Funds (Principal Investigator); Imclone James Pomposelli, MD, PhD, Burlington, MA
– Research Funds (Principal Investigator); Novartis – Research
Funds (Principal Investigator); Merck – Research Funds (Princi- Rocco Ricciardi, MD, MPH, Burlington, MA
pal Investigator); GSK – Research Funds (Principal Investigator)
11:20 am Targeted Therapy for Metastatic Colorectal

Cancer to the Liver
James Pomposelli, MD, PhD, Burlington, MA
Objectives: At the conclusion of this session, participants should be able to: a) describe the efficacy of the many
new chemotherapeutic agents in use for metastatic colorectal cancer, b) understand the present role of liver
targeted therapies for colorectal cancer metastases, including liver resection, ablative therapy, and other liver
targeted therapies, and c) recognize the rapidity of continued change in the management of patients with
metastatic colorectal cancer.

84
Wednesday, May 6
Benign III
Diverticulitis, Colitis and Trauma
1 2 6 *
11:00 am - 12:00 pm
Atlantic Ballroom
Moderators: Stephen Gorfine, MD, New York, NY and Steven Hunt, MD, St. Louis, MO
Disclosure: S. Gorfine: Pacira Pharmaceuticals, Inc. – Consulting Fee (Consultant)
Disclosure: S. Hunt: Karl Storz Endoscopy – Honorarium (Instructor); Ethicon Endosurgery – Honorarium (Instructor); Applied Medical –
W E D N E S D AY
Honorarium (Instructor); Adolor/GSK – Honorarium (Instructor); Covidien – Honorarium (Instructor); Richard Wolf – Honorarium (Speaker)
11:00 am Outpatient Treatment of Acute 11:30 am A Fast Track Recovery Protocol

Diverticulitis: Rates, Predictors Improves Outcomes in Elective Laparo-
of Failure S54 scopic Colectomy for Diverticulitis S57
D. A. Etzioni, R. R. Cannom, V. Y. Chiu, J. G. Touzios, D. W. Larson, R. R. Cima,
R. J. Burchette, P. I. Haigh, M. A. Abbas, Los J. H. Pemberton, H. K. Chua, E. J. Dozois,
Angeles, CA; Pasadena, CA Rochester, MN
Disclosure: D. Etzioni: No Affiliation Disclosure: J. Touzios: No Affiliation
Disclosure: M. Abbas: Raven Technologies – Research Grant Disclosure: D. Larson: No Affiliation
(Principal Investigator)
11:37 am Discussion
11:07 am Discussion
11:40 am Management of Colon Injuries in
11:10 am Diverticulitis: Does Age Predict the Combat Theater S58
Complicated Disease? S55 D. Cho, L. N. Kiraly, S. F. Flaherty, D. Herzig,
J. F. Hall, P. L. Roberts, R. Ricciardi, M. A. Schreiber, Portland, OR; Landstuhl,
C. Scheirey, P. W. Marcello, C. Wald, Germany
J. M. Sampson, D. Schoetz, Burlington, MA Disclosure: D. Cho: No Affiliation
Disclosure: Presenting and Senior Author: J. Hall: No Affiliation Disclosure: M. Schreiber: No Affiliation
11:17 am Discussion 11:47 am Discussion

11:20 am Risk Assessment of Conservative 11:50 am Anastomosis in Emergency Colon
Treatment Failure in Acute Left Surgery: A Large Propensity Score
Colonic Diverticulitis S56 Match Analysis S59
O. Pittet, N. Kotzampassakis, S. Schmidt, B. R. Swenson, T. L. Hedrick, R. G. Sawyer,
A. Denys, N. Demartines, J. M. Calmes, C. M. Friel, Charlottesville, VA
Lausanne, Switzerland Disclosure: B. Swenson: No Affiliation
Disclosure: O. Pittet: No Affiliation Disclosure: C. Friel: No Affiliation
Disclosure: J. Calmes: No Affiliation
11:57 am Discussion
11:27 am Discussion
Objectives: At the conclusion of this session, participants should be able to: (54) identify patients that are at high risk for failing outpatient
management of acute diverticulitis; (55) analyze the differences in presentation of diverticulitis in young populations; identify computed to-
mography findings that are predictive of severe diverticular disease; (56) predict the risk of conservative treatment failure of acute left colonic
diverticulitis; elaborate a treatment plan of acute left colonic diverticulitis; and define the severity of diverticulits episode in research proto-
cols; (57) identify the benefits of fast track protocols for laparoscopic colecotmy; define a fast track protocol; (58) describe differences be-
tween civilian and combat colon injuries; compare early complication rates for primary repair versus diversion in the combat setting and in
the context of available civilian literature; understand the management options for colon injuries including in the damage control setting;
and (59) understand and appreciate data demonstrating outcomes after emergency colon resection with and without an anastomosis.
The American Society of Colon and Rectal Surgeons designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™

85
Wednesday, May 6
ASCRS Annual Business Meeting

and State of the Society Address
12:00 - 1:30 pm
Diplomat Ballroom 3-5
Complimentary lunch provided to ASCRS members attending the Business Meeting
I. Call to Order IX. Nominating Committee Report and

Election of Officers and Council
II. Approval of 2008 Business Meeting
Minutes X. New Business
III. Obituaries XI. Introduction of New President
IV. Treasurer’s Report XII. Next Meeting: May 15-19, 2010

Alan Thorson, MD Hilton Minneapolis Hotel &
Minneapolis Convention Center
V. Scientific Program Report Minneapolis, MN
Neal Ellis, MD and James Merlino, MD Program Chair: Matthew Mutch, MD
VI. Special Reports Program Vice-Chair: Steven Hunt, MD
VII. Election and Elevation of Members XIII. Adjourn
VIII. State of the Society Address

Anthony Senagore, MD
2009-2010 Nominating Slate

The ASCRS Nominating Committee, consisting of Drs. Ann Lowry, Chair, Lester Rosen and
Douglas Wong, submits the following slate of Officers and Members-at-Large for election
by ASCRS Fellows at the Society’s Annual Business Meeting.
President . . . . . . . . . . .James Fleshman, MD RF President
José Guillem, MD (2008-2010)
President-Elect . . . . . . . . . .David Beck ,MD
Vice President . . . . . . .John Pemberton, MD Members-at-Large
Susan Galandiuk, MD (2007-2010)
Past President . . . . .Anthony Senagore, MD Neil Hyman, MD (2007-2010)
Secretary . . . . . . . . . . . Steven Wexner, MD Janice Rafferty, MD (2008-2011)
Mark Welton, MD (2008-2011)
Treasurer . . . . . . . . . . . .Alan Thorson, MD Michael Abel, MD (2009-2012)
Robert Madoff, MD (2009-2012)
86
Wednesday, May 6
Memorial Lectureship Honoring

Dr. Alejandro F. Castro
1:30 - 2:15 pm
Grand Ballroom
Saving the Sphincter:
A Story of Surgical Evolution 2 *
Richard Billingham, MD
Clinical Professor of Surgery
University of Washington
Seattle, WA
W E D N E S D AY
Mathews Oration
2:15 - 3:00 pm
Grand Ballroom
If an Operation Can’t Cure
You, What Can I Do? 3 4 *
Ira Kodner, MD
Solon and Bettie Gershman Professor
Section of Colon & Rectal Surgery
Director, Center for Study of Ethics
and Human Values
Washington University in St. Louis
St. Louis, MO

87
Wednesday, May 6
Parallel Session: 11-A
Video Session
3:30 - 5:00 pm
Grand Ballroom
Videos of advanced colorectal procedures and teaching techniques submitted by the faculty will be presented with a period
for questions after the presentation.
Moderators: Charles Ternent, MD, Omaha, NE

Disclosure: C. Ternent: No Affiliation
3:30 pm Laparoscopic Subtotal Colectomy 4:08 pm Discussion

and Rectopexy (HALS) V-18
4:10 pm Overlapping Sphincter Repair with
R. Khoo, Santa Rosa, CA
Tissue Augmentation V-35
K. Garrett, B. Gurland, T. Hull, M. Zutshi,
3:36 pm Discussion Cleveland, OH
3:38 pm Laparoscopic Repair of Post-
abdominoperineal Resection 4:16 pm Discussion
Perineal Hernia V-19
4:18 pm Robotic Total Mesorectal Excision in
M. Abbas, A, Kwok, V. Nguyen, Los
Severely Obese Female Patient V-5
Angeles, CA
L. Prasad, S. Marecik, J. Park, T. Edson, Park
Disclosure: Raven Technologies – Research Grant (Principal
Investigator) Ridge, IL and Chicago, IL
3:44 pm Discussion
4:24 pm Discussion
3:46 pm The Laparoscopic Management of
Early Postoperative Small Bowel 4:26 pm Robotic Right Colectomy V-26
Obstruction V-20 S. Tsoraides, A. Cha, D. Crawford, Peoria, IL
Z. Awad, E. Lambert, Jacksonville, FL
Disclosure: Genzyme – Honorarium (Speakers Bureau); W. L. 4:32 pm Discussion
Gore – Honorarium (Teaching and Mentoring in the O.R.)
4:34 pm Transanal Single Port Low Anterior
3:52 pm Discussion Resection V-30
3:54 pm Robotic Resection of a Presacral Mass V-22 A. Fajardo, S. Hunt, J. Fleshman, M. Mutch, St.
S. Celinski, A. Mavanur, M. Holtzman, Louis, MO
S. Chalikonda, Pittsburgh, PA Disclosure: No Affiliation
Disclosure: No Affiliation 4:40 pm Discussion
4:00 pm Discussion 4:42 pm Laparoscopic-assisted Natural Orifice
4:02 pm Double Port Laparoscopic-assisted Surgery: Transvaginal Sigmoidectomy
Ileal Pouch Anal Anastomosis V-29 and Rectocolpopexy V-31
Z. Murrell, M. Gaon, R. Alban, P. Fleshner, J. Sanchez, B. Krieger, S. Rasheid,
Los Angeles, CA J. Frattini, J. Marcet, Tampa, FL
Dr. Elena Vikis will present Disclosure: No Affiliation
Disclosure: No Affiliation 4:48 pm Discussion

88
Wednesday, May 6
Outcomes II
1 6 *
3:30 - 5:00 pm
Atlantic Ballroom
Moderators: Andreas Kaiser, MD, Los Angeles, CA and Alex Ky, MD, New York, NY
Disclosure: A. Kaiser: Ethicon (Consultantship); Cook Medical – Honorarium (Consultantship); McGraw-Hill – Royalties (Author)
Disclosure: A. Ky: Ethicon – Honorarium (Preceptor)
W E D N E S D AY
3:30 pm Simulated Laparoscopic Sigmoidectomy 3:57 pm Discussion
Training: Responsiveness of Surgery
4:00 pm Impact of Fast Track Surgery on Hemody-
Residents S60
namics and Renal Function: Results of a
R. Essani, R. Scriven, A. McLarty,
Controlled Randomized Trial S63
L. Merriam, H. Ahn, R. Bergamaschi,
M. Hubner, S. Muller, P. A. Clavien,
Stony Brook, NY
N. Demartines, M. P. Zalunardo, Lausanne,
Disclosure: R. Essani: No Affiliation
Switzerland; Zurich, Switzerland
Disclosure: R. Bergamaschi: No Affiliation
Disclosure: M. Hubner: Fresenius-Kabi – Honorarium (Speaker)
3:37 pm Discussion Disclosure: N. Demartines: Fresenius-Kabi – Research Support
(Principal Investigator)
3:40 pm ASCRS Residency Training After the Cost
Trial: Are Our Fellows Primed to Perform 4:07 pm Discussion
Laparoscopic Colectomy? S61 4:10 pm Hospital Based Factors in Sphincter
S. L. Stein, J. J. Stulberg, B. J. Champagne, Preserving Surgery for Rectal Cancer S64
New York, NY; Cleveland, OH I. M. Paquette, J. A. Kemp, S. Finlayson,
Disclosure: S. Stein: Covidien – Honorarium (Speaker); Olympus Lebanon, NH
– Honorarium (Speaker)
Disclosure: J. Kemp*: No Affiliation
Disclosure: B. Champagne: Covidien – Honorarium (Speaker);
Disclosure: S. Finlayson: No Affiliation
GSK Glaxo – Honorarium (Speaker)
*Dr. J. Kemp presenting for Dr. I. Paquette
3:47 pm Discussion
4:17 pm Discussion
3:50 pm Fluid Management for Laparoscopic
Colectomy: A Prospective Randomized 4:20 pm Quality of Life After Coloanal Anastomosis
Assessment of Goal Directed Administra- and Abdominoperineal Resection for Low
tion of Balanced Salt Solution or Rectal Cancers. Sphincter Preservation vs.
Hetastarch Coupled with an Enhanced Quality of Life S65
Recovery Program S62 M. S. Kasparek, I. Hassan, R. R. Cima,
A. J. Senagore, T. A. Emery, M. Luchtefeld, D. W. Larson, E. J. Dozois, R. E. Gullerud,
D. Kim, N. Dujovny, R. Hoedema, H. Slay, D. R. Larson, J. H. Pemberton, B. G. Wolff,
Grand Rapids, MI Rochester, MN; Munich, Germany;
Disclosure: Presenting and Senior Author: A. Senagore: Deltex Springfield, IL
Medical - Unrestricted Educational Grant; Tranzyme Pharma - Disclosure: M. Kasparek: No Affiliation
Consulting Fee (Consultant/Advisor) Disclosure: I. Hassan: No Affiliation
Deltex Medical provided an unrestricted educational
grant for the project. 4:27 pm Discussion
89
Wednesday, May 6
Outcomes II
(continued)
4:30 pm Caring for Octogenarian and Nonagenarian 4:47 pm Discussion

Colorectal Cancer Patients - What Should
4:50 pm Ghrelin Agonist TZP-101 for Management
Our Standards and Expectations Be? S66
of Postoperative Ileus After Segmental
H. Kunitake, D. S. Zingmond, C. Y. Ko, Los
Colectomy: A Multinational, Randomized,
Angeles, CA
Dose-Ranging, Double-Blind, Placebo-
Disclosure: H. Kunitake: No Affiliation
Controlled Study S68
Disclosure: C. Ko: No Affiliation
A. J. Senagore, I. Popescu, G. V. Rao,
4:37 pm Discussion S. Varshney, P. Fleshner, S. Berry,
J. C. Pezzullo, P. Charlton, G. Kosutic,
4:40 pm Post-Operative Ileus: It Costs More Than
Bucharest, Romania; Hyderabad, India; Bhopal,
You Expect S67
India; Los Angeles, CA; College Station, TX;
T. Asgeirsson, K. El-Badawi, A. Mahmood,
Washington, DC; RTP, NC; Grand Rapids, MI
J. Barletta, M. Luchtefeld, N. Dujovny, D. Kim,
Disclosure: Presenting and Senior Author: A. Senagore: Deltex
H. Slay, R. Hoedema, A. J. Senagore, Grand Medical - Unrestricted Educational Grant; Tranzyme Pharma -
Rapids, MI Consulting Fee (Consultant/Advisor)
Disclosure: T. Asgeirsson: No Affiliation
Disclosure: A. Senagore: Deltex Medical - Unrestricted Educa- 4:57 pm Discussion
tional Grant; Tranzyme Pharma - Consulting Fee (Consul-
tant/Advisor)
Objectives: At the conclusion of this session, participants should be able to: (60) assess the responsiveness of general surgery residents to
simulated laparoscopic sigmoidectomy training; develop a plan for simulated laparoscopic sigmoidectomy training for residents; (61) under-
stand patterns of laparoscopic colectomy training and impact of training on comfort level for graduating colorectal residents; (62) under-
stand the use of esophageal doppler for guiding fluid administration and the relative benefits of various fluid strategies; (63) understand
implications of 'fast track' programs on hemodynamics and renal function; (64) understand both patient and hospital factors associated with
sphincter preserving surgery for rectal cancer; describe the increased adoption of sphincter preserving techniques over time across the U. S.;
discuss differences in rates of sphincter preserving surgery across hospitals of different volume, location, and teaching status; describe impli-
cations of hospital variations in delivery of care for rectal cancer patients across the U. S.; (65) understand the effect of coloanal anastomosis
and abdominoperianal resection on patients´ quality of life; learn to improve counseling of these patients; (66) better understand the out-
comes of octogenarians and nonagenarians following colorectal cancer resection in a large population cohort; (67) understand the prevalence
and significance of post-operative ileus in our health system and realize the importance of prophyllaxis/treatment in controlling this morbid-
ity and the costs associated with it; and (68) understand a potential new therapeutic agent for the management of postoperative ileus.
Annual Reception
and Dinner Dance
Wednesday
Reception
7:00 - 8:00 pm
Dinner Dance
8:00 - 10:30 pm
Regency Ballroom
Tickets Required
90
Exhibits
Great Hall
Exhibit Hours
Monday: 9:00 am – 4:00 pm
Tuesday: 9:00 am – 4:30 pm
Wednesday: 9:00 am – 11:00 am
PLATINUM SPONSOR Alaven Pharmaceutical, LLC Booth 214

2260 NW Parkway #D
Marietta GA 30067
Adolor/GSK Booth 613 Phone: (770) 916-3926
700 Pennsylvania Drive Fax: (770) 916-3900
Exton PA 19341 Website: www.alavenpharm.com
Phone: (484) 595-1500
Website: www.adolor.com Alaven Pharmaceutical is a privately held specialty pharma-
ceutical company located in Marietta, Georgia. We develop
Adolor Corporation is a biopharmaceutical company and market prescription and non-prescription products that
specializing in the discovery, development and commer- treat women’s health, gastroenterological and anemia condi-
cialization of novel prescription pain management prod- tions. Our company was formed in 2003.
ucts. For more information, visit www.adolor.com.
• ROWASA® for the relief of flare symptoms associated
GlaxoSmithKline offers a number of programs to support with active mild to moderate distal Ulcerative Colitis
effective health management strategies and improve (UC), proctosigmoiditis, or ulcerative proctitis.
patient care. Visit our exhibit for information about our
products and programs. • TriLyte® with flavor packs (PEG-3350, sodium chloride,
sodium bicarbonate, and potassium chloride for oral solu-
EXHIBITS
tion) is indicated for patients aged 6 months and older for
Advanced Infusion Booth 300 bowel cleansing prior to colonoscopy.
P.O. Box 390122 • Proctofoam® HC (hydrocortisone acetate 1% and
Snellville GA 30039 pramoxine hydrochloride 1%. Topical aerosol) for relief of
Phone: (770) 979-3379 anal or perianal corticosteroid responsive dermatomes.
Fax: (770) 979-0015
Website: www.advancedinfusion.com • Balneol® is a hygienic cleansing lotion for perianal and
external vaginal areas.
Disposable infusion pumps and catheters for post surgical
pain control featuring our patented Sta Catheter for hemor- • UniFiber® is an all natural insoluble fiber therapy
rhoid post surgical pain. (powdered cellulose) for relieving and preventing
constipation.
Agency for Medical Innovations Booth 400
20 Main St. Ste 205 ALOKA Ultrasound Booth 426
Natick MA 01760 10 Fairfield Blvd
Phone: (508) 655-1200 Wallingford CT 06492
Fax: (508) 655-0012 Phone: (203) 269-5088; (800) 872-5652
Website: www.ami.at Fax: (203) 269-6075
Website: www.aloka.com
(DG) HAL/RAR. Doppler Guided Hemorrhoid Arterial
Ligation / Rectal Anal Repair System for hemorrhoid treat- Aloka Ultrasound features surgical ultrasound systems that
ment with ligation and mucopexy. offer exceptional image quality and unmatched clinical ver-
satility. Our extensive array of transducers allows for imag-
ing during both open and laparoscopic surgical procedures.
They also provide the superior resolution required for
hepatic tissue, vessel evaluation and for ultrasound guidance
of ablative procedures.
91
Exhibits
Alpine Biomed Booth 320
GOLD SPONSOR
17800 Newhope Street, Ste B
Fountain Valley CA 92708
Phone: (800) 222-0074
Applied Medical Booth 713
Fax: (714) 839-8429 22872 Avenida Empresa
Website: www.alpinebiomed.com Rancho Santa Margarita CA 92688
Phone: (949) 713-8000
Alpine manufactures and supplies innovative diagnostics for Fax: (949) 713-8200
the Gastroenterolgy, Neurology, and related markets. Our Website: www.appliedmed.com
gastrodiagnostic equipment and accessories includes a com- As a new generation medical company with a history of
plete system and accessories for anorectal function testing, responding to evolving clinical needs, Applied Medical is
biofeedback, and pudendal nerve motor latency testing. well recognized for its innovative products for colorectal
surgery and its comprehensive educational workshops.
American College of Surgeons Applied’s laparoscopic advancements include the GelPort®
Oncology Group (ACOSOG) Booth 327 system, Direct Drive® atraumatic graspers and the Kii®
DUMC GelPort balloon trocar. Applied’s GelPortSM workshops
2400 Pratt Street, Terrace Level 0311 enable surgeons to adopt a minimally invasive approach
Durham, NC 27705 for traditional open procedures. To register for a work-
Phone: (919) 668-8600 shop, or to learn more about Applied, visit
Fax: (919) 668-7123 www.appliedmedical.com.
Website: www.acosog.org
The American College of Surgeons Oncology Group is one
of ten cooperative groups funded by the National Cancer Axcan Pharma Booth 601
Institute (NCI) to develop and coordinate multi-institutional 721 Route 202-206, 1st Floor
Bridgewater NJ 08807
clinical trials and is the only cooperative group whose primary
Phone: (908) 927-9600
focus is the development of clinical trials with surgical objec- Fax: (908) 927-9648
tives. The ACOSOG includes general and specialty surgeons, Website: www.axcan.com
representatives of related oncologic disciplines and allied
health professionals in academic medical centers and commu- Axcan is a leading multinational specialty pharmaceutical
nity practices throughout the United States of America. company focused on gastroenterology. The company devel-
ops and markets a broad line of prescription products to
treat a range of gastrointestinal diseases and disorders such
American Express OPEN Booth 822 as inflammatory bowel disease, irritable bowel syndrome,
200 Vessey St. cholestatic liver diseases and complications related to pan-
New York, NY 10285 creatic insufficiency.
Phone: (212) 640-2000
Fax: (212) 640-9171 CANASA® 1000 mg mesalamine suppositories are indicated
Website: www.open.com for the treatment of active ulcerative proctitis. CANASA®
American Express® Business Cards give you automatic 1000 mg suppositories reduce rectal bleeding, urgency,
access to the tools and resources that American Express tenesmus, mucous, and bloody diarrhea caused by inflam-
OPENSM has to offer, including benefits that can help you mation of the rectum. CANASA® 1000 mg mesalamine are
save money, gain control over your practice expenses, earn supplied in boxes of 30 and 42 individually plastic-wrapped
valuable rewards and much more. suppositories.
BRONZE SPONSOR
American Medical Systems, Inc. Booth 618
10700 Bren Rd West
Minnetonka MN 55343
Phone: (952) 930-6000
Fax: (952) 930-6462
Website: www.americanmedicalsystems.com
American Medical Systems is a world leader in medical
devices and procedures that treat incontinence, vaginal
vault prolapse and menorrhagia. Any one of these condi-
tions can profoundly diminish a patient’s quality of life
and significantly impact relationships. Our products pro-
vide a cure or reduce the incapacitating effects of these
diseases, often through minimally invasive surgery.
92
Exhibits
BK Medical Systems, Inc Booth 313 Canica Design Booth 923
250 Andover St 36 Mill Street
Wilmington MA 01887 Almonte ON KOA 1AO
Phone: (800) 876-7226 Canada
Fax: (978) 988-1478 Phone: (800) 705-8312
Website: www.bkmed.com Fax: (613) 256-0360
Website: www.canica.com
Flex Focus: Your Upwardly Mobile Colorectal Partner
Canica’s range of Dynamic Wound Closure systems prima-
I am the future of colorectal ultrasound. With high-
rily close retracted wounds ranging from dehisced cuts to
resolution 3D and complete 360º imaging I help you get
abdominal eviscerations, eliminating the need for flaps,
started quickly and:
grafts or mesh. Discover how Canica makes difficult closure
• Compare normal to abnormal anatomy simple. Visit www.canica.com for details.
• See all layers of the rectal wall
• See the extent of fistula tracts Cardinal Health Booth 317
7000 Cardinal Place
• Help visualize rectal tumors Dublin OH 43017
• Assess anal sphincter tears Phone: (614) 757-5000
Fax: (614) 553-5876
You are busy and need a partner that allows you to concen- Website: www.cardinalhealth.com
trate on what you are good at. Get to know me better and
see for yourself what a good partner I am. I have the Snowden-Pencer® and V. Mueller® Products – We put
pictures to prove it. quality surgical instruments in your hands, and a world of
resources at your fingertips. Our product offering includes a
full line of open and laparoscopic instruments, with
SILVER SPONSER reusable, take-apart and disposable product solutions.
With emphasis on ergonomic and reposable instrument de-
Boston Scientific Booth 205 signs, the Diamond-Line®, Diamond-Touch® and Dia-
EXHIBITS
100 Boston Scientific Way mond-Flex® instrument lines uniquely address the
Marlborough MA 01752 individual needs of the advanced laparoscopic surgeon.
Phone: (508) 683-4166 Our integrated approach to instrumentation, Full Circle In-
Fax: (508) 683-5803 strumentation™, means that we are your source for the
Website: www.bostonscientific.com people, selection, craftsmanship and solutions that encom-
Boston Scientific Endoscopy develops innovative technol- pass all of your needs.
ogy for less invasive, more efficient GI procedures. We
stand beside physicians, surgeons and nurses, providing Caris Diagnostics Booth 913
comprehensive support locally and through hands-on 8400 Esters Blvd #190
education and industry sponsorships, to help improve Irving TX 75063
patient outcomes. Phone: (214) 596-2229
Fax: (214) 596-2280
Website: www.carisdx.com
Calmoseptine, Inc. Booth 515 Caris Diagnostics (Caris DX) is a leading provider of the
16602 Burke Lane highest quality diagnostic and translational development
Huntington Beach CA 92647-4536 services encompassing anatomic pathology and molecular
Phone: (714) 840-3405 testing. Caris Diagnostics provides world-class pathology
Fax: (714) 840-9810 services to physicians who treat patients in the community
Website: www.calmoseptineointment.com setting. Additional information is available at
Calmoseptine Ointment is a multi-purpose moisture barrier www.carisdx.com.
that protects and helps heal skin irritations. Calmoseptine
temporarily relieves discomfort and itching. Free samples at Collaborative Group of Americas on
our booth. Inherited Colorectal Cancer Booth 207
Cleveland Clinic Foundation
9500 Euclid Ave; Mail Code A-30
Cleveland OH 44195
Phone: (216) 444-9052
Fax: (216) 445-8627
Website: www.cgaicc.org
Inherited Colon Cancer educational materials, and
announcements of future meeting giveaways.
93
Exhibits
BRONZE SPONSOR D2 Market Research Booth 921
35 Breakwater Square
Cook Medical Booth 501 Freehold, NJ 07728
Phone: (908) 770-2324
750 Daniels Way
Bloomington IN 47404 D2 Market Research provides a full range of customized
Phone: (800) 468-1379 quantitative and qualitative research solutions for the
Fax: (800) 554-8335 pharmaceutical industry.
Website: www.cookmedical.com
Cook® Medical will exhibit the Surgisis Biodesign® Fistula
Plug, a revolutionary biologic product for anal and recto- BRONZE SPONSOR
vaginal fistula closure. It treats even difficult cases without
causing muscle damage and pairs perfectly with the Surgi- DiagnoCure Booth 919
sis Biodesign Fistula Brush, specially designed for fistula 1045A Andrew Drive
tract identification and preparation. Surgisis Biodesign — West Chester PA 19380
a whole new category of tissue repair. Phone: (858) 731-1455
Fax: (866) 702-6381
Website: www.diagnocure.com
DiagnoCure Oncology Laboratories (West Chester, PA)
PLATINUM SPONSOR presents Previstage™ GCC Colorectal Cancer Staging
Test, a high-value molecular diagnostic detecting
Covidien Booth 305 Guanylyl Cyclase C (GCC) for more accurate staging
150 Glover Ave of colorectal cancer, increasing clinician confidence in
Norwalk CT 06856 making critical treatment decisions.
Phone: (203) 845-1000
Fax: (203) 845-1776
Website: www.covidien.com Electro Surgical Instrument Co. Booth 212
Covidien is a leading global healthcare products company 37 Centennial St.
that creates innovative medical solutions for better patient Rochester NY 14611
outcomes and delivers value through clinical leadership Phone: (585) 235-1430
Fax: (585) 235-1438
and excellence. Covidien manufactures a diverse range of Website: www.electrosurgicalinstrument.com
industry-leading products in five segments including
Surgical and Energy-based Devices. Please visit Electro Surgical Instrument Company (ESI) offers a com-
www.covidien.com to learn more. plete array of fiberoptic lighted instruments for the colon
and rectal surgeon. Anoscopes, specula and deep pelvic
retractors.
CS Surgical, Inc. Booth 419
662 Whitney Drive Ellman International Booth 416
Slidell LA 70461 3333 Royal Ave
Phone: (985) 781-8292 Oceanside NY 11572-3625
Fax: (985) 781-8244 Phone: (516) 267-6582; (800) 835-5355
Website: www.cssurgical.com Fax: (516) 569-0054
CS Surgical is your leading supplier of surgical instruments Website: www.ellman.com
for the Colon & Rectal surgeon. Our exhibit will feature the Ellman International, a worldwide leader and manufacturer
industry’s widest variety of deep pelvic retractors, the newest of high frequency radiosurgical equipment, presents the
Cima-St. Mark’s retractor for Hand Assisted Laparoscopic Surgitron IEC Dual Frequency. This device utilizes 4.0
Deep Pelvic Surgery, our table mounted retractor system, MHz for cut, blend, and coag. Bipolar utilizes 1.7 MHz. It
hemorrhoidal ligators, suction ligators, anoscopes, rectal provides pressureless incisions with minimal tissue alter-
retractors, intestinal clamps, scissors, needle holders, probes ation, superior biopsy specimens and excellent cosmetic
and directors, and Welch Allyn products. results. Please visit our booth for a demonstration on how
radiosurgery can benefit your practice.
94
Exhibits
Elsevier Saunders/Mosby Publisher Booth 718 EZ Surgical Inc Booth 823
P O Box 360446 1150 Broadway #220
Birmingham AL 35236 Hewlett NY 11557
Phone: (205) 542-7755 Phone: (516) 374-2078; (888) 391-6674
Fax: (501) 665-9298 Fax: (516) 977-1524
Website: www.elsevier.com
The DASH™ is a single use malleable absorptive retractor,
Elsevier Saunders, Mosby and Churchill Publishers of for use in various open and hand assisted laparoscopy
Continuing Education Publications. The leader in Journals surgery procedures. The DASH™ contains an inner
for Physicians.We have the new Keighly Surgery of the Anus malleable stainless steel mesh that can easily be reshaped
Rectum and Colon. Also a new Colonoscopy CT text due during surgery.
shortly. The Cameron Current Therapy in Surgery is avail- The DASH™ is uniquely designed to provide an improved
able also. surgical window, protect the surrounding tissues from injury
and prevent their intrusion into the working space.
DIAMOND SPONSOR The DASH™ is FDA and CE approved, and is currently in
early sales around the U.S. and Europe. A highly successful
Ethicon Endo-Surgery, Inc. Booth 505 clinical study including over 150 cases was conducted and
4545 Creek Rd published; the device was used in over 50,000 cases since its
Cincinnati OH 45242 2007 FDA approval.
Phone: (513) 337-7000; (800) 873-3636 Product Benefits:
Fax: (513) 337-3670 • Allows easy reshaping and reforming during surgery
Website: www.ethiconendo.com
• Enhances access to surgical site
Ethicon Endo-Surgery, Inc. develops and markets • Minimizes need for excess bulky metal retractors
advanced medical devices for minimally invasive and open • Provides absorption capacity of 12 lap pads in one
surgical procedures. The company focuses on procedure- • Reduces the risks of retained foreign bodies by the use of
enabling devices for the interventional diagnosis and an integrated lap/retractor
EXHIBITS
treatment of conditions in general surgery, bariatric sur-
gery, gastrointestinal health, plastic surgery, orthopedics,
gynecology, and surgical oncology. BRONZE SPONSOR
Ferndale Laboratories, Inc. Booth 301
Exiqon Diagnostics Booth 117 780 West Eight Mile Rd
15501 Redhill Ave Ferndale MI 48220
Tustin CA 92780 Phone: (248) 548-0900; (800) 621-6003
Phone: (800) 662-6832 Fax: (248) 548-8427
Fax: (714) 566-1260 Website: www.ferndalelabs.com
Website: www.exiqon.com
Ferndale Laboratories, Inc. is dedicated to providing
Exiqon Diagnostics, a division of Exiqon A/S, is a leader treatments for patients with anorectal disorders.
in personalizing medicine for cancer patients. Exiqon Our products include:
Diagnostics is dedicated to developing and performing Analpram HC® (hydrocortisone acetate 1% or 2.5% and
novel molecular and cell-based oncology assays to help pramoxine hydrochloride 1%) – Cream, lotion, and
physicians individualize and optimize treatment selection singles offer patients relief of anorectal itching, burning,
for their patients. The Company offers a broad range of and inflammation.
clinical laboratory services including the Oncotech EDR™
Assay and molecular biomarker testing. By utilizing propri- L.M.X. 5® (lidocaine 5%) – Anorectal cream providing
etary LNA™ technology and miRNA biomarkers, Exiqon temporary relief of pain, itching and discomfort associated
Diagnostics is establishing the next generation of molecular with anorectal disorders.
diagnostics for oncology. Exiqon Diagnostics has performed
oncology services for more than 150,000 cancer patients
from over 1000 hospitals throughout North America and
Europe. Exiqon Diagnostics is the trade name for
Oncotech, Inc., a wholly owned subsidiary of Exiqon A/S.
95
Exhibits
General Surgery News Booth 700 I-Flow Corporation Booth 518
545 W 45th St-8th Flr 20202 Windrow Dr
New York NY 10036 Lake Forest CA 92630
Phone: (212) 957-5300 Phone: (800) 448-3569
Fax: (212) 957-7230 Fax: (949) 206-2600
Website: www.generalsurgerynews.com Website: www.iflow.com
General Surgery News is a monthly newspaper designed to ON-Q is labeled to significantly reduce pain better than
keep general surgeons abreast of the latest developments in narcotics alone and to significantly reduce narcotics intake
the field. The publication features extensive meeting cover- after surgery. ON-Q was upheld as a best practice for post-
age, analysis of journal articles, educational reviews, and surgical pain relief and its widespread use was encouraged as
information on new drugs and products. part of an independent study published in the prestigious
Journal of American College of Surgeons. Currently, more than
55 studies on the use of ON-Q have been completed and
SILVER SPONSOR published or presented, and more research is being con-
ducted to explore the benefits of ON-Q. Medicare recog-
Genzyme Biosurgery Booth 705 nizes ON-Q as a payable covered benefit and is therefore
55 Cambridge Pkwy, 5th Floor medically necessary. For more information, please visit our
Cambridge MA 02142 website at www.iflo.com.
Phone: (617) 494-8484
Fax: (617) 761-8789
Website: www.seprafilm.com Int’l Foundation for Functional
Gastrointestinal Disorders (IFFGD) Booth 308
Genzyme Biosurgery is a leading developer of biothera-
PO Box 170864
peutic and biomaterial products, including prevention
Milwaukee WI 53217
following abdominopelvic surgery. Our products and Phone: (414) 964-1799; (888) 964-2001
pipeline harness the power of biology to improve surgical Fax: (414) 964-7176
results by preventing postsurgical adhesions. Seprafilm® Website: www.iffgd.org
Adhesion Barrier is a bioresorbable, site-specific barrier
that separates adhesiogenic tissue surfaces during the The International Foundation for Functional Gastrointesti-
critical 7-day period of peritoneal healing. nal Disorders (IFFGD) is a nonprofit education and
research organization dedicated to informing, assisting and
supporting people affected by functional gastrointestinal
Gore & Associates Booth 719 and motility disorders.
PO Box 2400
Flagstaff AZ 86003-2400
Phone: (928) 779-2771 SILVER SPONSOR
Website: www.goremedical.com
Gore Medical Products Division has provided creative ther- Intuitive Surgical Booth 215
apeutic solutions to complex medical problems for three 1266 Kifer Road
decades. During that time, more than 25 million innovative Building 101
Gore Medical Devices have been implanted, saving and Sunnyvale CA 94086
Phone: (408) 523-2488
improving the quality of lives worldwide. The extensive
Fax: (408) 523-1390
Gore Medical family of products includes vascular grafts, Website: www.intuitivesurgical.com
endovascular and interventional devices, surgical materials
for hernia repair, soft tissue reconstruction, staple line Intuitive Surgical, Inc. is the global technology leader in
reinforcement, and sutures for use in vascular, cardiac and robotic-assisted, minimally invasive surgery. The Com-
general surgery. pany’s da Vinci® Surgical System offers breakthrough tech-
nology designed to enhance surgical capability, improve
clinical outcomes and drive operational efficiencies.
HRA Research Booth 423
400 Lanidex Plaza
Parsippany NJ 07054
Phone: (973) 240-1200
Fax: (973) 463-1888
Website: www.hraresearch.com
Our team of experienced interviewers will be distributing
carefully developed questionnaires. We’ll be gathering the
answers to vital marketing and clinical questions-answers
that can affect the introduction of new products or the con-
tinuation of existing healthcare products and services.
96
Exhibits
Karl Storz Endoscopy Booth 819 LifeCell Booth 206
600 Corporate Pointe 1 Millennium Way
Culver City CA 90230 Branchburg NJ 08876
Phone: (310) 338-8100 Phone: (908) 947-1044
Fax: (310) 410-5537 Fax: (908) 947-1502
Website: www.karlstorz.com Website: www.lifecell.com
Karl Storz Endoscopy-America, Inc., an international leader LifeCell is a leading provider of hernia repair and breast
in endoscopic equipment and instruments, designs, engi- reconstruction products including AlloDerm® and
neers, manufactures and markets products with an emphasis Strattice®. LifeCell Tissue Matrices support tissue regenera-
on visionary design, precision craftsmanship and clinical tion through rapid revascularization, cell repopulation and
effectiveness. white cell migration; may help to optimize aesthetic out-
comes in breast applications; and may minimize the risks of
some complications. LifeCell is launching Strattice for
BRONZE SPONSOR breast plastic surgery revisions in 2009.
Konsyl Pharmaceuticals, Inc. Booth 412 Lumitex MD Booth 113
8050 Industrial Park Rd
8443 Dow Circle
Easton MD 21601
Strongsville OH 44136
Phone: (410) 822-5192
Phone: (440) 243-8401; (800) 969-5483
Fax: (410) 822-5264
Fax: (440) 243-8402
Website: www.konsyl.com
Website: www.lumitex.com
Konsyl Pharmaceuticals, Inc. is a manufacturer of Lumitex Medical Devices creates, manufactures and distrib-
natural dietary fiber supplement based products. Psyllium utes unique devices for medical illumination. LightMat
Fiber products include powders and capsules, available in Surgical Illuminator provides cool, shadowless deep cavity
multi-dose packaging as well as single dose sachet packag- lighting. Flexible or malleable, it may be placed onto most
ing. Konsyl® Original has been doctor recommended for retractors or instruments. VersaLight Multifunctional Sur-
over 50 years and the only all-natural, gluten-free product
EXHIBITS
gical Illuminator illuminates, irrigates, aspirates and pro-
with 6 grams of psyllium per dose. KPI also manufactures vides moderate blunt retraction in one easy to use hand held
SITZMARKS® a medical device for gastrointestinal surgical tool. www.lumitexmd.com
diagnostic purposes. SITZMARKS®, administered under
a physicians order, consist of Barium Sulphate impreg-
nated PVC 0 rings placed inside a gelatin capsule. Once Market Access Partners Booth 818
ingested, the 0 rings are released and travel the gastroin- 3236 Meadowview Rd
testinal tract. X-rays at specific times can help diagnosis Evergreen CO 80439
conditions such as hypomotility, bowel obstruction or Phone: (303) 526-1900
Fax: (303) 526-7920
outlet delay. SITZMARKS are available in three different Website: www.marketaccesspartners.com
lumens.
Market Access Partners provides market research consulting
to the medical device and pharmaceutical industries. We use
Lexion Medical Booth 522 innovative qualitative and quantitative methodologies to
5000 Township Parkway research opinions of physicians, nurses and patients. We
St Paul MN 55110 offer a management-oriented approach to product develop-
Phone: (877) 9-LEXION ment and marketing.
Fax: (651) 636-1671
Website: www.lexionmedical.com
MAST Biosurgery, Inc. Booth 821
LEXION Medical, a leader of innovative medical technolo- 6749 Top Gun Street Suite 108
gies improving patient safety, offers the Insuflow® Laparo- San Diego CA 92121
scopic Gas Conditioning Systems and the PneuVIEW® Phone: (858) 550-8050
Laparoscopic Smoke Elimination System. Fax: (858) 550-8060
Website: www.mastbio.com
The SurgiWrap® Bioresorbable Protective Sheet is designed
to support and reinforce soft tissue and minimize unwanted
post-surgical soft tissue attachments to the device, FDA
Cleared for both open and laparoscopic procedures. MAST
Biosurgery is a leader in the development and production of
bioresorbable polymer implants.
97
Exhibits
George Percy McGown Booth 102
GOLD SPONSOR
122 Wyckoff St
Brooklyn NY 11201-6307
Phone: (954) 435-0845 Medtronic, Inc. Booth 321
Fax: (954) 435-0864 710 Medtronic Parkway
Website: www.gpmcgown.com Minneapolis MN 55432
Phone: (763) 514-4000
Instruments for the Colorectal Surgeon specializing in Fax: (763) 514-4879
Hemorrhoid ligators (15 kinds) all in stock all the time. Website: www.medtronic.com
Introducing the new McGown Magic Loading Cone™.
Medtronic is a global leader in medical technology -
alleviating pain, restoring health and extending life for
MD Logic, Inc. Booth 304 millions of people around the world. Products include
2170 Satellite Blvd #435 Enterra® Therapy, an implantable neurostimulator for
Duluth GA 30097 treatment of chornic, intractable (drug refractory) nausea
Phone: (770) 497-1560 and vomiting secondary to gastroparesis of diabetic or
Fax: (770) 497-1469
Website: www.mdlogic.com
idiopathic etiology.
MD Logic is a touch screen based EMR/EHR with the sim-

plest input device for documentation. With the touch of a
finger, they can create compliant patient records, prescrip- BRONZE SPONSOR
tions, referral letters and charge tickets thus eliminating dic-
tation and transcription costs. Paperless charting is effortless Merck & Co., Inc. Booth 513
with the easiest electronic medical record in the industry. 351 N Sumneytown Pike
North Wales PA 19454-2505
Phone: (267) 305-5000
SILVER SPONSOR Fax: (267) 305-1266
Website: www.merck.com
Mederi Therapeutics Inc. Booth 104 We invite you to visit our exhibit featuring INVANZ®
8 Sound Shore Dr #160 (Ertapenem Sodium). Inquiries about our professional,
Greenwich CT 06830 informational, and educational services are welcomed.
Phone: (203) 542-8103
Fax: (203) 869-1013
Mederi Therapeutics, makers of Secca, a minimally inva- M F B International, Inc Booth 107
sive treatment for fecal incontinence. 8323 NW 64th St.
Miami, FL, 33166
Phone: (305) 436-6601
Mediwatch USA Booth 221 Fax: (305) 436-6627
Website: www.bluebidet.com
1501 Northpoint Parkway, Ste 103
West Palm Beach FL 33407 M.F.B. International, Inc. is the national distributor of the
Phone: (888) 471-2611 product “Blue Bidet”. “Blue Bidet” is an attachment to any
Fax: (866) 871-8262 one or two pieces toilet that allows the user to include water
Website: www.mediwatch.com in her or his personal hygiene after the use of the toilet. It is
Mediwatch offers the best in Pelvic Floor diagnostics prod- very easy to install and to operate does not require electric-
ucts. We provide Urodynamics, Ultrasound, Anorectal ity. Is an excellent product for the whole family and specially
Manometry and Pudendal nerve testing devices, which are helpful for seniors, handicap, overweight persons, pregnant
complimented with complete training and long-term sup- woman, hemorrhoids patients, post surgery patients,
port. Our display includes the Sensic Urodynamics system, Crohn’s disease patients, discomfort caused during bowel
Encompass “Total” Pelvic Floor diagnostic system and Por- movements (constipation or diarrhea), etc.
tascan Ultrasound systems.
98
Exhibits
CORPORATE SPONSOR SILVER SPONSOR
Microline Booth 619 Olympus - Gyrus ACMI Booth 813
800 Cummings Center, Suite 166J 136 Turnpike Rd
Beverly MA 01915 Southborough MA 01772
Phone: (978) 922-9810 Phone: (508) 804-2600
Fax: (978) 922-9209 Fax: (508) 804-2624
Website: www.microlinepentax.com Website: www.gyrusacmi.com
Laparoscopic Surgical Instruments for General Surgery, Olympus and Gyrus ACMI, two of the world’s leading
Ob-gyn, Urology and Bariatric surgical procedures. suppliers of minimally invasive surgical technologies have
Product portfolio comprises cutting, dissecting, grasping, joined forces to create a more versatile organization. The
cauterizing and litaging instruments. best-in-class tissue management systems of Gyrus ACMI
perfectly complement the innovative array of world-class
medical systems and leading-edge opto-digital technology
offered by Olympus.
SILVER SPONSOR
Myriad Genetic Laboratories, Inc. Booth 612 PENTAX Medical Company Booth 519
320 Wakara Way 102 Chestnut Ridge Rd
Salt Lake City UT 84108 Montvale NJ 07645-1856
Phone: (800) 469-7423 Phone: (800) 431-5880
Fax: (801) 584-3615 Fax: (201) 391-1677
Website: www.myriadtests.com Website: www.pentaxmedical.com
Myriad Genetic Laboratories offers COLARIS® and PENTAX introduces the most advanced and intuitive GI
COLARIS AP ® testing for Lynch syndrome (HNPCC) suite of imaging technologies, the PENTAX i-PLAT-
and the various adenomatous polyposis syndromes, FORM. This innovative platform offers the highest resolu-
EXHIBITS
including FAP, AFAP, and MAP. A leader in gene research tion HD image on the market with 50% more resolution
and discovery, Myriad provides educational support pro- than the next nearest image, all the while orchestrating
grams for both physicians and patients. built-in efficiency tools such as automatic procedure set-up,
always-on remote servicing, and on-demand benchmarking
analysis tools.
My Studio Space Booth 421
2659 W. Guadalupe Rd Suite D213 The Prometheus Group Booth 523
Mesa AZ 85202
1 Washington St #303
Phone: (480) 491-4932
Dover NH 03820
Fax: (480) 323-2668
Phone: (603) 749-0733
Website: www.mystudiospace.com and www.hemorrhoid.net
Fax: (603) 749-0511
Web site design and colorectal practice marketing. We have Website: www.theprogrp.com
proctologic web sites that are first page on Google and Manufacturers of the Pathway CTS 2000 Pelvic Muscle
Yahoo! Rehabilitation System, Telesis Sacral Nerve Latency Testing
System and Noman Anorectal Manometry System.
NiTi™ Surgical Solutions Booth 805
17295 Chesterfield Airport Road, #200
Chesterfield MO 63005
Phone: (636) 532-4048
Fax: (636) 532-4049
Website: www.nitisurgical.com
NiTi™ Surgical Solutions has developed the first major
advance in closure for gastrointestinal surgery in more
than 30 years. NiTi’s proprietary technology represents a
breakthrough in natural healing with tissue-sparing, uni-
form Compression Anastomosis. The company’s unique line
of products utilizes Nitinol-based elements to press
together the ends of resected tissue, enabling a natural
reconnection of the intestine after removing a section, for
example, as part of a colon cancer treatment. The company
is commercializing a family of FDA-cleared and CE-marked
disposable tissue closure devices.
99
Exhibits
ResiCal, Inc. Booth 209 Sandhill Scientific, Inc. Booth 200
PO Box 489 9150 Commerce Center Circle #500
Orchard Park NY 14127 Highlands Ranch CO 80129
Phone: (800) 204-6434 Phone: (303) 470-7020
Fax: (716) 662-5871 Fax: (303) 470-2975
Website: www.resical.com Website: www.sandhillsci.com
Calmol 4® Hemorrhoidal Suppositories are predomi- For over 27 years, Sandhill Scientific has been a Total Solu-
nantly recommended by physicians. Calmol 4 contains tions Provider in the field of G.I. Diagnostics and offers a
soothing active ingredients (cocoa butter and zinc oxide) to full range of anorectal diagnostic tools for a comprehensive
provide temporary lubrication for anorectal discomforts. evaluation of the anal canal, rectum and pelvic muscles.
Calmol 4 has a long established safety profile. There is no Sandhill also offers therapeutic biofeedback options for
absorption of active ingredients and no interaction with pelvic muscle retraining.
internal medications. Calmol 4 contains no anesthetics, no
vasoconstrictors, and no topical steroids. Patient samples SAPI MED SpA Booth 800
available. Via Santi 25 -Z.1, D4 Scalo
Alessandria 15100, Italy
RG Medical USA Booth 105 Phone: 390131348109
468 Craighead St Fax: 390131348383
Nashville TN 37204 Website: www.sapimed.com
Phone: (615) 269-7256 We produce and distribute in more than 40 countries all
Fax: (615) 269-4605 over the world disposable medical devices for colorectal sur-
Website: www.rgmedical.com gery such as: anoscopes, rectoscopes, retractors, hemorrhoid
RG Medical USA, Inc. specializes in a wide variety of banding ligators, anal dilators.
equipment, instruments and ancillary products. The prod-
uct line includes rigid and flexible endoscopes, video sys- Sierra Scientific Institute Booth 115
tems, surgical instruments and disposables along with the 5757 W. Century Blvd.
Proctowash and Retrowash line of colonic lavage kits. Los Angeles, CA 90045
Phone: (310) 641-8492
Salix Pharmaceuticals, Inc Booth 121 Fax: (310) 872-5558
1700 Perimeter Park Dr Website: www.sierrainst.com
Morrisville NC 27560-8404 SSI produces High-Resolution solid-state manometry
Phone: (919) 862-1000 systems for gastrointestinal motility study. Our ManoScan
Fax: (919) 862-1095 360™ dramatically siimplifies clinical procedures and pro-
Website: www.salix.com vides intuitive pressure images that reveal diagnostically
Salix Pharmaceuticals, Inc. follows a competitive strategy of significant conditions not seen with conventional manome-
in-licensing late-stage pharmaceutical products to treat GI try. The ManoScan 360™ is now upgradeable to High-
diseases. The salix portfolio includes APRISO™, Resolution Manometry with Impedance. Also available are
COLAZAL®, XIFAXAN®, OsmoPrep®, MOVIPREP®, the new AccuTrac™ pH and Impedance monitoring sys-
AZASAN®, ANUSOL-HC®, PROCTOCORT®, tems, ManoShield disposable catheter sheaths for both
PEPCID® Oral Suspension, and DIURIL® Oral Suspen- esophageal and anorectal catheters, and small diameter
sion. Exceptional customer service, a dedicated specialty adult and pediatric solid-state catheters.
sales force, and quality products underscore Salix’s commit-
ment to the gastroenterology community. Sigma Tau Pharmaceuticals Inc Booth 723
9841 Washington Bvd #500
Gaithersburg MD 20878
Phone: (301) 948-1041
Fax: (301) 948-2049
Website: www.vsl3.com
VSL#3 is a high-potency probiotic for the dietary manage-
ment of ulcerative colitis, ileal pouch, and IBS. Noted for
decreasing diarrhea, frequency, and urgency VSL#3 is
imported by Sigma-Tau Pharmaceuticals, Inc., a subsidiary
of Sigma-Tau S.p.A.
100
Exhibits
Simbionix USA Corp Booth 526 Surgin/OrigynRx Booth 901
11000 Cedar Avenue, Suite 210 37 Shield
Cleveland OH 44106 Irvine CA 92618-5212
Phone: (216) 229-2040 Phone: (714) 832-6300 x252
Fax: (216) 229-2070 Fax: (714) 832-2020
Website: www.simbionix.com Website: www.surgin.com
Simbionix is a global leader in medical simulation technol- Surgin manufactures the Hemorrhage Occluder Pin (HOP)
ogy. Simbionix products provide medical experts with with an easy-to-use applicator that stops PRESACRAL
hands-on training in a comprehensive array of MIS proce- BLEEDING. The HOP is available in 2 sizes 10mm and
dures, including: Endourology, Percutaneous Access, 14mm. A Salgado driver is now available to help insert the
Endovascular Interventions. Its GI Mentor provides train- HOP into the sacrum.
ing in upper and lower endoscopy procedures, EUS and
ERCP. Simbionix LAP Mentor™, the world leader Laparo- TEI Biosciences Booth 622
scopic Simulator provides powerful training in basic and 7 Elkins St
advanced procedures. The new Colorectal module provides Boston MA 02127
real-life simulation of the Sigmoidectomy procedure from Phone: (866) 524-0022
the vessel isolation through creation of the anastomosis. Fax: (888) 623-2259
The module feature a true-to-life separating mesentery Website: www.teibio.com
planes simulation, one of the more difficult challenges of TEI Biosciences produces novel biological products for soft
the sigmoidectomy procedure. tissue repair and reinforcement applications – from plastic
and reconstructive surgery and hernia repair to wound man-
SmartPill Corporation Booth 223 agement, dura, tendon.
847 Main St
Buffalo NY 14203 THD America, Inc. Booth 918
Phone: (716) 882-0701
Fax: (716) 882-0706 1731 SE Oralabor Rd
Ankeny IA 50021-9412
EXHIBITS
Website: www.smartpillcorp.com
Phone: (515) 289-7160
The SmartPill Corporation is a developer of ingestible, Fax: (515) 289-7190
capsule-based medical devices, peripheral software and Website: www.thdamerica.com
electronic components that aid in the diagnosis, definition THD™ is an emerging developer of innovative surgical and
and therapeutic intervention of gastrointestinal disorders diagnostic products. Our flagship product/procedure,
and diseases. THD-HP™ (Transanal Hemorrhoidal Dearterializaiton-
Hemorrhoidopexy), is a minimally-invasive surgery for the
Sontec Instruments, Inc. Booth 204 treatment of internal hemorrhoids and prolapse. THD-
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101
Exhibits
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102
Abstracts
Results: A total of 652 colectomies were performed during the study
period, 484 prior and 168 after initiation of the new protocol. All cases were
General Surgery Forum divided into laparoscopic, open, and laparoscopicaly-assisted (extracorporeal
division of major vessels and mesentery). By the end of the first year, com-
pliance with protocol reached 50% for right sided and 82% for all other
colectomies. There was a significant sharp drop in LOS for all procedures
GSF-1 after initiation of Fast track. In-hospital stay decreased by 1.9 days for open,
SINGLE PORT ACCESS (SPA) COLON SURGERY - 20 1.5 days for lap-assisted and 2.8 days for laparoscopic colectomies. This
LAPAROSCOPIC COLON PROCEDURES PERFORMED held true for both right and all other colectomies: decrease by 1.8 days and
THROUGH A SINGLE PORT OF ENTRY. 2 days respectively. During the same period, the percentage of re-admissions
(within 30 days) increased from 7.9% the pre-pathway period to 13.8% in
E. R. Podolsky and P. G. Curcillo Surgery, Drexel Univeristy College of
the post-pathway period, consistent with previous studies.
Medicine, Philadelphia, PA.
Conclusions: Institution-wide implementation of a clinical colectomy
Purpose: In April 2007, we developed Single Port Access (SPA) surgery. pathway protocol is feasible and leads to a significant decrease of LOS across
The SPA technique enables multiport laparoscopic procedures to be per- operative technique and perioperative practice patterns. Features associated
formed through a single incision, often hidden within the umbilicus. Fur- with success where ease of use, standardization of order sets and care pat-
ther, we have developed the technique to be performed using standard rigid terns across rotating residents and coordination with allied health person-
instrumentation and standard access trocars without the need for additional nel to facilitate expectations and discharge. Despite some resistance and a
instrumentation, port devices or costs. Having successfully applied the tech- variety of perioperative practices and level laparoscopic training, the new
nique to nearly 200 procedures, we now demonstrate its applicability and protocol improved LOS all surgeons performing colectomies
success in colon surgery.
Methods: 20 patients undergoing colon procedures using the Single Port
Access (SPA) approach were reviewed. Diagnosis included colon cancer, GSF-3
benign masses, ulcerative colitis and diverticulitis. All patients underwent the PREDICTORS OF FULMINANT COLITIS AND MORTAL-
procedure using the SPA technique through a single incision in the lower ITY IN PATIENTS WITH CLOSTRIDIUM DIFFICILE
abdominal wall. Resection and anastomosis were performed both intracor- INFECTION.
poreally and extracorporeally. Incision length, operative time, blood loss,
N. J. Umoh1, I. Sucandy1, H. Dancea1, L. Choi1, L. Esolen2 and
margins node retrieval and postoperative course were reviewed.
Results: All patients successfully underwent SPA colon surgery. All por-
M. Olson1 1General Surgery, Geisinger Medical Center, Danville, PA and
2
tions of the colon have been successfully resected, including one total proc- Infectious Diseases, Geisinger Medical Center, Danville, PA.
tocolectomy with J-Pouch. Average incision lengths in SPA procedures were Purpose: This study aims to identify predictors of fulminant Clostrid-
3.5cm. No additional port sites were necessary. Node retrieval averaged 18 ium difficile (C. diff) colitis and risk factors for mortality among patients with
nodes (14 - 22) and margins were adequate in cancer procedures. There were severe C. diff colitis.
no postoperative leaks. Three patients had prolonged ileus (>3 days) with Methods: A retrospective review of records of 128 patients that had a
one readmission. Follow-up of 16 months has demonstrated only one her- first time diagnosis of C. diff colitis in 2007 was performed. The diagnosis
nia. of C. diff colitis was confirmed by a positive exotoxin assay. Severe C. diff
Conclusions: Conclusions : We have successfully applied the Single Port colitis was defined as septic shock requiring vasopressors while fulminant
Access (SPA) technique to a variety of general surgical and gynecologic pro- colitis was defined as either mortality or emergent colectomy resulting from
C. diff colitis. Demographic, clinical and biochemical parameters were
G ENERAL S URGERY F ORUM

cedures. Review of our first 20 colon procedures using this technique demon-
strates successful application in colon resection. In addition we demonstrate assessed for predictors of fulminant colitis using univariate and multivari-
the success of multiple quadrant surgery with this access technique. We are ate logistic regression analyses. A subgroup analysis was then performed to
able to adhere to standard multiport dissection techniques through a single identify factors associated with mortality among patients with severe C. diff
port of entry. The “independence of motion” afforded by our access tech- colitis. The study protocol was approved by the Institutional Review Board
nique allows us to perform procedures using standard instrumentation and of the Geisinger Health System.
trocars. Results: The study population was made up of 52% women with a
median age of 65 years. 53% had community acquired and 47% had hos-
pital acquired C. diff colitis. 83% had a prior history of antibiotic expo-
GSF-2 sure within 30 days of diagnosis. Fulminant colitis was present in 23 (20%)
IMPLEMENTATION OF INSTITUTION-WIDE FAST patients and associated with 77% mortality. Only 39% of patients with ful-
TRACK PATHWAY LEADS TO DECREASE IN POST-COLEC- minant colitis underwent a colectomy. The independent predictors of ful-
TOMY LENGTH OF STAY. minant colitis (odds ratio, 95% confidence interval) were septic shock (29.0,
V. Y. Poylin, E. R. Woods and D. Nagle Surgery, Beth Israel Deaconess 6.4-130.9), bandemia (1.1, 1.0-1.2), peak lactate (1.4, 1.0-2.0) and Ghali-
Medical Center, Boston, MA. Charlson co-morbidity index (1.3, 1.0-1.6). The mode of acquisition did
not predict fulminant colitis. 29 (23%) patients had severe C. diff colitis
Purpose: Previously, initiation of a fast track protocol by a dedicated
with a 45% mortality rate. Peak lactate (3.8, 1.4-10.3) was an independ-
group of surgeons has been shown to improve morbidity and length of stay
ent predictor of mortality in severe C. diff colitis patients while colectomy
(LOS) for the group. The feasibility of an institution-wide protocol, encom-
was a protective factor (0.015, 0.0003-0.8).
passing all members of the department, independent of their peri-operative
Conclusions: Fulminant colitis occurs in a fifth of hospitalized patients
practices has never been assessed
with C. diff colitis. Septic shock, the presence of medical co-morbidities,
Methods: Retrospective review of a prospectively collected database of
increasing bandemia and peak lactate are independent predictors of fulmi-
all colectomies at a single center between 9/2004 and 9/2008. Outcomes were
nant colitis. Early identification of patients at risk of fulminant colitis and
compared between surgeries performed prior to and after initiation of a
subsequent emergent colectomy is essential to reducing mortality.
Fast track pathway (9/2007). Fast track protocol includes multimodality pain
management, early ambulation and early feeding
103
Abstracts
Association of demographic, clinical and biochemical factors with fulminant colitis Conclusions: Simple daily spinning of the seton, resulting in progres-
among patients with Clostridium difficile infection sive migration of the fistula tract, is an alternative technique for treating com-
plex, high transphincteric anal fistulas.
GSF-5
SURGICAL TREATMENT AT THE END OF LIFE FOR
PATIENTS WITH COLORECTAL CANCER: DOES HOSPICE
CARE DECREASE USE?
R. R. Cannom, R. W. Beart, G. T. Ault, A. M. Kaiser, A. McElrath-
Garza, P. Vukasin and D. A. Etzioni Colorectal Surgery, University of
Southern California, Los Angeles, CA.
Purpose: Medical expenditures at the end of life contribute substantially
to the high costs of medical care in the United States, with approximately
25% of annual Medicare payments directed to the 5-6% of Medicare ben-
eficiaries who die in that year. It is widely perceived that hospice utilization
can lead to improved quality of care and decreased use of resources at the
end of life. We hypothesized that geographic regions with higher utilization
of hospice care would have lower rates of surgical procedures in the last 6
months of life.
Methods: We used the Surveillance, Epidemiology, and End Results-
Medicare linkage to analyze hospice and inpatient surgical procedure use
during the last 6 months of life for individuals aged 67 years and older diag-
nosed with colorectal cancer between 1992 and 2002. Abdominopelvic oper-
ations were identified using international classification of disease codes.
Abbreviations: CI, confidence interval; OR, odds ratio; WBC, white blood cell count Regional use of hospice before death was categorized as high, medium, or
low using Dartmouth hospital referral regions as the geographic region of
interest. Surgical procedure use was analyzed using multivariate statistics,
GSF-4 adjusting for patient and regional factors.
NON-CUTTING SETONS FOR PROGRESSIVE MIGRATION Results: A total of 7,120 patients were analyzed. Patients were aged
OF COMPLEX FISTULA TRACTS: A NEW SPIN ON AN OLD 76.7 years on average, and 51.0% female. The overall use of hospice before
TECHNIQUE. death increased from 53.0% for patient deaths in 1995 to 70.6% in 2004.
G. Subhas, A. Gupta, S. Balaraman, V. K. Mittal and R. Pearlman Gen- Few patients (8.5%) required an abdominopelvic operation in the last 6
eral Surgery, Providence Hospital and Medical Centers, Southfield, MI. months of life. The primary diagnosis associated with these admissions was
most frequently gastrointestinal obstruction, pain, or hemorrhage. In a mul-
Purpose: Surgical repair of complex anal fistulas carries risk for anal tivariate model, patients in regions where hospice use was higher had a lower
incontinence, along with significant recurrence rates. Until now, the use of likelihood of undergoing a surgical procedure in the last 6 months of life
loose non-cutting setons has been limited to the control of sepsis and the (medium vs. low = OR 0.90 [0.74-1.08]; high vs. low = OR 0.80 [0.65-0.97]).
promotion of fibrosis of the fistula tract. Therefore, we evaluated the out- Conclusions: Patients in regions with higher rates of hospice use less
comes of complex, high transphincteric anal fistulas treated with the simple surgical procedures in the last 6 months of life. In general, use of surgical
daily spinning of non-cutting setons, called the Progressive Migration tech- procedures was quite low. Increased use of hospice may result in improved
nique. quality of care and modestly decreased use of surgical procedures, but it is
Methods: A retrospective review was undertaken of all operations for unlikely to dramatically reduce resource use related to care at the end of
anal fistula performed by a single colorectal surgeon from Jan 2002-Dec life.
2007. 24 patients with high transphincteric fistulas were treated with loose,
non-cutting 0-silk setons. The majority of fistulas (n=20) were located ante-
riorly, 4 had multiple tracts, but none were supralevator. Patients were asked GSF-6
to spin the seton daily, one revolution in each direction, pulling the knot LAPAROSCOPIC TOTAL COLECTOMY: A SINGLE INSTI-
through the fistula tract. Follow-up was done by phone with questionnaires TUTION’S EXPERIENCE.
to address incontinence pain scores, satisfaction and recurrence.
N. Bertelson, T. J. Saclarides, F. Abarca and M. I. Brand General Sur-
Results: Patients’ mean age was 48 years (range, 22-77 years), with M:F
ratio of 3:1. The mean duration for seton in place was 14 months (range, 2- gery, Rush University Medical Center, Chicago, IL.
40 months). Follow-up ranged from 12-81 months (mean, 45 months). The Purpose: Laparoscopic colectomy has become increasingly prevalent as
Progressive Migration technique resulted in the gradual healing of the fis- skills and technology have improved. Its benefits are multiple, however, it is
tula tract in 75% of patients (n=18), with no recurrence. In 38% (n=9), setons still an invasive procedure with potential complications. We feel laparoscopic
completely worked their way to the surface, requiring no further surgery. In total colectomy differs from segmental colectomy in its complexity, techni-
another 38% (n=9), progressive migration was extensive enough to allow a cal demands, and outcome. We wished to review our institutional experience
‘completion fistulotomy’, cutting only a thin skin bridge or substantially with laparoscopic total colectomy (LTC).
smaller transphincteric tracts. 25% (n=6) had Crohn’s disease and all were Methods: A retrospective review of a prospectively managed database of
fistula free. Reported incontinence rates of 0% for solid and liquid stool, and 46 patients was carried out. Non-hand assisted LTC was performed jointly
8% (n=2) for flatus compared favourably to other fistula repair techniques. by 2 board certified colorectal surgeons, assisted by a general surgery resi-
25% (n=6) poorly tolerated the setons, and a definitive procedure was per- dent. LTC was performed over a 5-year period. Trochar fascial incisions
formed. Satisfaction levels were acceptable (15-very satisfied, 8-satisfied, and and mesenteric defects were not closed routinely. We assessed patient age
1-just satisfied). and comorbidities, diagnosis, length of stay and complications.
104
Abstracts
Results: Mean patient age was 38 years. Comorbidities were Conclusions: These data suggested that metabolic profiling of CRC
asthma/COPD (20%), hypertension (13%), diabetes (7%), cardiac (4%), mucosae hold potential in segregating tumors based on their metastatic poten-
obesity (4%). Diagnoses were ulcerative colitis (39%), inertia (22%), FAP tial and tumor sites. In conclusion, this paper highlighted that HR-MAS
(13%), Crohn’s (9%), and cancer (7%). Procedures were proctocolectomy NMR and GC/MS metabonomics are both unique and complementary tech-
and ileostomy +/- ileal pouch and total colectomy with IRA. Mean OR time niques in the metabolic profiling of human CRC.
was 5 hours 48 minutes (3hrs 38 min – 8 hrs 6 min). Conversion rate was
4% (all in 1st year). Mean length of stay was 10 days (4-30 days). Forty-four
percent were discharged within 1 week of surgery, 35% stayed longer than
10 days. Fifty-nine percent had complications including ileus (28%), wound RF-2
infection (13%), intra-abdominal abscess (4%), thrombotic events (4%). Late SINGLE NUCLEOTIDE POLYMORPHISM OF THYMIDY-
complications (after 30 days) included SBO (adhesions in 3 patients), her- LATE SYNTHASE GENE FOR PREDICTING TUMOR
nias, anastomotic stenosis, enterovaginal fistula. Sixteen patients (34%) RESPONSE TO PREOPERATIVE CHEMORADIATION
required ER visits for complications such as infection, dehydration, vomit- THERAPY IN RECTAL CANCER.
ing, pain.
H. Hur, J. S. Kim, N. D. Kim, B. S. Min, S. K. Sohn and C. H. Cho
Conclusions: LTC is a long and technically exhausting procedure. LTC
Surgery, Yonsei University College of Medicine, Seoul, Korea, South.
has a mean length of stay of 10 days and has a significant morbidity rate. The
general advantages attributable to laparoscopic segmental colectomy may Purpose: Thymidylate synthase (TS) expression is known to affect tumor
not be realized with LTC apart from better cosmesis compared to open sur- response after preoperative 5-fluorouracil (5-FU)-based chemoradiation
gery. therapy (CRT). TS gene expression is modulated by a polymorphism in TS
enhancer region (two (2R) or three (3R) 28-base pair repeats). A novel GÇC
Single nucleotide polymorphism (SNP) in the second repeat of 3R alleles
decrease the transcriptional activation of TS gene. This study aimed to cor-
relate TS gene polymorphism with tumor response after preoperative CRT
in rectal cancer.
Methods: 27 patients with rectal cancer were prospectively enrolled
Research Forum between October 2007 and July 2008. Preoperative 5-FU-based CRT was
performed in all patients, and 4-6 weeks later, surgery was done with cur-
ative intent. TS gene polymorphism of tumor tissue obtained before pre-
operative CRT from all patients were correlated with pathological
RF-1 response of surgical specimens, assessed both by histopathologic staging
METABOLIC PROFILING OF HUMAN COLORECTAL CAN- (pTNM) and by tumor regression grade (TRG) according to Mandard’s
CER USING HIGH-RESOLUTION MAGIC ANGLE SPIN- criteria ( patients with TRG1-2 being defined as responders and patients
NING NUCLEAR MAGNETIC RESONANCE (HR-MAS NMR) with TRG3-5 as non-responder).
SPECTROSCOPY AND GAS CHROMATOGRAPHY MASS Results: There is no difference in tumor response (T, N-downstaging,
SPECTROMETRY (GC/MS). and TRG response) between 19 patients with 3R/3R homozygote and 8
patients with 2R/3R heterogygote. 13/14(92.9%) patients with GÇC SNP
P. Koh1, E. Chan2, M. Mal2, K. W. Eu1, A. Blackshall3 and H. Keun3
1
(3C/3C(6), 3G/3C(5), 2/3C(3)) showed significant tumor response (T-down-
Department of Colorectal Surgery, Singapore General Hospital, Singapore, staging) as compared to only 7/13(53.8%) patients without GÇC SNP
Singapore, 2Department of Pharmacy, Faculty of Science, National Uni- (3G/3G(8), 2/3G(5)) (p=0.033). In subgroup of 19 patients with 3R/3R
versity of Singapore, Singapore, Singapore and 3Department of Biomolec- homozygote, all patients (11/11) with GÇC SNP (3G/3C(6). 3G/3C(5)
ular Medicine, Imperial College of London, London, United Kingdom. showed T-downstaging, as compared to only 4/8(50%) patients with 3G/3G
Purpose: Current clinical strategy for staging and prognostication of genotype (p=0.018). 9/11(81.8%) patients with GÇC SNP showed N-down-
CRC relies mainly upon the TNM or Duke system. This clinicopathologi- staging and 7/11(63.6%) patients were TRG responders. Of 8 patients with-
cal staging information is a crude guide to prognostication because it reflects out GÇC SNP, 3 patients (37.5%) showed N-downstaging and TRG
the delay in diagnosis in the case of an advanced cancer and gives no insight response, respectively.
into the biological characteristics of the tumor. We hypothesized that the Conclusions: T-downstaging, N-downstaging, and TRG response after
global analysis of metabolites in colon mucosae would define metabolic sig- preoperative CRT in rectal cancer were more often in patients with GÇC
natures that discriminate CRC from normal mucosae and distinguish the SNP of TS. Assessment of SNP of TS may predict tumor response after pre-
clinicopathological characteristics of CRC. operative 5-FU based CRT in rectal cacner.
Methods: The application of high-resolution magic angle spinning
nuclear magnetic resonance (HR-MAS NMR) and gas chromatography mass
spectrometry (GC/MS) metabonomics in tissue typing of biopsied CRC
specimens and their matched normal mucosae obtained from 32 CRC patients
RESEARCH FORUM
was investigated for the first time in this paper. The orthogonal partial least
squares discriminant analysis models generated by metabolic profiles obtained
from both analytical platforms separated the test groups with ROC AUC
values greater than 0.95.
Results: A total of 31 marker metabolites were identified using the two
analytical platforms. Majority of these metabolites were associated with the
metabolic perturbations in CRC including tissue hypoxia, elevated glycoly-
sis, increased nucleotide biosynthesis, lipid metabolism, inflammation and
steroid metabolism. Partial least squares discriminant analysis and inde-
pendent T-test with Welch’s correction showed that the metabolite profiles
obtained via HR-MAS NMR could differentiate Duke A & B stages from
Duke C & D stages (p < 0.01) and colon from rectal cancers (p < 0.001).
105
Abstracts
merase chain reaction. Statistical analysis were done using relative quan-
RF-3 titation comparative CT assay.
SULFUR-CONTAINING AMINO ACID, METHIONINE, HAS
Results: After 1 hour stimulation (Fig), the expression of SDF-1 and
A PROKINETIC EFFECT ON HUMAN COLON IN VITRO.
MCP-3 increased (fold expression, 3.2±1.9 and 4±3.1) in the group euth-
E. Choe, K. J. Park and J. S. Moon Surgery, Seoul National University anized at 0 hour. The fold expression of SDF-1 (1.2±0.2) and MCP-3
Hospital, Seoul, South Korea. (2.1±1.6) decreased compared to control 24 hours after stimulation,
Purpose: Although constipation is a major health problem, development although the difference was not statistically significant (p = 0.2 and 0.4).
of new effective drugs to manage this problem has not been satisfactory. We At 4 hours stimulation, no significant elevation of expression was noticed
thought to determine whether methionine, a specific blocker of stretch- in either group euthanized at 0 hrs (1±1.1 and 0.93±1.1) or 24 hrs later
dependent K+ channels in mouse causing depolarization and enhanced spon- (0.3±0.2 and 0.2±0.2).
taneous contractions, has any effect on human colon in vitro. Conclusions: Low voltage electrical stimulation causes mild upregula-
Methods: Human colon tissues were obtained from the specimens of tion of cytokine expression that may lead to potential stem cell homing, innate
patients undergoing colon resection for non-obstructive neoplasms and or exogenous. However, the optimal frequency, pulse, and duration are yet
immediately stored in oxygenated Krebs-Ringer’s bicarbonate (KRB) solu- to be explored. This is a potential option for an innovative therapy for anal
tion. Conventional microelectrode recording was performed and contractile sphincter augmentation using low voltage electrical stimulation as a condi-
activity of muscle strips and the propagation of the contractions in whole tioning injury to home mesenchymal stem cells.
colon segment were measured.
Results: At 10µM concentration, methionine depolarized the resting
membrane potential (RMP) of circular muscle (-50.5±6.4 vs -48.9±7.0mV;
p=0.018; n=12). In circular muscle (CM) strip, methionine increased the
amplitude (17.2±13.2 vs 27.8±11.2mN; p=0.04; n=6) and the area under
the curve (AUC, 266.4±159.3 vs 420.3±151.5mN X sec; p=0.006; n=6). In
the whole colon segment, methionine increased the amplitude (18.6±9.8
vs 22.9±10.5mN; p=0.027; n=9) and the AUC (665.1±87.2 vs 805.8±649.7
mN X sec; p=0.026; n=9) of the high amplitude contractions in the CM.
These effects were maximal at the concentration of 10 µM and were not
observed in longitudinal muscles of both the strip and the segment of colon.
Methionine reversed the effects of pretreatment with 100µM sodium nitro-
prusside, 1µM tetrodotoxin and 100µM Nw-oxide-L-arginine, resulting
in depolarization of the RMP, and increased amplitude and the AUC of
contractions in both the muscle strip and the colon segment. Methionine
treatment had effect on the wave pattern of the colon segment by evok-
ing small sized amplitude contractions superimposed on preexisting wave
patterns in 3 of 11 tissues examined.
Conclusions: Methionine enhanced the basal contractile activity in the
CM, both in the muscle strip and the segment of the human colon and has
the effect of overcoming the spontaneous neuronal effect and release of NO
and reversed the effect of nitrergic stimulation. A compound mimicking
methionine may provide prokinetic functions in human colon.
RF-4 Expression of SDF-1 and MCP-3 after 1 and 4 hours of low voltage electrical stimula-
LOW VOLTAGE ELECTRICAL STIMULATION CAUSES tion evaluated at 0 hr and 24 hours post stimulation.
CYTOKINE EXPRESSION IN THE ANAL SPHINCTER.
L. B. Salcedo1, L. Lian1, M. Damaser2, P. Zaszczurynski2 and M. Zut- RF-5
shi1 1Colorectal Surgery A-30, Cleveland Clinic Foundation, Cleveland, OH THE EFFECTS OF PELVIC AUTONOMIC DENERVATION
and 2Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH. ON RECTAL MOTILITY IN THE RAT.
Purpose: SDF-1 and MCP-3 are cell signaling cytokines released dur- T. J. Ridolfi1, T. Takahashi2, L. Kosinski1 and K. A. Ludwig1 1Surgery,
ing inflammation post injury. Low grade injury like hypoxia has been used
Medical College of Wisconsin, Milwaukee, WI and 2Zablocki VA Medical
as a conditioning injury in various organs like heart and brain.A low grade
Center, Milwaukee, WI.
injury can be a stimulus to attract stem cells to an area and promote repair.
Aim : To investigate the effect of low voltage electrical stimulation on cytokine Purpose: It has been suggested, for the treatment of fecal incontinence
expression as a potential for homing stem cells to the anal sphincter. (FI), sacral nerve stimulation (SNS) exerts its effects through modulation of
Methods: 24 female Sprague Dawley rats were equally allocated into rectal motility as opposed to isolated effects on the pelvic floor or anal sphinc-
groups receiving 0.25 mA current to the anal sphincter (40 ters. The success of this treatment modality for FI and other pelvic prob-
pulses/sec,100Hz) for 1 and 4 hours or sham for each time point . Sham lems suggest an important role for the pelvic autonomic nerves. This has
controls for each duration used electrode needle insertion to the anal been difficult to study in humans. The exact mode of the beneficial effects
sphincter without stimulation. The rats were euthanized immediately (0 of SNS in treating patients with FI and other pelvic problems remains unclear.
hr) or 24 hours post-stimulation. The anal sphincter was dissected and The purpose of this study is to establish a rat model to determine how dam-
cytokine expression analysis was performed using real-time polymerase age to and stimulation of the pelvic autonomic nerves affects rectal motility.
chain reaction. Analysis of fold expression were done using relative quan- Methods: Strain gauge transducers were implanted on the serosal sur-
titation comparative CT assay and t-test comparison (p <0.05).Values are face of the rectum of 11 male Sprague Dawley rats. Motility was recorded
presented as mean ± standard errors. The anal sphincter was dissected daily for three days after either transection of bilateral parasympathetic pelvic
and cytokine expression analysis was performed using real-time poly- nerves (PN) (n=3), transection of bilateral sympathetic hypogastric nerves
106
Abstracts
(HGN) (n=3), or sham operation (n=3). 2 rats were subjected to electrical pro-inflammatory cytokine was higher in group 1 on postoperative day 4
nerve stimulation: one to unilateral HGN and one to unilateral PN. Colonic (group 1: 21533 + 27900 vs. group 2: 1130 + 3563 pg/ml; p < 0.001). Serum
motility was calculated by determining a Motility Index (MI) of representa- VEGF levels were higher in group 1 on postoperative day 4 (group 1:
tive 30 min transducer recordings (MI=area under the curve expressed as 1212 + 1025 vs. group 2: 408 + 407 pg/ml; p < 0.01). Peritoneal fluid
g.s). Comparisons between groups were made using the student’s t-test. VEGF levels were also higher in group 1 at 48 hours (group 1: 4857 +
Results: Transection of bilateral PN resulted in a significant decreased 4384 vs. group 2: 630 + 461 pg/ml; p < 0.001) and postoperative day 4
mean MI compared to sham operation (518g.s v 975g.s, p=0.04). Transec- (group 1: 32807 + 98486 vs. group 2: 1002 + 1229 pg/ml; p < 0.001). A
tion of bilateral HGN resulted in a significant increase in mean MI com- positive correlation between serum IL-6 and VEGF serum levels was
pared to sham operation (5029g.s v 975g.s, p=0.02). Stimulation of the uni- observed on postoperative day 4 (r=0.7; p<0.01).
lateral PN caused rectal contraction while electrical stimulation of the Conclusions: These results suggest that not only the inflammatory
unilateral HGN caused rectal relaxation. response but also the angiogenic pathways are stimulated in patients with
Conclusions: Rectal motility can be significantly altered by transecting intra-abdominal infection after surgery for colorectal cancer. The implica-
or stimulating both the sympathetic and parasympathetic pelvic nerves. The tions of this finding on long-term follow-up need to be evaluated.
ability to isolate and manipulate the pelvic nerves in this rat model may be
useful in studying how damage to these nerves plays a role in the patho-
physiology of FI and how SNS may be useful as a treatment. Activation of RF-7
pelvic autonomic nerves via a spinal or supraspinal reflex is a possible mech- DIAGNOSTIC ACCURACY OF MRI IN ASSESSING TUMOR
anism for the observed effects of SNS and deserves further investigation. INVASION WITHIN PELVIC COMPARTMENTS IN RECUR-
RENT AND LOCALLY ADVANCED RECTAL CANCER.
P. Georgiou1, G. Brown2, V. Constantinides1, A. Antoniou1,
R. J. Nicholls1 and P. P. Tekkis1 1Chelsea and Westminster Campus, Impe-
rial College, London, United Kingdom and 2Department of Radiology, The
Royal Marsden Hospital, London, United Kingdom.
Purpose: The aim of the study was to assess the diagnostic accuracy of
MRI in detecting local intrapelvic spread of recurrent and locally advanced
primary rectal cancer.
Methods: Data were collected on 27 patients with recurrent (n=24) and
locally advanced primary (n=3) rectal cancer. The pelvis was divided into cen-
tral, anterior, lateral, posterior and inferior compartments. A radiologist spe-
cialised in pelvic MRI reviewed the preoperative scans in a single blinded
fashion. These were compared with the intraoperative and histological find-
ings (gold standard). The sensitivity and specificity for the presence or absence
of tumour at the individual pelvic compartments was calculated respectively.
Comparison of Motility Index (MI) in rats after undergoing sham operation, bilateral Results: The anterior compartment was involved (True +ve and False –
parasysmpathetic pelvic nerve transection (PN cut) or bilateral sympathetic hypogastric ve) in 10 patients above and in 22 below the peritoneal reflection. There
nerve transection (HG cut) on post operative day one. Rats with PN cut showed a signifi-
was involvement of the lateral, central, posterior, inferior compartments and
cant decrease in MI when compared to sham rats (457g.s v 975g.s). Rats with HG cut showed
a significant increase in MI when compared to sham rats (5029g.s v 975g.s). Statistical sig-
the peritoneum in 17, 23, 11, 18 and 7 patients respectively. Sensitivity for
nificance was calculated using the Student’s t-test. * p<0.05 peritoneal involvement, anterior compartment above and below the peri-
toneal reflection was 100%, 100% and 90.9% respectively. Sensitivity for
central and inferior compartments was 95.7% and 88.9% respectively. Sen-
RF-6 sitivity for posterior and lateral compartments decreased to 90.9% and 88.2%
POSTOPERATIVE INTRA-ABDOMINAL INFECTION respectively. The specificity for the absence of peritoneal involvement, ante-
INCREASES INFLAMMATORY RESPONSE AND ANGIO- rior compartment above and below the peritoneal reflection was 89.5%,
GENESIS AFTER SURGERY FOR COLORECTAL CANCER. 82.4% and 60% respectively. Specificity for both central and inferior com-
partments was 100%. Specificity for posterior and lateral compartments
S. Alonso, M. Pera, M. Pascual, D. Parés, S. Salvans, M. Gil, R. Courtier,
decreased to 68.8% and 77.8% respectively. A positive resection margin (R1)
X. Mayol and L. Grande Colorectal Surgery, Hospital del Mar, Barcelona,
was present in 6 patients at the lateral (n=6) and posterior compartments
Spain. (n=2).
Purpose: Recent reports have suggested that intra-abdominal postop- Conclusions: The present study demonstrated that MRI was highly accu-
erative infection is associated with higher rates of overall and local recur- rate in diagnosing intra-pelvic tumour invasion. The lateral and posterior
rence and cancer-specific mortality. However, the mechanisms responsible compartments were most likely to be incorrectly staged, and had the high-
for this association are unknown. We hypothesized that the greater inflam- est risk of a positive resection margin. Further prospective studies are needed
RESEARCH FORUM
matory response in patients with postoperative intra-abdominal infection is to identify specific imaging criteria for optimizing the quality, reporting
associated to an increase in local and systemic angiogenesis. and pre-operative MRI planning for recurrent and locally advanced pri-
Methods: We designed a prospective cohorts study with matched con- mary rectal cancer.
trols. Patients with postoperative intra-abdominal infection (abscess and/or
anastomotic leakage) (group 1; n=17) after elective colorectal cancer resec-
tion operated on for cure were compared to patients with an uncomplicated
postoperative course (group 2; n=17). IL-6 and VEGF levels were deter-
mined by ELISA in serum and peritoneal fluid at baseline, 48 hours and post-
operative day 4 or at the time the peritoneal infection occurred.
Results: No differences were observed in age, gender, preoperative
CEA, tumor stage and location and type of procedure performed.
Although there were no differences in serum IL-6 levels at 48 hours, this
107
Abstracts
S2
Podium Presentations CAN WE INCREASE THE RATES OF COMPLETE
RESPONSE FOR DISTAL RECTAL CANCER? RESULTS OF
A PROSPECTIVE STUDY USING ADDITIONAL
CHEMOTHERAPY DURING THE RESTING PERIOD OF
S1 NEOADJUVANT CRT.
NEOADJUVANT THERAPY FOR RECTAL CANCER: DOES R. O. Perez1, A. Habr-Gama1, W. Nadalin2, J. Sabbaga2, P. Aguilar2,
THE INTERVAL BETWEEN CHEMORADIATION AND SUR- I. Proscurshim1 and J. Gama-Rodrigues1 1Angelita & Joaquim Gama Insti-
GERY MATTER? tute, Sao Paulo, Brazil and 2Colorectal Surgery, Hospital Alemão Oswaldo
L. F. Lobato, D. Geisler, A. da Luz Moreira and V. W. Fazio Colorectal Cruz, São Paulo, Brazil.
Surgery, Cleveland Clinic OH, Cleveland, OH. Purpose: Alternative approaches have been suggested in highly selected
Purpose: To determine whether the interval between completion of patients with complete clinical response after neoadjuvant CRT for distal
neoadjuvant chemoradiation and surgery affects tumor downstaging, onco- rectal cancer in order to spare them from potentially unnecessary radical sur-
logic outcomes and perioperative morbidity/mortality. gery. Addition of chemotherapy in the resting period between RT comple-
Methods: Between 1997 and 2007, 342 consecutive patients with stage tion and tumor response assessment could potentially increase rates of com-
II and III rectal cancer undergoing neoadjuvant chemoradiation were iden- plete tumor regression. The impact on complete response rates of a CRT
tified from our prospectively maintained IRB-approved colorectal cancer regimen including additional chemotherapy is the purpose of this prospec-
database. 165 patients were excluded from this study due to concurrent IBD, tive study.
FAP, HNPCC, other malignancy, urgent surgery, incomplete chemoradia- Methods: 50 consecutive patients from a single institution, with non-
tion or insufficient data. Patients were divided into 2 groups in accordance metastatic distal rectal cancer (<7cm from the anal verge) were prospec-
with the interval between chemoradiation and surgery: A) 4 – 7 weeks B) 8 tively included. Patients were managed by 5400 Gy of external beam radia-
– 14 weeks. Pathologic response, perioperative morbidity/mortality and onco- tion and 5FU/Leucovorin-based chemotherapy given for 3 consecutive days
logic outcomes were compared between the two groups. Fischer’s exact test, every 21 days. Overall, patients received 6 identical cycles of chemotherapy
Chi square, Wilcoxon rank-sum and logistic regression were used for analy- (3 delivered concomitantly with RT and 3 delivered during the “resting”
sis. A p value of <0.05 was considered statistically significant. period before tumor response assessment). Tumor response assessment was
Results: 177 patients, 129 (73%) males, were identified with a median performed after 9 weeks of CRT. Patients with complete clinical response
age of 57 (19-85) years. Operations included 51 (29%) abdominoperineal were enrolled in a strict follow-up program and were not immediately oper-
resections (APR) and 125 (71%) low anterior resections (LAR). The median ated on. Patients with incomplete clinical response were referred to surgery.
interval between neoadjuvant chemoradiation and surgery was 8 (4-14) weeks. Results: 29 patients have completed 12 months of follow-up and were
The median follow-up was 48 (1-143) months. Group A contained 86 patients included in this preliminary analysis. 28 (97%) successfully completed treat-
and Group B 91 patients. Chemotherapy regime was 5FU based and median ment. Median follow-up was 23 months. 14 patients (48%) were considered
radiotherapy dose was 5040 cGy (4000 – 6100). There was a statistically sig- as complete clinical responders sustained for at least 12 months (median 24
nificant difference in complete pathologic response rate (pCR) between the months) after CRT completion by clinical assessment alone. Additional 5
two groups, 17% versus 30% (p=0.03) in favor of Group B. There was also patients (17%) were considered as complete responders after ypT0 follow-
a significant improvement in the local recurrence rates: 3% versus 13% ing FTLE. Overall, CR rate was 65%.
(p=0.04) in the group with higher pCR rates. No patient expired within 30 Conclusions: Addition of chemotherapy during the resting period after
days after surgery. Table 1 summarizes our results. neoadjuvant CRT is associated with acceptable toxicity and high tolerabil-
Conclusions: An interval between neoadjuvant chemoradiation and sur- ity rates. The considerably high rates of complete response of this prelimi-
gery of 8 – 14 weeks resulted in higher pCR rates and less local recurrence nary series requires further follow-up but may provide valuable information
with no changes in perioperative complications. for a future prospective randomized trial including this alternative CRT reg-
Table 1 imen.
Extended CRT regimen including additional cycles of chemotherapy during the “rest-
ing” period after RT
108
Abstracts
results of patients with T2-3 rectal cancer treated with neoadjuvant high dose
S3
P ODIUM P RESENTATIONS
rate endorectal brachytherapy (HDREBT) targeting the tumor bed exten-
COMPLETE REMISSION AFTER NEOADJUVANT
sion seen on MRI.
RADIOCHEMOTHERAPY IN RECTAL CANCER. RADICAL
Methods: Patients with newly diagnosed rectal adenocarcinoma were
SURGERY OR “WAIT AND SEE”? staged with chest X-Ray, abdominal and pelvic CT scan, pelvic MRI and
H. P. Kessler, S. Merkel and W. Hohenberger Dept. of Surgery, Univer- endorectal endoscopic ultrasound. Those with no evidence of metastases
sity of Erlangen, Erlangen, Germany. were treated with neoadjuvant HDREBT using 26 Gy in 4 fractions, fol-
Purpose: After neoadjuvant long-term radiochemotherapy in rectal can- lowed by TME surgery, 6 to 8 weeks later. In patients with positive nodes
cer, in the literature, complete remissions have been reported in up to a rate on final pathology, adjuvant chemotherapy was given using 5-fluorouracil
of 33 %. It is still unclear if these patients need to undergo radical resection and leucovorin and 45 Gy in 25 fractions of external beam radiation therapy
or may just be observed in a regular follow-up. from 1998 to 2005. Since 2006, adjuvant FOLFOX regimen was given alone.
Methods: Between 1/1/1995 and 31/12/2007, at the Dept. of Surgery Results: Study included 302 patients: 270 T3 tumors; 7 T4 tumors, 25
of the University of Erlangen/Germany, 895 patients with primary rectal T2 tumors (CRM involved) and 34 % of our patients were N+. Median age
carcinoma were operated on radically by anterior or abdomino-perineal resec- was 69 years (range 42-90). Acute proctitis (grade 3) was observed in 2
tion. In 340 patients (38 %), neoadjuvant radiochemotherapy had been per- patients. Anastomotic leak rate was 10 % and perineal wound infection rate
formed, in 331 of these in a long-term protocol. was 12%. Among the surgical specimens, 27.4% were ypT0, 36.4% showed
Results: 54 out of 331 patients (16.3%) showed complete remission of micro foci of residual disease, 36% showed gross residual tumor and 29.8%
the primary tumor at pathological examination. Regarding regional lymph N+. Seventy eight percent of them were able to receive adjuvant chemother-
nodes, in 5 out of 54 patients (9%) metastases (pN1) were found (one patient apy as planned. With a median follow up time of 57 months (4-120 months),
pNX). After a median follow-up of 43 months (range 4-149 months), the at 5 years, actuarial local recurrence rate is 4.7%, the disease-free survival is
observed 5-year survival was 95.6 % (95%CI 94.9-100%), the cancer-related 65%, and the overall survival rate is 68%.
5-year survival 100%. So far, no locoregional recurrence has been observed Conclusions: In the era of TME surgery, limited radiation target vol-
in any patient. In one patient, 64 months after start of therapy, irresectable ume to the tumor bed with HDREBT allows excellent tumor regression,
distant metastases in liver and urinary bladder have been diagnosed. local control, and avoidance of toxicity to normal tissues. This highly tar-
Conclusions: After neoadjuvant radiochemotherapy and complete remis- geted form of radiation therapy is proposed as a new strategy to optimize
sion of the tumor, prognosis of rectal carcinoma is excellent. So far, at our treatment compliance to adjuvant chemotherapy.
department, in 11 patients (7 patients with primary tumor, 4 patients with
locoregional recurrence) radical surgery has been canceled consciously
because of complete tumor remission after neoadjuvant therapy. Such cases S5
are still sporadic as no homogeneous pathway to indication has been set up. TRANSANAL ENDOSCOPIC MICROSURGERY (TEM)
RESECTION OF RECTAL TUMORS: OUTCOMES AND
RECOMMENDATIONS.
B. M. Tsai1, C. O. Finne1, J. Nordenstam1, D. Christoforidis2, R. D. Mad-
off1 and A. F. Mellgren1 1Division of Colon & Rectal Surgery, University
of Minnesota, Minneapolis, MN and 2Department of Surgery, Centre Hos-
pitalier Universitaire Vaudois, Lausanne, Switzerland.
Purpose: Transanal endoscopic microsurgery (TEM) provides a mini-
mally invasive alternative to radical surgery for excision of early rectal tumors.
The purpose of this study was to review a single institution experience with
TEM for the treatment of benign and malignant rectal tumors.
Methods: A prospective database documented all patients undergoing
TEM at a single institution from October 1996 until December 2007. We
analyzed patient and operative factors, complications, and tumor recurrence.
Patients with previous excisions or less than six months of follow-up were
excluded.
Results: Two-hundred nine patients with a mean follow-up time of 35
(range 6-133) months were included in the study. Complications included
urinary retention (30), fecal incontinence or soiling (11), suture line dehis-
cence (6), bleeding requiring blood transfusion (3), rectal stricture (1), and
ileus (1). Final tumor pathology, recurrence rate, and time to recur are shown
S4 in the table. Eighty-six percent of recurrent adenomas were salvaged with
NEOADJUVANT HIGH DOSE-RATE ENDORECTAL endoscopy and 40% of recurrent malignancies underwent radical salvage
BRACHYTHERAPY (HDREBT) IN THE ERA OF TOTAL procedures.
MESORECTAL EXCISION (TME) FOR PATIENTS WITH Conclusions: Transanal endoscopic microsurgery is an effective method
RECTAL CANCER: TEN YEAR FOLLOW-UP. for excision of rectal tumors. For curative intent, we recommend limiting
A. S. Liberman1, C. Richard2, K. Waschke1, G. Artho1, J. Parent1, its use to carcinoid tumors, benign tumors, and select early rectal cancers
G. Bourdon2, B. Stein1, P. Charlebois1, F. Letellier2, D. Anderson1, (T1). Patients treated for adenocarcinoma need to be followed for an extended
S. Devic1 and T. Vuong1 1McGill University, Montreal, QC, Canada and time, since these tumors can recur several years after excision.
2
University of Montreal, Montreal, QC, Canada.
Purpose: In the era of TME surgery, pelvic nodal recurrence accounts
for only 1% of local recurrence in patients with rectal cancer. Modalities that
are less toxic than standard external beam radiation and chemotherapy may
be appropriate for neoadjuvant therapy. This study reports on the long-term
109
Abstracts
Tumor pathology and recurrence rates
S7
SALVAGE TREATMENT OF RECURRENCES AFTER
TRANSANAL ENDOSCOPIC MICROSURGERY (TEM).
F. T. Ferenschild1, I. M. Dawson2, G. W. Tetteroo2, J. H. de Wilt1 and
E. J. de Graaf2 1Surgical oncology, Erasmus Medical Center Daniel den
Hoed, Rotterdam, Netherlands and 2Surgery, IJsselland Hospital, Capelle
aan den IJssel, Netherlands.
Purpose: Transanal excision is often used for T1 rectal cancers, but its
impact on local recurrences is unknown. Aim of this study is to evaluate the
outcome and management of local recurrences after TEM for pT1 rectal
S6 cancer.
CAN MRI AFTER CHEMORADIATION FOR RECTAL CAN- Methods: From 1996, a total of87 patients who underwent TEM for
CER SELECT PATIENTS WITH A GOOD RESPONS FOR pT1 were registered in a database. Sixteen patients developed a local recur-
LOCAL EXCISION? rence during follow-up. In this study these patients were analyzed with spe-
cial emphasize on local recurrence.
G. L. Beets1, S. M. Engelen1, M. J. Lahaye2, G. Lammering3, R. Jansen4,
Results: Mean age at diagnosis of the primary tumor was 68 years (range
R. M. van Dam2, J. W. Leijtens5, J. Konsten6, C. J. van de Velde7 and 45-93 years). Mean follow-up was 3,4 years (range 1-10.6 years). Mean time
R. G. Beets-Tan2 1Surgery, Maastricht University Medical Center, Maas- to local recurrence was 14 months (range 5–50 months). Four patients were
tricht, Netherlands, 2Radiology, Maastricht University Medical Center, Maas- not operated because of concomitant disease. Seven patients underwent a
tricht, Netherlands, 3Radiotherapy, Maastro Clinic, Maastricht, Netherlands, low anterior resection, four patients an abdominal perineal resection and in
4
Medical Oncology, Maastricht University Medical Center, Maastricht, one patient a Hartmann procedure was performed. Eleven patients had a
Netherlands, 5Surgery, Laurentius Hospital, Roermond, Netherlands, complete resection (R0) and one patient had a microscopically incomplete
6
Surgery, Viecuri Medical Center, Venlo, Netherlands and 7Surgery, Leiden resection (R1). After treatment no rerecurrences developed. Four patients
University Medical Center, Leiden, Netherlands. developed distant metastases and died because of ongoing disease. There
Purpose: Although still very controversial, a local excision could be con- were no other cancer related deaths. The five-year overall survival was 25%
sidered in selected patients after a good response to chemoradiation of rec- in patients with a recurrence.
tal cancer. The purpose of the study is to determine the accuracy of MRI for Conclusions: Salvage surgery for local recurrences after TEM for T1
predicting T & N stage after chemoradiation (CRT), to evaluate if MRI rectal cancer is feasible without renewed local recurrences. However, worse
could become a selection tool. survival indicates careful patient selection. The value of neo-adjuvant treat-
Methods: From February 2003 until January 2008 296 rectal cancer ment in these patients needs to be subject of future trials.
patients were enrolled in a prospective multicenter study to evaluate MRI-
based tailored treatment of primary rectal cancer. Patients were stratified
into three treatment groups based on MRI with USPIO, a lymph node spe- S8
cific contrast agent: (a) early tumours (wide CRM and N0 status), (b) non- SHORT AND LONG-TERM RESULTS IN RECTAL CANCER
locally advanced tumours and (c) locally advanced tumours (close/involved BY LAPAROSCOPIC APPROACH. OUR EXPERIENCE IN
CRM, N2 status or distal tumours). 95 locally advanced tumours received MORE THAN 450 CASES.
chemoradiation and were scheduled for a second MRI with USPIO pre- S. Delgado, A. Ibarzabal, N. Salgado, F. Higuera, J. Maurel and A. Lacy
ceding the resection. MRI and histology was available in 79 patients. In 62 Hospital Clinic, Barcelona, Spain.
of the 79 patients the USPIO contrast agent was used. The yT and yN stage Purpose: Laparoscopic assisted surgery for rectal cancer is still a chal-
after the chemoradiation was prospectively predicted with confidence level lenge for surgeons. Actually colorectal surgeons believe that total mesorec-
scoring on MR by expert and non-expert radiologists. The findings were tal excision (TME) provides favourable oncologic results for the treatment
compared with histology as the gold standard. A ROC analysis was per- of rectal cancer and more and more believe that laparoscopic approach is a
formed and accuracy figures calculated. good and safe approach to do it. There are some studies reporting on the
Results: In the 79 patients there were 16 ypT0, 21 ypT1-2 and 42 ypT3- feasibility and favourable outcome of laparoscopic surgery for rectal cancer,
4 tumors. For the distinction between ypT0-2 and ypT3-4 the area under but not many studies reporting long-term results. The objective of this paper
the curve (AUC) of the ROC curve was 0.84 for the expert and 0.69 for the is to asses the short and long-term results of rectal cancer patients treated
non-expert. Sens, spec, PPV and NPV for the expert were 0.95, 0.46, 0.64, by laparoscopic techniques in a Gastrointestinal Unit.
0.90, and for the non-experts 0.88, 0.41, 0.60, 0.76. In 62 patients evaluable Methods: From March 1998 to June 2008 all patients with an adeno-
for nodal prediction there were 18 ypN+ and 44 ypN0 tumors. The AUC carcinoma of the rectum admitted to our unit were evaluated to be operated
of the ROC curve for nodal status prediction was 0.90 for the expert and 0.72 by laparoscopic approach.
for the nonexpert.The sens, spec, PPV and NPV for the expert were 0.89, Results: Four hundred and sixty two (297 male and 165 female) were
0.80, 0.64, 0.95, and for the non-expert 0.73, 0.55, 0.37, 0.85. included with a mean age of 66.7 years. Surgical technique was: 245 low ante-
Conclusions: With a NPV of 80-90% for both tumor remnant extend- rior resections with total mesorrectal excision, 79 abdomino-perineal, 90
ing through the bowel wall and for involved lymph nodes, MRI after anterior resections, 30 Hartmann’s procedure, 16 colostomy and 2 procto-
chemoradiation for rectal cancer could become a tool in the selection of good colectomy. Protective loop ileostomy was performed in 160 patients (48%
responders for local excision in selected patients. of patients with sphincter preservation). Conversion to open approach rate
was 12.3% (28 because of difficult dissection, 23 adjacent organs infiltration,
3 bleeding, 3 hipercarbia and two uretheral section). Thirty-six patients
presented anastomotic leakages (10,7% of resections with anastomosis). Mean
hospital stay was 6.1 days and the starting of the oral intake was 48 hours.
The mean of lymph nodes was 13.3. The local recurrence rate was less than
5%, with a global survival superior to 75% (89.7 Stage I, 82 Stage II, 71.6
Stage III and 31 Stage IV).
110
Abstracts
Conclusions: Laparoscopic surgery in patients with adenocarcinoma of quently. The table summarizes the accuracy across specialty (p-value is com-
the rectum can be safely performed. Short and long term results were comparison to medical student). All seven conditions were correctly identified
parable to series of conventional surgery. by only 4.1% of subjects, while all conditions were misdiagnosed in 20.2%.
There was no correlation between years of experience and diagnostic accu-
racy (p=NS).
S9 Conclusions: Diagnostic accuracy for common anorectal conditions was
RISK FACTORS FOR ANASTOMOTIC LEAKAGE FOLLOW- suboptimal across all clinical specialties, including surgery. Although many
ING PREOPERATIVE RADIOTHERAPY COMBINED WITH specialties had a diagnostic accuracy significantly better than medical stu-
LOW ANTERIOR RESECTION-THE INDICATION OF dents, there was no association between years of experience and diagnostic
DEFUNCTIONING STOMA. accuracy. Improved programs for clinician education for these common con-
L. Wang and J. Gu Gastroenterology Surgery Department, Peking Uni- ditions should be developed.
Comparison of Clinician Accuracy Across Specialties
versity School of Oncology, Beijing Cancer Hospital & Institute, Beijing,
China.
Purpose: The aim of this retrospective study was to evaluate the risk fac-
tors for symptomatic leakage following low anterior resection (LAR)for
patients who had neo-adjuvant radiation and identify the indication of defunc-
tioning stoma.
Methods: In a 6-year period from April 2002 to May 2008, 707 consec-
utive patients with mid-low rectal cancer were treated with LAR procedure
following TME in our hospital. 225 patients received pre-operative radio-
therapy +/- systematic or regional intra-arterial chemotherapy. All pre-radi-
ated patients’ clinical data were studied in a retrospective manner. Twenty-
six variables, including patient, tumour and operation factors, were recorded
and statistic analyzed for any association with anastomotic leakage.
Results: The symptomatic leakage rate in pre-radiated patients was
9.6%(24 / 225). All leakage occurred in patients whose anastomosis level was
NS= Not Significant
lower than 4cm from the anal verge. Multivarible analysis in low anastomo-
sis group showed male gender and absence of defunctioning stoma was the
independent risk factor for leakage.
Conclusions: Although preoperative radiotherapy was concerned as a
S11
MODIFIED HANLEY PROCEDURE FOR MANAGEMENT OF
high risk factor to anastomotic leakage, not all pre-radiated patient need dis-
COMPLEX HORSESHOE FISTULAE.
functioning stoma. From this study, anastomosis higher than 4cm to anal
verge was comparable safe and defunctioning stoma can be selective. How- A. M. Kaiser, L. Browder and S. Sweet Dept. Colorectal Surgery, Uni-
ever, defunctioning stoma was absolutely necessary in pre-radiated patients versity of Southern California, Los Angeles, CA.
whose anastomosis was lower than 4cm, especially in male patients. Purpose: Horseshoe fistula is a complex and challenging disease due to
its configuration and the degree of sphincter involvement. Lack of recogni-
tion, recurrence, duration of wound healing, and incontinence remain cen-
S10 tral issues surrounding the definitive treatment of the disease. In view of
A PROSPECTIVE ANALYSIS OF CLINICIAN ACCURACY IN evolving new treatment options for fistulae (e.g. collagen plug), aim of our
THE DIAGNOSIS OF BENIGN ANORECTAL PATHOLOGY: study was to review the outcome of patients who were primarily treated
COMPARISON ACROSS SPECIALTIES AND YEARS OF with a traditional approach.
EXPERIENCE. Methods: We retrospectively reviewed patients who presented between
A. Grucela, H. Salinas, S. Khaitov, R. M. Steinhagen, S. R. Gorfine and 2003-2008 with a posterior horseshoe abscess/fistula and were treated with
D. B. Chessin Surgery, Mount Sinai Medical Center, New York, NY. a modified Hanley procedure and seton management. Excluded were patients
Purpose: Over 50 percent of patients presenting to the Colorectal Sur- with Crohn’s disease or fistulae related to malignancy or surgical complica-
geon with “hemorrhoids” are found to have other anorectal pathology as the tions, and patients whose fistula was treated with another method. Data col-
etiology of their symptoms. Many times the initial erroneous diagnosis was lection included demographics, duration of the disease and of the treat-
provided after consultation with another physician. Therefore, we prospec- ment, outcome and incontinence.
tively evaluated the diagnostic accuracy of clinicians for common anorectal Results: 23 patients (M/F 19/4) were included in the analysis. Mean age
pathology, stratified by specialty and years of experience. was 50.9±10.2yrs (range 25-68). The median symptom duration was 24
Methods: We selected representative images of seven common anorec- months (range 1-216), 3 patients (19%) had previously received colostomies
at outside facilities without resolution. All patients received a posterior mid-
line cutting seton. the average number of lateral draining setons was 1.8 ±1.3,
tal conditions (abscess, prolapsed internal hemorrhoid, condyloma, throm-
bosed external hemorrhoid, full-thickness rectal prolapse, fissure, and fis-
tula). These images were all correctly identified by all members of the and they were removed after 1.4±1.1 months once the induration and sup-
Division of Colon and Rectal Surgery prior to study commencement. Study puration had resolved. Subsequently, the cutting seton was tightened in 3-4
subjects included attending physicians, fellows, residents, and medical stu- week intervals on average 4.6 times. Mean healing time was 10±4 months.
dents. Subjects were shown the images and asked to provide a written diag- Overall follow-up was 11.5 months (range 3-28): 94% patients had com-
nosis on study-specific forms. Overall diagnostic accuracy was assessed and plete resolution, 1 patient (6%) suffered a recurrence. Most patients recov-
stratified across specialties and years of clinical experience. Medical stu- ered fast and were fully functional and able to work no later than 4 weeks
dents served as the control group. postoperatively; 2 patients were retired, 2 on disability for other reasons.
Results: 414 subjects participated in our study. The overall diagnostic None of the patients complained of incontinence.
accuracy was 37% and was significantly higher among clinicians than stu- Conclusions: Fecal diversion alone does not result in resolution of a horse-
dents (53.5% vs. 21.9%, p<0.001). Clinicians correctly identified condyloma shoe fistula. A modified Hanley procedure with drainage of the deep postanal
and rectal prolapse most frequently and hemorrhoidal conditions least fre- space, a cutting and often multiple temporary draining setons proved to be safe,
111
Abstracts
highly successful, and did not result in fecal incontinence. The completion of Primary healing was achieved in thirty seven patients (82.2%). The healing
the treatment took months, but patients remained functional even with setons time ranged from four to ten weeks and the mean was eight weeks. Eight
in place. patients (17.7%) had recurrence after a period between three months to eight
months of surgery. No significant morbidity was noted in any of the forty-
five patients.
S12 Conclusions: A new technique for fistula-in-ano surgery aimed at total
LIGATION OF THE INTERSPHINCTERIC FISTULA TRACT anal sphincter preservation appears to be safe, easy and have a good early
(LIFT): AN EFFECTIVE NEW TECHNIQUE FOR COMPLEX outcome.
FISTULAE.
J. I. Bleier1, H. Moloo2 and S. Goldberg3 1Surgery, University of Penn-
sylvania, Philadelphia, PA, 2Surgery, University of Ottowa, Ottowa, ON, S14
Canada and 3Colon and Rectal Surgery, University of Minnesota, Min- FOLLOW-UP OF COLLAGEN PLUG FOR ANORECTAL FIS-
neapolis, MN. TULAS.
Purpose: The management of complex cryptoglandular fistulas is diffi- S. Khaitov, E. C. Ly, E. Steinhagen and A. J. Ky Surgery, Mount Sinai
cult. Maintaining continence while achieving durable fistula closure is the Hospital, New York, NY.
goal of surgical management. This study describes our experience with a Purpose: This study was designed to obtain follow-up of the original
novel sphincter sparing technique which involves ligation and division of the patients who underwent the Surgisis (Anal Fistula Plug) previously reported
fistula tract in the intersphincteric space. from our institution and present clinical update of our original patients.
Methods: All patients from July 2007 to October 2008 with ultrasound Methods: This was a prospective analysis of all patients who originally
confirmed trans- or supra-sphincteric fistula treated with the LIFT proce- received the Anal Fistula Plug for treatment of anorectal fistulas between
dure were prospectively followed using a computerized database. Procedures April 2006 and February 2007. Statistical analysis was performed with Fisher’s
were performed by surgeons with colorectal fellowship training in a high exact test. All of the patients was follow-up with physical exam of the origi-
volume referral center. Demographic data, co-morbidities, previous attempts nal Surgisis Plug site and whether there was recurrence of the fistula.
at repair and post-operative data were collected. Follow-up was defined as Results: Forty-five patients were originally treated with the Anal Fis-
date of last contact with the patient. tula Plug. There were 27 males and 17 females with average age of 44.1 years
Results: 32 patients (16 male) underwent a LIFT procedure for trans- treated for simple (n = 24) or complex (n = 20) fistulas. Preliminary results
sphincteric fistula over a 15 month period. Median age was 46.6 years. had indicated an 84 percent healing rate by 3 to 8 weeks postoperatively,
Twenty-six patients (81%) had a previous attempt at repair with a median of which progressively declined from 72.7 percent at 8 weeks to 62.4 percent
4 failed prior surgical procedures. Follow up data was available in 94% at 12 weeks and 51 percent at a median follow-up of 24 (range, 19-29) months.
(30/32). Median follow-up was 21 weeks. Successful fistula closure was On physical exam and further follow-up of all patients and average of 16
achieved in 50% of the patients (16/32). Median time to failure was 10 weeks months later, three patient had evidence of incomplete healing of the exter-
(range 2-37 weeks). No patient reported incontinence symptoms after LIFT nal site without drainage. One of these three patient developed a recurrence
procedure. All patients were discharged on the day of surgery. of the fistula 27 months after placement of the Plug. Long-term Anal Fis-
Conclusions: The LIFT procedure is a new sphincter sparing proce- tula Plug closure rate was significantly higher in patients with simple and
dure for complex transsphincteric fistula. The success rate is comparable to long than complex fistulas (70.8 vs. 35 percent; P < 0.02) and with non-
other sphincter preserving techniques. Importantly, it resulted in no incon- Crohn’s disease vs. Crohn’s disease (66.7 vs. 26.6 percent; P < 0.02. Postop-
tinence. Adding safe, muscle-sparing surgical options to our armamentar- erative complications included perianal abscess in five patients (3 Crohn’s
ium for dealing with trans-sphincteric fistula is essential. Additionally, the disease, 2 non-Crohn’s disease).
procedure is easy to learn and has very low cost. Long-term follow-up and Conclusions: Anal Fistula Plug is most successful in the treatment of
randomized controlled trials are necessary to assess efficacy and durability. simple anorectal fistulas but is far from perfect. It is associated with a high
failure rate in complex fistula and particularly in patients with Crohn’s dis-
ease. Despite the fact that the fistula may be closed, an indication of possi-
S13 ble later recurrence is the presence of a nonhealed external wound. How-
THE LIGATION OF INTERSPHINCTERIC FISTULA TRACT ever, despite the decreasing success rate wit the Plug over time, it is still the
(LIFT) FOR FISTULA-IN-ANO: SPHINCTER SAVING TECH- best option for those whose fistulas traverse a large amount of sphincter.
NIQUE.
A. Shanwani1, M. N. Azmi2 and N. Amri2 1Surgical Department, Hospi-
tal Raja Perempuan Zainab II, Kota Bharu, Malaysia and 2Colorectal Unit, S15
Surgical Department, Medical Faculty, International Islamic University, TRANS ANAL OPEN HEMORRHOIDOPEXY.
Kuantan, Malaysia. B. Govaert1, F. Pakravan2, C. Helmes2 and C. G. Baeten1 1Surgery, Maas-
Purpose: The study was designed to assess results of total anal sphinc- tricht University Medical Center, Maastricht, Netherlands and 2Coloproc-
ter saving technique by ligating the intersphincteric fistula tract (LIFT) for tology, Coloproktologisches Zentrum Dusseldorf, Dusseldorf, Germany.
the treatment of fistula-in-ano. Purpose: Despite all developments in the recent years the choice of an
Methods: A prospective observational study in forty-five fistula-in-ano adequate treatment for hemorrhoids remains a problem. The hemor-
patients treated by ligation of intersphincteric fistula tract (LIFT) tech- rhoidopexy as described by Longo (PPH) follows a concept different from
nique from May 2007 to September 2008. All patients had fistulas arising the excision and destruction techniques from earlier years. With this tech-
from cryptoglandular infections. They were followed-up by a standard pro- nique the hemorrhoidal tissue is preserved, which is important for anal sen-
tocol to determine the healing time, recurrence rate and related morbidity sation and continence. The high costs of the PPH can probably be overcome
associated with the procedure. by the proposed technique while at the same time the idea of preserving the
Results: Forty-five patients were included in the study of which five hemorrhoidal tissues is sustained. This study evaluates the results of this pro-
patients (11.1%) were recurrent fistula-in-ano after previous surgery using cedure performed in tweo centers.
other recognized treatment procedures. The mean age was 42.6 years. The Methods: Between November 2006 and November 2008, 154 patients
mean follow-up was nine months ranging from two months to sixteen months. with third degree hemorrhoids were treated with trans anal open hemor-
112
Abstracts
rhoidopexy in both centers. All patients were positioned in lithotomy posi-
S17
tion and under general anaesthesia the anal mucosa was sutured to the rec-
PATIENT SATISFACTION AND OUTCOMES FOLLOWING
tal wall with four Z stitches after removal of a small rectal mucosa flaps at
STAPLED TRANSANAL RECTAL RESECTION (STARR PRO-
about four centimetres from the dentate line. The four stitches were cir-
cumferential positioned at equal distances. Postoperatively the patients fol- CEDURE) FOR OBSTRUCTIVE DEFECATION SYNDROME.
lowed a fibre rich diet for one week. N. Bhoot, E. Haas and T. B. Pickron Minimally Invasive Colon and Rec-
Results: The study group consisted of 154 patient (84 males) with a mean tal Surgery, University of Texas Medical School at Houston, Houston, TX.
age of 52.4 years (st dev 14). At the time of the study mean follow up was Purpose: Obstructive defecation syndrome (ODS) is a prevalent ailment
340 days (st dev 148). 125 patients (81.1%) were without any complaint at and affects the quality of life and daily activities of many patients. ODS is
first follow up at one week. 28 patients (18.2%) experienced pain and were recognized both as a functional disorder resulting from anal dyssynergia, as
treated with oral analgesics. 1 (0.6%) patient had a bleeding which led to a well as an anatomical disorder. We recently introduced the STARR proce-
second intervention. 4 patients (2.6%) had a minor bleeding that stopped dure in our practice as a means to treat patients with ODS secondary to the
spontaneously. After one month 133 patients (86.4%) had no complaints any- anatomical disorders of rectocele and internal intussusception.
more. 19 patients (12.3%) experienced segmental prolapse during follow- Methods: All patients who underwent STARR procedure over a two year
up examinations. 7 (4.5%) of them had the same operation a second time and period for ODS secondary to concomitant anatomical disorders of recto-
were satisfied after the intervention. 17 (11.0%) patients had remaining symp- cele and intussusception were entered into a prospective database. Pre-oper-
toms like pruritus. ative evaluation included an ODS questionnaire, physical examination, anal
Conclusions: The proposed operation seems to be very effective. It can physiology studies and defecography. Outcomes data included a compara-
be performed under direct vision and is very cost effective compared the tive analysis of ODS scores and patient satisfaction survey.
PPH procedure. Results: A total of 35 pts were evaluated in this study with a mean fol-
low up of 18 months. All patients were female with a mean age of 51. 40%
of the patients underwent biofeedback for anal dyssynergia before surgical
S16 correction. Mean pre-operative ODS score was 12.0 and mean post ODS
TRANSANAL HEMORRHOIDAL DEARTERIALIZATION score at 3 to 6 months after surgery was 3.9 (P-value <0.0001). The most
(THD): AN EFFECTIVE MINI-INVASIVE THERAPEUTIC improved patient outcomes were diminished need for self-digitation and lax-
APPROACH TO HEMORRHOIDS. ative use. 49% of the patients reported their results as excellent, 37% as good,
C. Ratto, A. Parello, L. Donisi, F. Litta and G. B. Doglietto Surgical Sci- 7% as adequate and 7% as poor. When asked if they would undergo the
ences, Catholic University, Rome, Italy. procedure in retrospect, 84% responded ‘yes.’ Twenty- two percent of patients
had minor post-operative complaints. There was one long term complica-
Purpose: Transanal hemorrhoidal dearterialization (THD) is an inno-
tion in which a stricture was successfully managed with balloon dilatation.
vative technique to treat haemorrhoids, making a doppler-guided trans-anal
Conclusions: STARR procedure is a good option for the anatomical cor-
ligation hemorrhoidal arteries within the lower rectum. Results of a con-
rection of ODS secondary to rectocele and intussusception. The ODS score
secutive patient series are reported.
in our patients was significantly improved and the majority would undergo
Methods: One hundred seventy patients (mean age: 47.1±13; 95 males,
the procedure again based on their outcome. Furthermore, the complication
55.9%) were submitted to THD from April 2005 to October 2008. Accord-
rate is low and those with enterocele can be successfully treated in this fash-
ing to the Goligher classification of haemorrhoids, 13 pts (7.6%) were grade
ion under laparoscopic guidance.
II (bleeding not responsive to medical therapy), 146 (85.4%) grade III, 12
(7.2%) grade IV. 26 pts (15.2%) presented also anal fissure (16 grade III pts)
or skin tags (6 grade III and 4 grade IV pts). Operation provided hemor-
rhoidal dearterialization (every time 6 arteries) in all patients, adding a
S18
CHRONIC ANAL FISSURE: THE HIGH-DOSE BOTOX
mucosal/submucosal pexy in 57 pts (33.5%, 45 grade III pts, 30.8%, 12 grade
EXPERIENCE.
IV, 100%) First consecutive 12 pts (7.2%) were treated in general/spinal
anaesthesia, while the other 158 pts (92.8%) in sedoanalgesia. After opera- J. Park, S. M. Barone, J. C. Reilly, L. Kondylis and P. D. Kondylis Sec-
tion, patients were regularly followed up at 1 week, 1 and 3 months, and, tion of Colon and Rectal Surgery, Saint Vincent Health System, Erie, PA.
then, all together, in a recent follow up session (October-November 2008). Purpose: The purpose of this study was to evaluate the efficacy and dura-
Results: Postoperative bleeding occurred in 4 cases (2.4%), requiring bility of botulinum toxin type A (Botox) chemical relaxation of the internal
surgical hemostasis in 2. Only 1 patient (operated for post-PPH recurrent anal sphincter in the management of anal fissure.
III degree haemorrhoids) suffered of pain for more than 1 week due to hem- Methods: Computer database review of our community-based colon and
orrhoidal thrombosis; this patients was indicated for a partial hemor- rectal surgery practice from September 2001 through August 2008 identi-
rhoidectomy. Mean follow up was 16.0±10.0 months (range 1-40). Recur- fied patients with anal fissure who underwent Botox injection into the inter-
rence of hemorrhoidal diseases occurred in 3 grade III pts (1.8%), treated nal anal sphincter. Exclusion criteria included inflammatory bowel disease,
with hemorrhoidectomy in 1, re-do THD in 2; all 3 pts obtained a complete HIV-associated ulcer, age less than 21 years, imprisonment, recent Botox
resolution of symptoms. injection elsewhere, and pelvic radiation. A retrospective chart review iden-
Conclusions: THD seems to be a very effective mini-invasive option to tified age, gender, history of prior fissure, use of nitroglycerine or nifedip-
treat haemorrhoids, available also in a day-surgery setting. Low morbidity ine, Botox dose, healing, recurrence, and sphincterotomy rates. A fissure was
and recurrence rate would be prominent positive characteristics from this defined as “healed” only after lighted anoscopy confirmed total resolution.
preliminary experience. Treatment of IV degree hemorrhoids is a challeng- Length of follow-up was defined as time from injection to either last nor-
ing option for further studies. mal exam or exam with recurrence. Patients with unsuccessful initial injec-
tion treatment were offered medical management, a second salvage injec-
tion, or surgical therapy.
Results: 256 patients underwent initial injection (126 women: 130 men,
median dose 60 units, range 20-80 units) with a mean follow-up of 237 days.
Mean age at first injection was 50 years. 84% of patients had a course of
advanced topical therapy before injection (60% nifedipine, 16% nitroglyc-
erine, 8% both). Initial healing was identified in 65% (167/256). Of these
113
Abstracts
patients, recurrence developed in 23% (39/167). 30 patients underwent sec-
ondary injection for nonhealing and 15 for recurrence, with a 50% and 67%
S20
AN INCREASE IN COMPLIANCE WITH SCIP MEASURES
healing rate, respectively. 32% (8/25) of the secondarily successful cases went
DOES NOT PREVENT SURGICAL SITE INFECTION IN
on to recur. Female gender was associated with a higher recurrence rate (29%
vs 17% for males). Minor transient seepage occurred in 6 patients (2%). 47 COLORECTAL SURGERY.
patients (17%) ultimately required sphincterotomy or a flap procedure. C. Pastor1, A. Artinyan1, J. H. Baek1, M. G. Varma2, E. Kim2,
Conclusions: Botulinum toxin A injection is a reasonable treatment for L. A. Indorf2, L. Gibbs3 and J. Garcia-Aguilar1 1Department of Surgery,
chronic and recurrent anal fissure, especially for those patients concerned City of Hope National Medical Center, Duarte, CA, 2Department of Sur-
with the risks of traditional sphincterotomy. Females and those with a his- gery, University of California, San Francisco, San Francisco, CA and
tory of a healed fissure were more likely to develop recurrences. 3
Department of Infection Control, University of California, San Francisco,
San Francisco, CA.
Purpose: A goal of the Surgical Care Improvement Project (SCIP) is to
S19 improve quality of care by implementing evidence-based health care prac-
VALIDATION OF RISK INDEX CATEGORY AS A PREDIC-
tices that prevent surgical complications. This study was designed to test
TOR OF SURGICAL SITE INFECTION IN COLORECTAL
the hypothesis that an increase in compliance with a number of SCIP process
PATIENTS. measures will decrease the rate of surgical site infections (SSI) in patients
C. Pastor1, J. H. Baek1, M. G. Varma2, E. Kim2, L. A. Indorf2, L. Gibbs3 undergoing elective colorectal resections.
and J. Garcia-Aguilar1 1Department of Surgery, City of Hope National Med- Methods: A multidisciplinary task-force was convened to implement and
ical Center, Duarte, CA, 2Department of Surgery, University of California, monitor compliance with individual SCIP process measures in a series of
San Francisco, San Francisco, CA and 3Department of Infection Control, patients having colon or rectal surgery at a tertiary institution. Data was
University of California, San Francisco, San Francisco, CA. collected prospectively and reviewed monthly. System changes to increase
Purpose: The National Nosocomial Infection Surveillance (NNIS) sys- compliance with process measures were introduced as needed. Data on SSI,
tem developed a basic risk index category (RIC) as predictor of surgical site defined according to the Center for Disease Control guidelines, was col-
infection (SSI). However, the utility of the RIC has been questioned because lected prospectively. All patients were followed for a minimum of 30 days.
it does not take into consideration procedure-specific factors and the inac- For data analysis, patients were distributed in two groups treated in two con-
curacy of post-discharge surveillance of SSI in the NNIS data set. This study secutive periods; group A (from 4/1/06 to 5/31/08) and group B (from 6/1/07
was designed to validate the RIC in a population of patients undergoing to 7/31/08). Comparisons between groups were performed by using a mul-
colorectal resections and an accurate diagnosis of SSI. tivariate logistic regression analysis.
Methods: We prospectively collected demographic and clinical infor- Results: A total of 491 consecutive patients were treated between both
mation in 535 consecutive patients undergoing colon and rectal resections consecutive periods; 238 in group A and 253 in group B. There were not sta-
at a tertiary hospital over a 28-month period. Variables included: age, gen- tistically significant differences in patient’s characteristics, diagnosis or sur-
der, BMI, diabetes, serum albumin, tobacco use, diagnosis, ASA score, surgical procedures between groups. Data on compliance with process meas-
geon, site of surgery (pelvic or abdominal), type of surgery (urgent or elec- ures and SSI rates are presented in table 1.
tive), surgical approach (open or laparoscopic), stoma; wound classification, Conclusions: Compliance with most process measures aimed to prevent
duration of surgery (more or less than 180 min.), prophylactic antibiotics, SSI increased during the study period, but the increase in compliance did
perioperative normothermia, and perioperative glucose control. Data on SSI not translate into a significant reduction in the SSI rates. The reduction in
was collected according to CDC-NNIS guidelines. All patients were fol- the SSI rates in colorectal patients that can be expected from an increase in
lowed for a minimum of 30-days after surgery. Logistic regression was used compliance with the SCIP process measures will be at best modest, far from
to identify potential risk factors for SSI. the 25% goal in reduction of surgical complications targeted by SCIP for
Results: A total 99 (19%) developed SSI; superficial in 62 (11.5%), deep 2010. Other prophylactic measures may be required to further reduce the
in 7 (1.3%), and organ-specific in 25 (4.6%). The ASA score, wound classi- SSI rates in this patient population.
fication, duration of surgery, open approach were associated with increased TABLE 1. COMPARISON OF COMPLIANCE WITH PROCESS MEASURES
BETWEEN PERIODS
risk of infection in multivariate analysis. The rate of SSI was higher for
patients with IBD (25% vs. 17%), BMI >30 (24% vs.17%), and for patients
younger than 60 years of age (22% vs. 15%), but the differences did not reach
statistical significance. When incorporated into the model, RIC was found
to be statistically associated with SSI. The odds ratio for SSI was 2.7 (95%
CI; 1.6-4.4; p<0.001) for patients with RIC ≥ 2 compared to RIC ≤1.
Conclusions: The RIC is a strong predictor of SSI in a population of
colorectal surgery patients even when the diagnosis of SSI is prospectively
collected.
S21
DOES ABSOLUTE GLYCEMIC RESPONSE OR THE VARI-
ABILITY OF GLYCEMIC RESPONSE AFFECT SURGICAL
SITE INFECTION RATES?
A. Mahmood2, K. El-Badawi1, T. Asgeirsson2, M. Luchtefeld2, D. Kim2,
R. Hoedema2, N. Dujovny2, H. Slay2 and A. J. Senagore1 1Spectrum
Health, Grand Rapids, MI and 2The Ferguson Clinic/ Michigan Medical PC,
Grand Rapids, MI.
Purpose: Despite the significant interest in perioperative glycemic con-
trol, there is little data defining the consistency of glycemic response and the
114
Abstracts
incidence of surgical site infection (SSI). The aim of this study was to assess fore, draconian implementation of a “never event” payment policy defined
the variation in glycemic response and the risk of SSI and hospital stay as merely by the occurrence of SSI irregardless of SCIP implementation appears
defined by the maximum, minimum, and area under the curve for perioper- premature. It may be better to sequentially analyze additional care measures
ative glucose in patients undergoing colectomy. before making adverse payment decisions.
Methods: We evaluated all patients undergoing colectomy from 7/2007
thru 6/2008. We assessed the maximum and minimum levels of glucose, as
well as the area under the curve (AUC) for elevated glucose perioperatively S23
using all available glucose measures. The 3 assessments of glycemic response FACTORS ASSOCIATED WITH PERINEAL WOUND COM-
were used to define two groups of patients based upon the incidence of SSI PLICATIONS AFTER ABDOMINOPERINEAL RESECTION
(SSI) or absence of SSI (nSSI). FOR CANCER OF THE RECTUM.
Results: We evaluated 183 consecutive patients undergoing colectomy, G. El-Gazzaz, R. P. Kiran and I. C. Lavery Colorectal surgery, Cleve-
which included 22 diabetic patients in the study group. The incidence of land Clinic Ohio, Cleveland, OH.
SSI for the entire population was 17/183 (9.3%). There was no significant
Purpose: Perineal wound complications have a significant impact on
difference in the mean blood glucose level between the groups (SSI- 136;
postoperative morbidity after excision of the rectum and anus. The aim of
nSSI- 136), however the SSI group had a statistically higher maximum glu-
this study is to evaluate factors affecting perineal wound complications after
cose level (SSI- 194; nSSI 162; p<.05) and a lower minimum glucose level
abdominoperineal resection (APR).
(SSI- 100; nSSI 117; p<.05). Using AUCs for elevated glucose, there was no
Methods: The clinical records of all patients who underwent APR for
significant difference in the incidence of SSI with glucose >110 mg/dl (SSI-
rectal carcinoma between 1980 and 2007 were reviewed. Data pertaining to
59%; nSSI- 62%) or glucose >150mg/dl (SSI 6%; nSSI 18%). Length of stay
demographics, tumor characteristics, use of preoperative neoadjuvant ther-
was significantly increased with SSI (SSI 10.4 days; nSSI 4.5 days).
apy were retrieved. Complications studied included delayed wound healing
Conclusions: The data demonstrate that patients with SSI appear to
(absence of healing >1 month), wound infection, dehiscence, abscess or sinus
have wide fluctuations in glycemic response with statistically higher maxi-
requiring drainage/debridement, or reoperation and perineal hernias. Fac-
mums and lower minimums compared to patients without an SSI. Using
tors associated with these complications were evaluated.
AUC as an assessment of global glycemic response we were unable to iden-
Results: 696 patients underwent APR with primary closure of the per-
tify a difference in SSI between aggressive and moderate glucose levels post-
ineal wound (male 59%, age 63±13 years and BMI 27.5 kg/m2). 273 patients
colectomy. The variable glycemic response associated with SSI may be related
(39.2%) received neoadjuvant chemoradiation. The median radiation dose
to alterations in insulin resistance and raises question regarding the benefit
4310 cGY, range (1500-6100). The overall rate of wound complications was
of aggressive administration of additional insulin in this population.
16.2%. Reoperation was required in 5.2 % patients. Overall wound com-
plication rate, infection and delayed healing were significantly increased in
S22 patients who had undergone neoadjuvant therapy (Table). Occurrence of
DOES SCIP COMPLIANCE MAKE SURGICAL SITE INFEC- perineal sinus, ulceration and hernia were not significantly different. Vari-
TION A NEVER EVENT? ables with significant associations with perineal wound complications included
preoperative neoadjuvant therapy (p=0.01, OR (95%CI) = 1.66 (1.10 - 2.48),
K. El-Badawi1, A. Mahmood2, T. Asgeirsson2, M. Luchtefeld2, D. Kim2, hypertension (p=0.002), obesity (p=0.04), ASA>=3 (p=0.003), any co-mor-
R. Hoedema2, H. Slay2, N. Dujovny2 and A. J. Senagore1 1Spectrum bidity (p=0.001), and post-operative bleeding (p=0.04). Risk of wound com-
Health, Grand Rapids, MI and 2The Ferguson Clinic/ Michigan Medical PC, plications did not correlate with age, gender, and disease stage.
Grand Rapids, MI. Conclusions: Preoperative neo-adjuvant chemoradiation increases the
Purpose: Colectomy has recently been identified as disproportionately rate of perineal wound complications after APR but lower than previously
accounting for major surgical complications with surgical site infections (SSI) reported. Most patients have good healing. A selective approach in the use
being the most common issue. The Surgical Care Improvement Project of preoperative radiation and chemotherapy may further reduce this risk
(SCIP) which includes choice and timing of antibiotics, glycemic control, Perineal wound complication after APR for cancer rectum
avoidance of hypothermia, and proper skin care/hair removal was imple-
mented in hopes of reducing the incidence of SSI. Despite varied reports of
the impact of SCIP on SSI, there has been a move to defining SSI as a “never
event” by payers. The aim of this study was to assess the role of SCIP com-
pliance in SSI following colectomy.
Methods: We reviewed all SSI’s after colectomy performed at our insti-
tution during 2007. Surgical procedure, urgency of cases (emergent vs elec-
tive), comorbidities, perioperative antibiotics, skin care, glycemic control,
and thermal regulation were noted. Length of stay and complications were
the outcomes assessed. We then analyzed adherence to SCIP protocol and
impact on complications.
Results: 151 colectomies were performed at our institution during this
time period. Of these, we focused on the 30 wound/infectious complica- S24
tions identified. A total of 10 of the 30 cases had breaks in their care related THE MORBIDITY OF CLOSTRIDIUM DIFFICILE INFEC-
to the SCIP protocol. The main culprit for failure to adhere to the SCIP TION FOLLOWING ELECTIVE COLONIC RESECTION—
protocol was inappropriate timing of antibiotic administration (23%). 7% RESULTS FROM A NATIONAL POPULATION DATABASE.
of cases had inappropriate selection of antibiotic prophylaxis and 10% of
K. Lesperance1, M. Spencer2 and S. R. Steele1 1Madigan Army Medical
cases with hyperglycemia were identified. Nonetheless, 67% of cases with
Center, Tacoma, WA and 2Colon and Rectal Surgery, University of Minnesota,
documented SSI’s adhered to all aspects of the SCIP protocol.
Conclusions: Surgical site infections remains a significant problem which Rochester, MN.
clearly requires improvement to lower cost and improve the quality of sur- Purpose: Clostridium difficile (CD) infection represents a continued
gical care after colectomy. However, even complete adherence with SCIP emerging threat. We examined the outcomes associated with CD colitis fol-
protocol clearly does not eliminate the risk of SSI after colectomy. There- lowing elective colonic resection.
115
Abstracts
Methods: All elective colectomies were selected from the 2004 – 2006
Nationwide Inpatient Sample. Key terms to identify post-operative CD infec-
S26
A PROSPECTIVE ANALYSIS OF THE OUTCOME OF ILEAL
tion included pseudomembranous colitis, antibiotic-associated colitis, and
POUCH-ANAL ANASTOMOSIS IN INFLAMMATORY
Clostridium difficile. All cases with a primary diagnosis of CD infection were
excluded. We used univariate and regression analyses to compare outcome BOWEL DISEASE PATIENTS WITH BACKWASH ILEITIS.
measures and identify factors associated with CD colitis. E. White, Z. Murrell and P. Fleshner Cedars-Sinai, Los Angeles, CA.
Results: Of 695,010 patients undergoing elective colectomy, 15% devel- Purpose: The outcome of ileal pouch-anal anastomosis (IPAA) in patients
oped CD colitis. CD patients were predominately Caucasian (65%), female with backwash ileitis (BWI) is controversial. The aim of this study was to
(53%), and older (mean age, 68 years). CD infection was associated higher prospectively compare the outcome of IPAA in a closely followed cohort of
wound (1.8% vs. 1.2%), pulmonary (12.1% vs. 6.4%), and gastrointestinal colitis patients with BWI (BWI+) and without BWI (BWI-neg).
(12.8% vs. 10.5%) complications, (all P<0.01). Length of stay (22.6 vs. 10.9 Methods: Prospectively generated clinical profiles on consecutive coli-
days) and mortality (16.2% vs. 4.9%) were also significantly higher in the tis patients undergoing IPAA with close postoperative followup by one sur-
CD group, (both P<0.001). Patients with CD colitis more frequently held geon were reviewed. All patients were classified after surgery as being either
Medicare insurance (68% vs. 51%) and underwent small segmental colonic BWI+ or BWI-neg. Outcomes included acute pouchitis (antibiotic respon-
resection as opposed to a defined anatomical resection (20.0% vs. 9.9%), sive), chronic pouchitis (antibiotic dependent or refractory), or de novo
(all P<0.001). Caucasian race was an independent predictor for the devel- Crohn’s disease (small inflammation above the pouch inlet or pouch fistula).
opment of CD colitis (O.R 1.4, 95% CI 1.24-1.67), while an underlying diag- Results: Within the study cohort of 334 patients were 39 patients who
nosis of colon cancer was associated with of a lower incidence of CD colitis were BWI+ (12%). Comparing the BWI+ and BWI-neg patients, there was
(O.R 0.71, 95% CI 0.59-0.84), both P<0.001. a higher incidence of pancolitis (100% vs 74%; p=.0001) and primary scle-
Conclusions: Clostridium difficile colitis is associated with worse out- rosing cholangitis (15% vs 2%; p=.001). After a median followup after stoma
comes following elective colonic resection and all efforts to diagnose, treat, closure of 26 months, 53 patients (16%) developed acute pouchitis, 37 patients
or avoid this infection altogether cannot be overemphasized. (11%) developed chronic pouchitis and 42 patients (13%) developed de novo
Crohn’s disease (CD). There was no significant difference in the incidence
of acute pouchitis, chronic pouchitis or de novo CD between the BWI+ and
S25 BWI-neg patient groups (see table).
TECHNICAL COMPLICATIONS AFTER ILEAL POUCH- Conclusions: There was a significantly higher incidence of pancolitis
ANAL ANASTOMOSIS MAY BE MISINTERPRETED AS and primary sclerosing cholangitis in BWI+ patients versus BWI-neg patient
CROHN’S DISEASE. groups. The incidence of acute pouchitis, chronic pouchitis and de novo CD
K. A. Garrett, F. Remzi, H. T. Kirat, B. Shen, V. W. Fazio and R. P. Kiran after IPAA did not differ significantly between BWI+ and BWI-neg patients.
Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH. This prospective study suggests that BWI+ patients can undergo IPAA and
expect a long-term outcome equivalent to BWI-neg patients.
Purpose: Manifestations of technical complications after ileal pouch-
anal anastomosis (IPAA) may mimic and hence be mislabeled as Crohn’s
disease (CD). We evaluate the presentation, treatment and outcomes for
patients potentially misdiagnosed as CD who underwent re-do IPAA.
Methods: Data of all patients initially referred to us with a diagnosis of Values in parentheses denote percentage
CD after IPAA at an outside institution and who then went on to have redo
IPAA at this institution were reviewed. Demographics, diagnosis, data per-
taining to primary and re-do IPAA were evaluated. Functional outcomes and S27
quality of life were compared with matched patients who had a primary IPAA PRESERVATION OF THE KOCK POUCH (KP) IS HIGH IN
in order to assess outcomes as a determinant of the appropriateness of change LONGTERM FOLLOW-UP.
in diagnosis from CD to technical complication. S. Forbes, S. Cowie, B. O’Conner, C. Victor, Z. Cohen and R. McLeod
Results: Thirty-three patients (17 female) underwent re-do IPAA for a
previous diagnosis of CD. Mean age was 36.2 ±9.8 years. Original diagno-
University of Toronto, Toronto, ON, Canada.
Purpose: Although the KP has largely been abandoned in favor of IPAA
sis was ulcerative colitis (n=31) and indeterminate colitis (n= 2). Indications
(illeal pouch anal anastomosis), many patients have had this procedure dat-
for redo-IPAA included pouch fistula (n=14), leak/sinus (n=18), pouch dys-
ing back 30 years. The objective of this study was determine long term out-
function (n=5), stricture (n=4), enterocutaneous fistula (n=2), pouchitis (n=2)
come of patients who had a KP constructed at our institution.
and retained rectal stump (n=1). All patients had treatment for CD prior to
Methods: all patients who had a KP constructed primarily or revised
referral, including Infliximab in 10 (30%). Mean time between primary and
were included in the study. Charts were reviewed retrospectively. Patients
re-do IPAA was 2.1 years (1.8-4.9, IQR). All patients had mucosectomy and
were surveyed to obtain follow-up information. Complications and reoper-
diverting ileostomy at re-do IPAA. Median follow up was 1.7 years (1.0-3.5,
ative procedures were classified as KP related or not related.
IQR). Pouch retention rate was 84.8%. Of 5 patients (15.2 %) who had pouch
Results: Between 1976 and 2006, 194 patients had a KP constructed.
failure after re-do IPAA, 4 underwent pouch excision with end or continent
Twelve patients were lost to follow-up leaving 182 patients (97 females;
ileostomy and 1 had repeat pouch revision. For the matched primary and
85 males; mean age 34.6 years). 148 patients had their KP constructed pri-
redo IPAA groups, frequency (p=0.75), incontinence (p>0.99), urgency
marily; 34 had revisions. In total 131 (71.9%) patients experienced 285
(p=0.64), pad usage (p=0.71), seepage (p=0.63), quality of life (p=0.08), hap-
complications. One hundred twenty six (69.2%) patients required further
piness with surgery (p=0.49), dietary (p=0.93), social (p=0.11), work (p=0.79),
surgery for KP related complications. The mean number of operations per
and sexual (p=0.73) restrictions were similar.
patient was 1.3 but ranged from 1-5.Valve slippage occurred in 65 (35.6%)
Conclusions: The differentiation of CD from postoperative pouch sur-
patients, fistula/abscess in 55 (30.2%) patients and valve prolapse in 25
gery-related complications can be difficult. It is prudent to re-evaluate patients
(13.7%). In total, 53 (29.1%) patients had their KP excised. The most com-
labeled as having pouch failure due to CD as a proportion of these patients
mon indication was valve slippage (42.3%), followed by peristomal abscess
have favorable long term outcomes after salvage with a re-do IPAA.
or fistula (24.5%), valve prolapse (10.2%) and chronic pouchitis or pre-
pouch ileitis (14.1%).Factors associated with KP excision were diagnosis
of Crohn’s disease (RR 2.75, 95% CI 1.17-6.48) and increasing number
of revisions (RR1.16/revision, 95% CI 1.01-1.34). The likelihood of hav-
116
Abstracts
ing a KP at 1 year was 0.956 (95%CI 0.926-0.986), at 5 years was 0.855
S29
(95%CI 0.799-0.911), at 10 years was 0.806 (95% CI 0.742-0.870) and at
OUTCOME AND LONG-TERM FUNCTION OF RESTORA-
20 years was 0.670 (95%CI 0.589-0.751).
TIVE PROCTOCOLECTOMY FOR CROHN’S DISEASE:
Conclusions: Despite a high risk of complications and need for further
surgery, a high proportion of patients have a well functioning KP at longterm COMPARISON TO PATIENTS WITH ULCERATIVE COLI-
follow-up. TIS.
A. Grucela, J. J. Bauer, S. R. Gorfine and D. B. Chessin Surgery, Mount
Sinai Medical Center, New York, NY.
S28 Purpose: Restorative proctocolectomy (RPC) with ileal pouch-anal
GENDER-SPECIFIC DIFFERENCES IN PELVIC ORGAN anastomosis is the most commonly performed operation for chronic ulcer-
FUNCTION AFTER PROCTECTOMY FOR INFLAMMA- ative colitis (CUC), as it provides an excellent functional outcome. How-
TORY BOWEL DISEASE. ever, it is controversial in patients with Crohn’s colitis, as the outcome
M. G. Varma1, S. L. Hart2, J. Lee1, J. Wang1, A. DelRosario1 and K. Del- may be poor. Our purpose was to compare patients with Crohn’s colitis
Rosario1 1Surgery, University of California, San Francisco, San Francisco, who underwent an RPC to a matched cohort of patients with CUC to
CA and 2Ryerson University, Toronto, ON, Canada. determine if there are any differences in outcome or function between
Purpose: Significant concern exists regarding the effect of proctectomy the two groups.
on sexual function in patients with inflammatory bowel disease(IBD)but lit- Methods: We queried our prospectively maintained database of patients
tle is known about the gender-specific differences in function.We sought to who underwent RPC from 1991-2008 for clinical, pathological, functional,
prospectively examine men and women with IBD pre- and post-proctectomy and outcome variables. We identified patients who underwent RPC for
to examine the effect of surgery on all pelvic organ function. Crohn’s colitis and comprehensively characterized this cohort of patients.
Methods: Participants(N=65) with IBD who were scheduled to undergo We compared this group to a matched cohort of patients who underwent an
proctectomy were recruited to complete a packet of questionnaires prior to RPC for UC to determine if there was any difference between the groups in
surgery, and six months after their last operation. These included the Inflam- outcome and long-term function.
matory Bowel Disease Questionnaire(IBDQ), the Sexual Function Ques- Results: We identified 13 patients with Crohn’s disease (7 females,
tionnaire(SFQ) adapted for men and women, the American Urological Asso- median age: 34 years) and matched them with 39 with CUC (21 females,
ciation Symptom Index(AUASI), the Sexual Satisfaction Survey(SSS), and median age: 35 years). The groups were well matched for age and gen-
the SF-36. Repeated measures analysis using time(pre vs. post-proctectomy) der as well as clinical and demographic variables. Indications for RPC in
and gender (male vs. female) and an interaction effect of time X gender exam- patients with Crohn’s disease were dysplasia/malignancy [n=6 (46%)] and
ined differences on aforementioned measures. failure of medical therapy [n=7 (54%)]. Seven patients (54%) with Crohn’s
Results: Forty patients completed both baseline and six month follow- disease had proctitis, but none had perianal or ileal disease. There were
up questionnaires. The mean age was 41.4(range 18-74) and 60% were men. 4 (30.8%) postoperative complications and no anastomotic leaks. With a
Seventy-five percent had ulcerative colitis, 28% had a previous colectomy median follow-up of 44 months in patients with Crohn’s disease, two
prior to proctectomy, 7.5% had permanent stomas, and 67% reported being patients (15.4%) had their pouches excised, one for severe perianal dis-
sexually active. A significant time X gender interaction revealed that men ease and one for intractable pouchitis. The long-term outcome between
had significantly larger increases in scores on the IBDQ and SFQ compared the two groups is compared in the table.
to women, while more women actually had a worsening of their SFQ scores Conclusions: RPC for Crohn’s colitis may result in fewer bowel move-
after proctectomy (67% vs. 21%, p=0.026). Although women had less ments in 24 hours, less incontinence, and a lower incidence of pouchitis when
improvement or worsening of urinary function scores, less improvement in compared to those who have the procedure for CUC. However, risk of pouch
the mental and physical composite scores of the SF-36, and less change in loss is higher in patients with Crohn’s colitis. Therefore, in properly selected
sexual satisfaction scores compared to men, these differences did not achieve patients with Crohn’s colitis, restorative proctocolectomy provides for an
statistical significance. acceptable outcome and long-term function.
Comparison of RPC Outcome for Crohn’s Disease and Ulcerative Colitis
Conclusions: These analyses suggest that men reported significantly
better sexual function after proctectomy than women. They were also more
likely to have more improvement in their inflammatory bowel disease-related
and general quality of life. Clearly improved disease symptoms positively
affects sexual function, however further investigation is required as to why
there may be gender-specific differences in post-proctectomy outcome
Comparison of pre and post-proctectomy scores in men and women
NS= Not Significant
117
Abstracts
32 gene signature was derived from these selected genes using 1000 repli-
S30 cates of K-fold validation (K=6).
HEALTHCARE RESOURCE UTILIZATION AND ASSOCI-
Results: 69 patients with disease-free survival and 31 patients with recur-
ATED COSTS BEFORE AND AFTER SURGERY FOR ULCER-
rent disease were included. Median follow-up was 120 and 67 months for
ATIVE COLITIS: A POPULATION-BASED STUDY IN OLM- non-recurrent and recurrent cases, respectively. 25 recurrences were distant.
STED COUNTY, MINNESOTA. Median lymph node evaluation for both groups was > 16 nodes. Demo-
S. D. Holubar1, R. R. Cima1, B. G. Wolff1, K. Long2, E. Barnitt2, graphics and tumor characteristics between groups were similar. 32 genes
E. V. Loftus3 and J. H. Pemberton1 1Division of Colorectal Surgery, Mayo from 43,148 probes were differentially expressed and found to be statistically
Clinic, Rochester, MN, 2Division of Healthcare Policy Research, Mayo Clinic, predictive of recurrence. Overall cross-validated accuracy of the signature,
Rochester, MN and 3Division of Gastroenterology, Mayo Clinic, Rochester, as measured by area under the ROC curve, was 0.803 (figure). The signa-
MN. ture predicts which patients are likely to recur, but also those that are not
Purpose: We hypothesized that chronic ulcerative colitis (CUC) patients likely to recur.
who undergo surgery have reduced direct medical costs after, as compared Conclusions: Differential gene expression within rectal cancers is asso-
with before, total proctocolectomy with ileal pouch-anal anastomosis (TPC- ciated with recurrence of early stage disease. A 32-gene signature can pre-
IPAA) or Brooke ileostomy (TPC-BI). dict patients at increased risk of more aggressive or less aggressive tumor
Methods: We identified a cohort of Olmsted County, MN residents with behavior. This information, which can be obtained via preoperative biopsy,
CUC who underwent TPC from 1988-2007. Total estimated direct health- may contribute to clinical decision making regarding neoadjuvant treatment
care costs were assessed using a cost-based administrative database. Our of early stage rectal cancers.
primary outcome was observed cost difference between 2 periods: 2-years
before the day of surgery (Period Before), and 2-years after surgical recov-
ery (Period After). Costs of the operative and recovery period (day of 1st
stage to day of stoma closure + 180 days) were excluded and will be reported
separately. Statistical significance was assessed using univariate analysis and
bootstrapping methods. Costs are reported in 2007 constant dollars. Out-
patient pharmaceutical costs, i.e. infliximab, were not included. Non-cost
data are median (interquartile range) or frequency (proportion).
Results: During the study period 100 CUC patients had TPC; of these
75 (59 IPAA, 16 TPC-BI) patients had complete costing data for both peri-
ods. Overall 45 (60%) were men, age 35 (28 – 45) years, median duration of
colitis 4 (1 – 11) years. During Period Before pre-operative corticosteroid
use was observed in 79%, and 6.7% had received at least one dose of inflix-
imab. The median number of abdominal imaging procedures per patient
during Period Before and Period After was 3.1 and 1.9, respectively. Total
direct medical costs on average were reduced by $6,216.86 (p<0.0001, boot-
strapped 95% CI: $217 to $11,498) in the 2-years after the surgical recov-
ery period.
Conclusions: These preliminary results suggest that definitive surgery
for CUC may result in a modest reduction in direct medical costs for those
who require surgery. Ongoing analysis will assess the impact of biologic ther-
apy and other covariates, additional disease-specific resource utilization, and
observed cost differences in surgical subgroups.
S31 Figure: Area under the ROC curve for 32-gene

signature predicting rectal cancer recurrence
GENE SIGNATURE PREDICTS EARLY STAGE RECTAL
CANCER RECURRENCE: A STEP TOWARD INDIVIDUAL-
IZED TREATMENT DECISIONS. S32
M. F. Kalady1, J. A. Sanchez1, K. DeJulius2, I. C. Lavery1, J. M. Church1 EFFECTS OF TNF ON P53 AND PUMA IN COLORECTAL
and H. Ishwaran3 1Colorectal Surgery, Cleveland Clinic, Cleveland, OH, CANCER.
2
Cancer Biology, Cleveland Clinic, Cleveland, OH and 3Quantitative Health D. M. Pastor1, R. B. Irby2 and L. S. Poritz1 1Surgery, Penn State Milton
Sciences, Cleveland Clinic, Cleveland, OH. S. Hershey Medical Center, Hershey, PA and 2Penn State Cancer Institute,
Purpose: Despite expected excellent outcomes of surgical resection for Penn State College of Medicine, Hershey, PA.
early stage rectal cancers, 20% of stage I and II rectal cancers recur. Identi- Purpose: Inflammatory bowel disease (IBD)-associated colorectal car-
fying biological factors that predict recurrence could allow more directed cinogenesis involves dysregulation of multiple cellular pathways. Mutation
therapy. This study identifies a tumor gene expression profile that accurately of the p53 gene is one of the earliest events in the stepwise progression from
predicts disease recurrence. colitis to dysplasia to malignancy. Integral to the pathogenesis of IBD is
Methods: Stage I and II rectal cancer patients treated by surgery alone TNFα, a pro-inflammatory cytokine that may also potentially contribute to
at a single institution with available fresh frozen tumor were included. All carcinogenesis in this setting. The purpose of the current study is to evalu-
cases were reviewed and validated for the clinical endpoints of recurrent or ate TNFα’s effects on p53 and PUMA, a downstream effector of p53 in the
non-recurrent cancer. Tumor mRNA was isolated from frozen tissue and apoptotic pathway. We hypothesize that TNFα upregulates p53 and PUMA
evaluated for total genome gene expression by microarray analysis. Back- and may contribute to carcinogenesis in IBD.
ground-corrected and normalized microarray data was then analyzed using Methods: HT29 (a colon cancer cell line with mutated p53) and HCT116
BAMarray software. Selected genes were further analyzed using unsuper- (a colon cancer cell line with wild-type p53) cells were treated with TNFα
vised hierarchical clustering and nearest shrunken centroid classification. A
118
Abstracts
(0, 50, 100, or 500 ng/mL) for 1, 6, 12, 24, 36, or 48h. Nuclear and cyto-
plasmic protein expression of p53 was determined by Western blot and
immunofluorescence with confocal microscopy. Changes in p53 and PUMA
mRNA expression were determined by qRT-PCR.
Results: p53 expression increased in both nuclear and cytoplasmic HT29
fractions following 48h of TNFα treatment by Western blot. Expression was
unchanged in HCT116 cells following treatment. A marked increase in
expression of p53 was seen in the nuclei of HT29 cells by immunofluores-
cence following 48h of TNFα treatment at 500 ng/mL. HCT116 cells, on
the other hand, failed to demonstrate an increase in p53 nuclear expression.
To further evaluate the increase in protein expression with TNFα in the
HT29 cell line, we assessed changes in p53 and PUMA mRNA expression
in these cells by qRT-PCR. PUMA mRNA transcript levels increased in
TNFα-treated HT29 cells as early as 1h and peaked 24h following treat-
ment. There was a 17-fold increase at 50 ng/mL, 22-fold increase at 100
ng/mL, and 18-fold increase at 500 ng/mL compared to untreated HT29
cells. p53 mRNA levels were minimally changed.
Conclusions: 1. TNFα increases nuclear and cytosolic p53 expression
in HT29 cells, but not in HCT116 cells. 2. TNFα upregulates PUMA mRNA
levels in HT29 cells. Our findings suggest that TNFα may be a factor in car-
cinogenesis in inflammatory bowel disease in cells carrying a p53 mutation.
S34
THE TRUTH ABOUT ADVANCED STAGE COLORECTAL
S33 CANCER: WHAT THE PRIMARY LESIONS DON’T TELL
SIRT1 AND EIF4E IN COLON CANCER OUTCOME. YOU.
M. H. Smith1, W. Pruitt2, K. Pruitt2, P. A. Cole1, Q. Chu1 and B. D. Li1 C. Messick, J. M. Church, X. Liu and M. F. Kalady Dept. Colorectal
1
Surgery, LSUHSC-Shreveport, Shreveport, LA and 2Molecular and Cellu- Surgery, Cleveland Clinic, Cleveland, OH.
lar Physiology, LSUHSC-Shreveport, Shreveport, LA. Purpose: Colorectal cancers (CRCs) are a heterogeneous group of tumors
Purpose: SIRT1, a class III histone deactetylase, initially studied for lifes- that develop through divergent oncogenic pathways characterized by genetic
pan regulation and stress response, selectively modifies histones and tran- and epigenetic changes. Resultant cancers can be classified by microsatellite
scription factors, including p53. Overexpression of eukaryotic initiation fac- instability (MSI) and CpG Island Methylator Phenotype (CIMP), which
tor 4E (eIF4E) increases translation of mRNA’s with long 5’UTR and define clinical phenotypes including variable response rates to 5-fluorouracil-
upregulates known downstream oncoproteins. In vitro, both appear to impact based chemotherapy. Since adjuvant or palliative chemotherapy targets
malignant transformation. We hypothesize that concomitant SIRT1 and metastatic lesions, the therapy must be effective against the metastases. This
eIF4E overexpression in colon cancer predicts clinical outcome. study evaluates molecular differences between primary colorectal cancers
Methods: A study of 98 malignant and 7 benign colon specimens was and their lymph node (LN) metastases.
initiated to assess SIRT1 and eIF4E by Western Blot. SIRT1 was detected Methods: An IRB-approved, prospectively maintained, CRC frozen tis-
using HELA cells as a standardized positive control. eIF4E level was quan- sue biobank was queried for primary stage III CRC previously analyzed for
tified relative to benign colon samples. Clinical data collected included age, MSI and CIMP. Adenocarcinoma-positive LNs from the same patients were
stage, T stage and N stage. Primary endpoints were cancer recurrence and obtained from Pathology. DNA from LNs was isolated and tested for MSI
death. Statistical analysis included Spearman correlation, chi-square test, and CIMP, then compared to matched primary tumor characteristics. Sta-
Kaplan-Meier survival analysis, log rank test, and odds ratio analysis. tistical analysis was performed using a McNemar’s test.
Results: 48 of 98 cancer specimens (49.0%) were SIRT1 (+), in contrast Results: 47 matched LNs from 47 CRC cases (34 colon and 13 rectal)
to 0 of 7 benign samples. 73 of 76 (96.1%) colon cancers tested had eIF4E were available and included. 6/47 (13%) primary tumors and 7/47 (15%)
overexpression (mean = 6.03-fold, 2 to 27). SIRT1 and eIF4E levels were LNs were MSI-H (p=1.0). There were 13/47 (28%) primary tumors and 6/47
highly correlated in cancer specimens (r = 0.38, p < 0.001, Spearman). There (13%) LNs that were CIMP+ (p<0.02). 8/47 (17%) patients showed dispar-
was no statistical significance between SIRT1 (+) and (-) cancers in tumor ity between primary tumors and LNs. Seven matched tumors and LNs var-
size (p = 0.77, chi-square test) or nodal status (p = 0.43). eIF4E overexpres- ied in their CIMP status while one matched tumor and LN showed differ-
sion was significantly higher in SIRT1 (+) compared to SIRT1(-) cancer sam- ences in MSI status. Interestingly, 7 (54%) of the 13 primary tumors that
ples (p = 0.0002). SIRT1(+) patients had a significantly higher rate of cancer were CIMP+ had LN metastases that were CIMP-negative (p<0.02).
recurrence versus SIRT1 (-) patients (p=0.007, log rank test). Patients in the Conclusions: Molecular characterization, notably the CpG Island
high eIF4E overexpression group had a significantly higher rate of cancer Methylator Phenotype, varies significantly between primary tumors and cor-
recurrence than those in the low group (p = 0.041). Patients with concomi- responding lymphatic metastases. Although the mechanism for this remains
tant high eIF4E and SIRT1 (+) tumors had odds ratio for recurrence 13.6- undefined, this finding suggests that molecularly-based adjuvant therapy
fold over those with low eIF4E and SIRT1(-) tumors (p = 0.021, CI, 1.48 to decisions should consider the molecular characteristics of cancer-positive
125.32). LNs as well as the primary tumor.
Conclusions: SIRT1 and eIF4E are not overexpressed in benign colon
samples. SIRT1 expression and eIF4E overexpression are highly correlated.
Concomitant SIRT1 expression and high eIF4E overexpression in colon can-
cer patients portend an increased risk of cancer recurrence.
119
Abstracts
metastasis was 86.9% when all three factors were positive, representing an
S35 up to 20% improvement in the prediction level as compared to the classic
GENE EXPRESSION SIGNATURE AND THE PREDICTION
LV (Lymph node involvement and Vessel cancer embolus) methods.
OF LYMPH NODE METASTASIS IN COLORECTAL CANCER
Conclusions: A new predictive panel including PAGE4 expression may
BY DNA MICROARRAY. help predict liver metastasis of CRC.
T. Watanabe and T. Kobunai Surgery, Teikyo University, Tokyo, Japan.
Purpose: Lymph node metastases is an important factor in determining
the outcome of colorectal cancer. If we can predict the presence of lymph
node metastases before surgery, it may be of help in deciding the need for
surgical lymph node dissection or additional preoperative treatment modal-
ity can be considered to improve survival. Our objective here was to iden-
tify a set of discriminating genes that can be used for characterization and
prediction of lymph node metastasis.
Methods: Eighty-nine colorectal cancer patients were studied. Gene
expression profiles of cancer was determined by human U133 Plus 2.0 Gene
Chip® (Affymetrix, Santa Clara, CA) and compared between patients with
and without lymph node metastasis.
Results: We identified 73 novel discriminating genes whose expression
differed significantly between patients with and without lymph node metas-
tases. Using this gene set, we were able to establish a new model to predict
the presence of lymph node metastasis with an accuracy of 88.4%. Dis- RT-PCR analysis of positive mRNA expression of CTA genes
criminating genes were associated with various functions, including recep-
tor activity and transcription regulatory activity. The list of genes included
transmembrane glycoprotein (PSMA), which has been reported to have a S37
close relation with lymph node metastasis in prostate cancer. PSMA showed EX VIVO SENTINEL LYMPH NODE MAPPING IN
significantly higher expression in patients with lymph node metastasis. PATIENTS UNDERGOING PROCTECTOMY FOR RECTAL
Conclusions: The present study suggested the possibility that gene CANCER.
expression profiling may be useful in predicting the presence of lymph node K. R. Finan, E. Bailey, M. Mutch, E. H. Birnbaum, J. L. Lewis and
metastasis so as to establish an individualized tailored therapy for colorectal J. W. Fleshman Colorectal Surgery, Washington University, St. Louis, MO.
cancer and to provide insights into the development of novel therapeutic tar- Purpose: Nodal metastasis is a prognostic indicator of long-term sur-
gets. vival in subjects with colorectal cancer. Controversy exists over the utility of
sentinel lymph node (SLN) mapping in the treatment of rectal cancer. The
purpose of this study was to evaluate the role of ex vivo SLN mapping.
S36 Methods: Subjects undergoing proctectomy for rectal cancer at a terti-
COMPARISON OF CANCER TESTIS ANTIGEN (CTA)
ary care center by 4 surgeons from 2003-2008 were included. Perioperative
EXPRESSION IN COLORECTAL CANCER WITH OR WITH- data was collected prospectively. SLN mapping was performed with ex vivo
OUT LIVER METASTASIS. injection of Isosulfan blue immediately after specimen extraction. SLNs were
G. Z. Chen and J. Gu Gastroenterology Surgery, Peking University School examined by multilevel evaluation (MLE), and when negative, by immuno-
of Oncology, Beijing Cancer Hospital & Institute. Beijing, PR China, histochemistry (IHC). Standard H&E evaluation was completed on non-
Beijing, China. SLN.
Purpose: Accumulating evidence suggests that Cancer Testis Antigen Results: The study population consisted of 58 subjects for treatment
(CTA) serves as potential targets for tumor-specific immunotherapy and as of low (17%), mid (29%) and high (54%) rectal cancers. 51 (88%) subjects
indicator of malignant phenotype. However, the role of CTA in colorectal received neoadjuvant therapy; 8 underwent short course radiation and 43
cancer (CRC) has yet to be elucidated. The purpose of this study is to eval- completed standard chemotherapy and radiation (nCXRT). The SLN detec-
uate CTA genes in predicting liver metastasis of CRC tion rate was 84%, with a mean SLN harvest of 1.8 nodes per subject. 15
Methods: The expression levels of 25 CTA genes were determined by (26%) subjects had SLN nodal metastasis on MLE. IHC did not improve
RT-PCR in 288 colorectal cancer tissue samples. Specimens were grouped detection of node positivity. The accuracy of SLN mapping was 71%, the
into three categories to include (1) primary tumors of colorectal cancer with sensitivity 44%, the negative predictive value 77% and the false negative
liver metastasis (PLM) (n=121); (2) primary tumors of colorectal cancer with- rate 56%. The mean total lymph node harvest was 12.1 nodes per patient
out liver metastasis (PNM) (n=129); and (3) liver metastases of colorectal (range 2-32). The mean lymph node harvest in subjects treated with nCXRT
cancer (LM) (n=38). Pearson χ2 analysis was performed to determine the was 11.7, compared to 13.3 nodes in those not receiving nCXRT (p=0.057).
association between expression of CTA genes and liver metastasis of CRC, 25 subjects had node positive disease on final pathology. Seven subjects
as well as the association between clinicopathologic parameters and liver were determined to have nodal disease only in the SLN. Thus, 28% of
metastasis of CRC. Multiple logistic regression analysis was employed to nodal disease was identified by SLN evaluation. Tumors were downstaged
assess the association between risk factors (CTA genes and clinicopathologic in 25 (49%) subjects receiving nCXRT, 24% were clinical complete respon-
parameters) and probability of liver metastasis of CRC. ders, and 20% pathologic complete responders. Of subjects who were down-
Results: The expression of three CTA genes (PAGE4, SCP-1 and staged by nCXRT, only 58% had an identifiable SLN, while a SLN was
SPANX) and three clinicopathologic parameters (lymph node involvement, identified in 96% of subjects not downstaged.
vessel cancer embolus and tumor invasion depth) correlated significantly with Conclusions: Detection of SLN positivity using MLE improved patho-
liver metastasis of CRC. Among these six risk factors, PAGE4 and lymph logic staging. Although SLN is not sensitive enough to replace full nodal
node involvement were identified as independent predictors for liver metas- dissection, its use as an adjunct to pathologic evaluation of surgical speci-
tasis in CRC patients. Furthermore, a liver metastasis logistic regression mens may improve prognostic evaluation and guide therapy.
model was established based on the PLV Panel (PAGE4, Lymph node involve-
ment and Vessel cancer embolus) in which the probability of developing liver
120
Abstracts
patients than that in N1 patients (77.8% vs 20.0%, p< 0.05). Tumor level
S38
(≤5cm or >5cm to anal verge) did not influence LNs positive rate nether in
INJECTING METHLYENE BLUE INTO THE INFERIOR
upper nor in lower mesorectum. This may strengthen the theoretical basis
MESENTERIC ARTERY ASSURES AN ADEQUATE NODAL
of TME that wherever the tumor is.Radical resction should include the dis-
HARVEST AND ELIMINATES PATHOLOGIST VARIABILITY tal one-third mesorectum.
IN RECTAL CANCER NODAL STAGING. Conclusions: Fat clearance greatly increased LN retrieval especially
T. G. Kerwel1, J. Spatz1, M. Anthuber1, K. Wünsch2, H. Arnholdt2 and small LN. In the distribution of LNs, the majority of LNs were found in
B. Märkl2 1Department of General, Visceral, and Transplant Surgery, lower mesorectum but anterior mesorectum has the smallest proportion of
Klinikum Augsburg, Augsburg, Germany and 2Department of Pathology, LNs. More small LNs retrieved could increase the accuracy of N staging.
Klinikum Augsburg, Augsburg, Germany. LNs involvement in upper or anterior mesorectum was mostly seen in N2
Purpose: The American Joint Committee on Cancer recommends exam- stage patients.
ination of a minimum of 12 lymph nodes in rectal cancer for accurate stag-
ing. Despite this, several studies have demonstrated that nodal harvest is
highly variable and often inadequate. This study was done to see if staining
the nodes with methylene blue dye produced a better and more accurate har-
vest in comparison to standard pathologic lymph node dissection.
Methods: Fifty patients with primary resectable rectal cancer were ran-
domized to undergo a standard nodal harvest vs. a harvest following ex-vivo
injection of the inferior mesenteric artery with methylene blue. A fat clear-
ance technique was subsequently carried out to identify the maximum pos-
sible number of lymph nodes and metastasis.
Results: The average lymph node harvest in the stained group was
30±13.5 and in the unstained group 17±11 (P<0.001). At least 12 nodes were
identified in every case in the stained group. In the unstained group, 7/25
cases (28 percent) did not meet the minimum criteria of 12 nodes (P<0.01).
Among the pathologists, no variability was found in the harvest for the stained
group (P<0.05) but variability was detected between the pathologists in the
unstained group (P=0.6). Following fat clearance, one case in the unstained
group was upstaged whereas no cases in the stained group were upstaged. small lymphnodes on the speciman of mesorectum after using modified fat clearing
Conclusions: Staining the lymph nodes with methylene blue is an accu- technique
rate staging technique, reliably produces an adequate harvest, and eliminates
nodal harvest variability among pathologists.
S40
SACRAL NERVE STIMULATION FOR CONSTIPATION:
S39 LOSS OF EFFICACY AND RE-OPERATIONS.
RESEARCH EVALUATION OF DISTRIBUTION AND Y. Maeda, L. Lundby, S. Buntzen and S. Laurberg Surgical Research
METASTASES PATTERN OF LYMPH NODES IN MESOREC- Unit, Aarhus University Hospital, Aarhus, Denmark.
TUM FOLLOWING TME PROCEDURE BY MODIFIED FAT Purpose: Sacral nerve stimulation (SNS) is an emerging treatment for
CLEARING TECHNIQUE. patients with severe constipation who have failed conservative treatments.
J. Gu, F. Y. Yao and L. Wang Gastroenterology Surgery Department, Peking There have been a few publications on efficacy but only two complications
University School of Oncology, Beijing Cancer Hospital & Institute, reported to date. We report our experience over 6 years focusing on subop-
Beijing, China. timal outcomes and revisions associated with SNS.
Purpose: Using modified fat clearing technique to gain insight into the Methods: Retrospective review was performed on patients who under-
distribution, and size of lymph nodes within the mesorectum from rectal can- went SNS between August 2002 and September 2008. Collected data
cer specimen following TME without any neo-adjuvant therapy included patients’ demographics, time since implantation of SNS, type and
Methods: Sixty mid-low rectal cancer patients were enrolled with TME management of suboptimal outcomes and complications. Stimulator pro-
procedure. Specimens were fixed in modified fat clearing solution to retrieve grams including amplitude and electrode setting were reviewed also.
LN, then to traditional pathological examination. The rectum was divided Results: 38 patients (6 men, 32 women, mean age 45.6 years, standard
into anterior,posterior,right and left lateral sides, which were further subdi- deviation (SD) 11.8) received a permanent stimulator after successful test
vided into 3 levels (upper, middle and lower). period. The mean treatment duration was 25.7 months (SD 20.4). 22 patients
Results: In sixty patients, totally 1436 LNs (average 23.9 per specimen) (58%) experienced at least one reportable event (RE) attributable to SNS.
were harvested, which was significantly higher than that by traditional man- The total of 58 REs were noted, including loss of efficacy, device-related
ual techniques(p<0.05). 985 small LNs (diameter<5mm) were retrieved. The pain and undesired change of sensation. Re-programming of stimulator suc-
percentage of LNs was 125(8.7%), 696(48.5%) and 615(42.8%) in anterior, cessfully managed 27 REs (47%). However, 13 REs (22%) required lead
posterior and bilateral mesorectum. We found in lower anterior section,con- replacements, 4 REs led to deactivation of stimulator and 3 REs required
siderable number of small LNs could be retrieved. The highest small LNs stimulator site revision surgery. There were one re-implantation of a new
retrieval rate 94.4%(118/125) could be observed in this section.In longitu- stimulator and one explantation also. The median time to intervention was
dinal axis,the distribution in the three levels of the rectum was simi- 9.5 months (range 0-54). Nearly one third of the REs occurred within first
lar:27.5%,37.2% and 35.3% was retrieved from upper,middle and lower month after implantation of a stimulator. There was no specific amplitude
mesorectum. Thirty three patients had 200 metastases LNs,in which 52% or combination of electrodes associated with REs.
were small LNs. Twenty percent patients had their N status ascended by the Conclusions: Nearly 60% of patients who received sacral nerve stimu-
small metastases LNs: 10% from N0 to N1 and 10% from N1 to N2. LNs lation for constipation experienced at least one reportable event. Loss or lack
metastasis rate in upper mesorectum was found significantly higher in N2 of efficacy and pain were common in the first month. Although they were
often solved by re-programming of stimulator, 31% required lead replace-
121
Abstracts
ments, revision surgeries or discontinuation of SNS. Patients undergoing SNS (10 pts, mean age 60.7 ± 17.6, range: 26-73), using the same selection
SNS for constipation need to be informed of these possibilities. Further criteria. At baseline, patients were studied with clinical evaluation (includ-
research is needed to identify the reasons of failure to maintain clinical ing Wexner score), 3D endoanal ultrasound (EAUS) and anal-rectal manom-
response and elucidate causes of device-related pain. etry (ARM), repeated at follow-up evaluation (median 60.0 months, range:
6-96 in SR group; median 33.0 months, range: 6-84 in SNS group).
Results: At baseline, both groups presented similar clinical, EAUS and
S41 ARM characteristics. Two SR pts (14.3%) had relapse of FI 6 and 19 months
ELECTRICALLY STIMULATED GRACILIS NEOSPHINC- after operation (they were submitted to dynamic graciloplasty and SNS,
TER CONSTRUCTION FOR END STAGE FAECAL INCON- respectively), while good/excellent continence was observed in all SNS pts.
TINENCE: EVALUATION OF LONG-TERM FUNCTIONAL Compared to baseline, both groups had significant improvement of clinical
OUTCOME. parameters (including Wexner score), while no differences were measured
J. Murphy, D. J. Boyle, C. Bhan, J. Saunders and N. S. Williams Centre concerning ARM data. In 12 out of 14 SR pts the repaired sphincter resulted
for Academic Surgery, The Royal London Hospital, Whitechapel, United ultrasonographically overlapped. At follow-up, comparison between SR and
Kingdom. SNS did not show significant difference in clinical (Table) and ARM param-
eters, also if related to lesion of internal, external or both sphincters.
Purpose: ESGN construction is an established treatment for patients Conclusions: These data seem confirm that SNS could be a valid option
with end stage faecal incontinence who wish to avoid a permanent stoma. to treat also FI pts with a sphincter lesion, not preceded by SR. On the other
However, few data are available describing the long-term efficacy of this pro- hand, even if the outcome in SR pts is not regrettable, a certain risk of FI
cedure. Consequently, the aim of this study was to assess mid/long-term func- relapse does exist. The optimal choice between SR and SNS in sphincter
tional outcome following ESGN construction, at 2 and 10 years postoper- lesion pts need to be established; in this view, further RCTs investigating
atively. modalities of presentation related to the two surgical strategies are awaited.
Methods: 119 patients (median age 42[range 13–75];81F) with a Williams
continence score ≥5 underwent ESGN construction between 1988-1999.
Fecal incontinence (FI) characteristics following Sphincter Repair (SR) and Sacral Nerve
Stimulation (SNS) in female patients with sphincter lesions.
ESGN was performed for: traumatic childbirth (n=52), surgical trauma
(n=23), atresia (n=20), anorectal excision (n=11), idiopathic incontinence
(n=9), and ileoanal pouch incontinence (n=4). Symptomatic assessment by
standardised questionnaires preoperatively was repeated following surgery,
and at 2 and 10 years. Anorectal physiological investigation was also per-
formed preoperatively and at 2 years.
Results: 119 patients consented to immediate postoperative follow up;
117 consented at 2-years, while 57 patients consented at 10-years. Conti-
nence improved for all patients postoperatively (median Williams score–2[1-
6];P<0.0001) and at 2-years (score–2[1-6];P<0.0001). When assessing all
patients, no significant difference was found between continence scores pre-
S43
operatively and at 10-years (score–4[1-6]). However, a sustained improve-
PREDICTIVE FACTORS FOR SUBCHRONIC TEST STIM-
ment at 10-year follow up (score–3[1-6];P=0.0013) was noted for patients in ULATION OUTCOME IN SACRAL NERVE MODULATION
the surgical trauma group. 25/119 patients required further interventions FOR THE TREATMENT OF FECAL INCONTINENCE.
(colonic conduit–23; ACE–2) for postoperative rectal evacuatory disorder B. Govaert, W. G. van Gemert and C. G. Baeten Surgery, Maastricht
(RED). Postoperative RED was more common in patients undergoing ESGN University Medical Center, Maastricht, Netherlands.
construction for obstetric injury (P=0.0079), with previous hysterectomy Purpose: Sacral Nerve Modulation is a well tolerated treatment for fecal
conferring additional risk (P=0.013). incontinence. A unique advantage of SNS treatment is the possibility to assess
Conclusions: These data suggest ESGN results in significant and sus- the feasibility of permanent stimulation by a temporary percutaneous nerve
tained symptomatic improvement in both the short and medium term. How- evaluation (PNE) and subchronic test stimulation. Little is known about
ever, long-term functional outcome is influenced by both the indication for the predictive factors for a successful percutaneous PNE and subchronic test
surgery and preoperative state of the patient. Currently the effect of improve- stimulation. The purpose of this study is to discover possible predictive fac-
ments in ESGN technique introduced after 1999 are unknown. Neverthe- tors associated with PNE and subchronic test outcome.
less, the reported data support the continued use of this procedure in highly Methods: We analysed data from all procedures performed in patients
selected patients. with fecal incontinence in the period from March 2000 till May 2007. Suc-
cessful outcome was defined as >50% improvement of incontinence episodes
in three weeks. Baseline demographics and anorectal investigations were
S42 analysed by logistic regression.
SACRAL NERVE STIMULATION IS A VALID THERAPY IN Results: Percutaneous nerve evaluations and subchronic test stimula-
FECAL INCONTINENT PATIENTS WITH SPHINCTER tion were performed in 245 patients (226 females). The univariate analy-
LESION, WHEN COMPARED TO SPHINCTER REPAIR. sis showed an external sphincter (EAS) defect to be significantly related to
C. Ratto, A. Parello, L. Donisi, F. Litta and G. B. Doglietto Surgical Sci- PNE test failure (p=0.008). The size of the EAS defect was not related to
ences, Catholic University, Rome, Italy. PNE test failure. In the logistic regression model we found higher age
Purpose: Sphincter lesions represents the major cause of fecal inconti- (p=0.046), male gender (p=0.042), previous failed tests (p=0.002) and EAS
nence (FI), particularly in females, with detrimental effects on daily activi- defects (p=0.005) to be predictors for failure. In the final model males with
ties and quality of life. Sphincter repair (SR) with overlapping is the tradi- repeated procedures due to either lead dislocation or insufficient results in
tional treatment, but a significant reduction of benefits has been reported the first procedure, had a significantly lower probability on successful out-
within 5 years after surgery. More recently, sacral nerve stimulation (SNS) come than females (p=0.021).
has been suggested after SR or as primary treatment. Conclusions: We have discovered several factors that can help predict
Methods: Twenty four females with FI in presence of SL were treated the outcome of PNE and subchronic test stimulation. Higher age, male gen-
with SR (14 pts, mean age 47.6±15.6, range: 26-70) or definitive implant of der, previously failed procedures and external sphincter defects on ultrasound
122
Abstracts
show a statistically significant relation with PNE and subchronic test stim- period. Groups were compared with respect to transfusion requirements,
ulation outcome failure. cause of bleeding, and progression to surgery.
Results: There were 77 patients total in both groups.32 patients
recieved AcA and 45 patients did not. The groups were similar demo-
S44 graphically with respect to age, comorbitities, and cause of hemorrhage.
WHAT IS OPTIMAL TREATMENT OF RECTAL PROLAPSE In the AcA group 12.5% (4/32) progressed to surgery compared to 35%
IN ELDERLY PATIENTS: ALTEMEIER PROCEDURE VS. (16/45) in the noAcA group which was significant. Tansfusion require-
LAPAROSCOPIC RECTOPEXY? ments were significantly lower among the AcA group with a mean 27 units
S. W. Lee1, O. Oliveira1, M. Gedeon1, D. L. Feingold2, T. Sonoda1, required verus 4.5 units for the nonAcA group. Diverticulosis was felt to
S. L. Stein1, K. J. Trencheva1, A. Li1 and J. W. Milsom1 1Colon and Rec- be the major cause of hemorrhage in both groups. There no aminocaproic
tal Surgery, New York Presbyterian Hospital - Weill Cornell Medical Col- acid related complications identified.
lege, New York, NY and 2Colon and Rectal Surgery, New York Presbyterian Conclusions: Aminocaproic acid appears to bea useful adjunct in the
treatment of massive lower gastrointestinal hemorrhage. It is associated
Hospital - Columbia Univ. Med Center, New York, NY.
with a significant reduction in both transfusion requirements and pro-
Purpose: To assess whether there are advantages in postoperative out- gression to surgery.
comes of elderly patients (pts) (> 70 yo) undergoing Altemeier procedure
(ALT) vs. laparoscopic rectopexy (RPX) for full-thickness rectal prolapse(RP).
Methods: We reviewed our data from a prospective clinical database and S46
the medical records of patients treated at a single institution from 2002 to MESENTERIC EMBOLIZATION: A SAFE AND EFFICA-
2008. Patients who underwent surgery for full-thickness rectal prolapse were CIOUS TREATMENT MODALITY OF LOWER GASTROIN-
evaluated. TESTINAL HEMORRHAGE.
Results: 16 patients underwent RPX (median age 83 (71-90) years; ASA
P. Rider, D. Beck, A. Timmcke, T. Hicks, C. Whitlow and D. Margolin
2.6) and 16 patients, ALT (median age 86 (73-94) years; ASA 2.8). ALT pts
Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, LA.
had a significantly higher recurrence rate when compared to RPX pts (table).
Mean length of follow up was longer for the ALT group compared to RPX Purpose: This study was designed to evaluate the short-term efficacy
group but most recurrence (5/6) occurred < 1 year. Median length of spec- and safety of highly selective microembolization in treatment of lower gas-
imen removed in ALT was 9.5 cm (6.5-18.5). Majority of pts in either group trointestinal bleeding.
had preop fecal incontinence. Significantly more ALT pts reported worsen- Methods: Patient outcomes from April 2004 to October 2008 regard-
ing periop fecal incontinence at (1-3 months). All RPX pts underwent gen- ing microembolization for lower gastrointestinal bleeding were retrospec-
eral anesthesia while 44 % of the ALT pts underwent regional anesthesia. tively reviewed after investigational review board approval at Ochsner Med-
One RPX pt required re-operation for incarcerated trocar site hernia. No ical Center.
other major complications occurred in either group. There was no differ- Results: Twenty-four separate hospitalizations (23 patients) were inves-
ence in minor complication rates. tigated. Mean age was 67 years. The patient population was composed of 8
Conclusions: RPX, compared to ALT, in elderly pts with RP resulted females and 15 males. Short term outcomes: microembolizations was suc-
in a significantly lower recurrence rate, better postoperative fecal inconti- cessful in achieving immediate hemostasis in all 23 patients (100%). One (4.3
nence, with equivalent complication rate. In elderly pts with RP who can tol- percent) patient bled after embolization and required operative intervention.
erate general anesthesia, RPX appears to offer several advantages over ALT Two patients (8.7%) developed postembolization ischemia. All three required
. operative intervention. Long-term outcomes: 23 patients were followed for
a mean of 16.4 months. One patient was readmitted with colonic stricture
requiring right hemicolectomy. One patient was readmitted 13 months after
initial treatment for recurrent bleeding which responded to repeat microem-
bolization.
Conclusions: This series of patients reviewed demonstrates the short
term success rate (100%) of hemorrhage control with regard to lower gas-
trointestinal bleeding. This modality of treatment carries little risk of ischemia
with only 8.7% requiring operative intervention due to acute ischemic com-
*Fisher’s exact ** Mann-Whitney plications. It can therefore be advised that microembolization can safely and
effectively be used as the primary modality of therapy in patients with lower
gastrointestinal bleeding apparent by angiography.
S45
THE ROLE OF AMINOCAPROIC ACID IN THE MANAGE-
MENT OF MASSIVE LOWER LOWER GASTROINTESTINAL S47
HEMORRHAGE. EFFECT OF RACE ON COLON CANCER CARE IN THE
G. Dunn, S. Clark and P. Cole LSUHSC/Christus Schumpert, Shreveport, DEPARTMENT OF DEFENSE HEALTH CARE SYSTEM.
LA. L. J. Hofmann, S. Lee, B. E. Waddell and K. G. Davis Deptartment of
Purpose: Lower gastrointestinal is a commonly encountered problem Surgery, William Beaumont Army Medical Center, El Paso, TX.
that is a source of major morbidity in those affected by it. Aminocaproic Acid Purpose: Black patients are more likely to die from colon cancer than
is an antifibrinolytic agent that has been shown to reduced blood loss in sev- whites in the United States. This increase in mortality is often attributed to
eral clinical situations. We reviewed our experience with the use of the disparities associated with stage at presentation and treatment. The aim
aminocaproic acid(AcA) in the management of lower gastrointestinal hem- of this study was to assess the influence of race on the treatments and sur-
orrhage. vivals of patients with colon cancer in an equal assess health care system.
Methods: We reviewed the records of patients treated by our service Methods: This retrospective cohort study included all black and white
with lower gastrointestinal hemorrhage From 2001 through 2006. Patients patients with colon cancer who were treated at Department of Defense facil-
recieving AcA were compared to those not receiving AcA during this time ities from 1993 to 2006. Disease stage, usage of surgery and chemotherapy,
123
Abstracts
and overall survival were studied in each group. Survival analysis was per- Percent of Colorectal Cancer Patients by Age at Diagnosis Category per 5-year Period
formed using Cox proportional hazard analysis.
Results: Of the 6958 patients identified, 1115 (16.0%) were black. Black
patients with colon cancer presented at younger ages (58.8 ± 12.7 years old
for blacks vs. 63.9 ± 12.7 years old for whites, independent t-test, p<0.001).
Black patients presented more frequently with Stage IV colon cancer, 24%
versus 18% of whites (p<0.001). However, there was no significant differ-
ence in the proportions of patients undergoing surgical resection for all stages
of colon cancer (88.2% for blacks vs., 87.3% for whites, chi-square, p>0.05).
There was no difference in the use of systemic chemotherapy for stage III
colon cancer (77.4% for blacks vs. 76.5% for whites, chi-square, p>0.05) or S49
stage IV colon cancer (61.1% for blacks vs. 58.2% for whites, chi-square, DOWNSTAGING FOLLOWING CRT FOR LOCALLY
p>0.05). When comparing all stages of colon cancer, the overall 5 year sur- ADVANCED RECTAL CANCER:IS THERE MORE (TUMOR)
vival rate was similar for black and white patients (56.1% for blacks vs. 58.5% THAN MEETS THE EYE?
for whites, log-rank, p>0.05). After adjusting for sex, age, tumor grade, and
stage, black race was not a risk factor for survival in Cox proportional haz- E. D. Mignanelli, L. F. Lobato, L. Stocchi, I. C. Lavery and D. Dietz
ard analysis (Hazard ratio: 0.993, 95% confidence interval: 0.898-1.098). Colon and Rectal Surgery, Cleveland Clinic Foundation, Cleveland, OH.
Conclusions: In an equal access health care system, black race was not Purpose: Pre-operative chemo-radiotherapy (CRT) can lead to patho-
associated with an increase in mortality from colon cancer. Black patients logic complete response (pCR) of rectal cancer. The nodal status of the
underwent surgical resection at a rate equal to whites for all stages of colon mesorectum in these patients is controversial. This study was designed to
cancer. In advanced stage colon cancer, chemotherapy was applied equally determine the relationship between post-CRT pathologic T-stage (ypT-
among black and white patients. stage) and nodal metastases and evaluate whether mural pCR results in ster-
ilization of mesorectal lymph nodes.
Methods: Clinico-pathological data from a prospectively maintained
S48 colorectal cancer database from 1997-2007 was examined. Inclusion criteria
EVALUATING THE AGE DISTRIBUTION OF PATIENTS were patients with extra-peritoneal rectal cancer, who underwent pre-oper-
WITH COLORECTAL CANCER: ARE THE U.S. PREVEN- ative CRT and subsequent radical resection. Exclusion criteria included
TATIVE SERVICES TASK FORCE GUIDELINES FOR COL- patients with rectal cancer associated with IBD, hereditary cancer syndromes
ORECTAL CANCER SCREENING APPROPRIATE? and those with synchronous cancers. Statistical analysis was performed using
the Kruskall-Wallis test and the Wilcoxon rank sum test for pair-wise group
J. K. Shellnut and H. J. Wasvary Colorectal Surgery, William Beaumont
comparisons.
Hospital, Royal Oak, MI.
Results: A total of 242 patients were identified (73.1% male, median age
Purpose: The purpose of this study was to evaluate the appropriateness 57 years old, (range 36 to 85 years old)). Pre-treatment TNM stage was avail-
of the current USPSTF screening recommendations for colorectal cancer. able in 232 patients; Stage I n=1 (0.5%), II n=145 (62.5%) and III n=86 (27%).
Evaluation of age at diagnosis data for colorectal cancer patients treated Complete data regarding pre-operative CRT was available in 177 patients
within the Beaumont Hospital System was undertaken to determine what (73.1%). The median dose of radiotherapy was 5040cGy (3060-6100cGy).
percent of patients with colorectal cancer fall within the USPSTF guidelines The mean pre-operative radiotherapy dose and the interval between com-
for colorectal cancer screening. pletion of radiotherapy and surgery are similar when stratified by ypT-stage
Methods: Age at diagnosis and stage of cancer data were collected on (p=0.55 and p=0.72 respectively). Low anterior resection was performed in
colorectal patients using the Beaumont Hospital System Tumor Registry. 174 patients (71.6%) and the remainder underwent APR. A mural pCR was
The registry currently has information on all colorectal cancer patients treated achieved in 62 patients (25.6%). In the pCR group lymph node metastatic
from January 1973 to March 2008. A database search of all patients having disease was found in 2 patients (3.2%). The rate of metastatic lymph nodes
been treated for colorectal cancer identified 7,008 patients. These data were increased as ypT-stage increased (ypT1=11.1%, ypT2=29.2%, ypT3=37.3%).
then analyzed dividing the 35-year time period into seven 5-year increments. Conclusions: The number of patients with a mural pCR that have lymph
The age at diagnosis data were then analyzed using the Chi-Square test to node metastases is low. These findings may have implications for the man-
determine if there has been a change in the age distribution of colorectal can- agement strategies of these patients including the use of local resection or a
cer patients over time. Stage of cancer data were evaluated using the Chi- watch-and-wait policy. However, when the response to CRT is not complete,
square test to determine if the distribution of tumor stage varied by age cat- radical surgery should remain the treatment based on relatively high rates
egory. of lymph node involvement.
Results: The percent of patients < 50 years old, with colorectal cancer,
has not changed from 1973 to 2008. The percent of patients over age 75,
however, has increased significantly from 29% to 40% (P <0.0001.) Patients S50
over the age of 85 comprised 12% of all colorectal cancer patients in the PALLIATIVE RESECTION OF THE PRIMARY LESION IN
past five years. This was a significant increase over previous five year time STAGE IV RECTAL CANCER PROLONGS SURVIVAL.
periods (P <0.0001.) Patients under the age of 50 were more likely to pres-
C. Cellini, S. Hunt, A. Lin, E. Birnbaum, J. Fleshman and M. Mutch
ent with stage 4 disease than those over 50 (19% vs. 12%, P = 0.035.)
Conclusions: Failing to screen patients over 75 would potentially miss Colorectal Surgery, Washington University School of Medicine, St. Louis,
40% of patients with colorectal cancer. In the past five years 49% of patients MO.
were under 50 or over 75 years old, placing them outside screening recom- Purpose: Surgical resection of the primary lesion and liver metastasis
mendations. These data place current USPSTF screening recommendations remains the optimal management of stage IV rectal cancer. For patients with-
for colorectal cancer in question as almost 50% of patients fall outside these out synchronous resections, recent advances in chemotherapy have had sig-
guidelines. nificant impact on their outcomes. We compared outcomes for patients with
metastatic rectal cancer managed with synchronous resection, staged resec-
tion or resection of rectal tumor only.
124
Abstracts
Methods: A prospective database was queried for patients with metasta- ingrowth after 1 and 3 months respectively. One patient had the stent removed
tic rectal cancer to the liver only from 2002 to 2008. Data collected from due to persistent tenesmus and stent migration occurred in one case.
clinic and hospital charts included pre-treatment CEA, metastatic sites, and Conclusions: These results demonstrate colonic stenting by a combined
number of liver lesions. Statistical analysis was determined by ANOVA. Sur- radiological and endoscopic approach to be safe and useful in palliation to
vival was determined using the Kaplan–Meier method. avoid major surgery or stoma in patients with incurable and obstructing
Results: Seventy-six patients were identified with rectal cancer metasta- colonic cancer. It can also be used as a bridge to surgery, converting emer-
tic to the liver only; eight patients were excluded due to incomplete charts. gency operations to an elective setting, in resectable and acutely obstructed
Of the 68 patients, 30 had synchronous resections of the primary and liver colonic cancer, with acceptable mortality and morbidity.
metastasis, 14 had staged resections of the primary and liver lesions, and 24
had resection of the primary only. All patients received neoadjuvant 5-FU
based chemoradiation and adjuvant chemotherapy with FOLFLOX +/- S52
bevaxizumab. Median follow up was 15 months (range 1-57 months). After IS THE PHENOTYPE MIXED OR MISTAKEN? HYPER-
adjuvant therapy, 37% patients were deemed eligible for liver resection. The PLASTIC POLYPOSIS SYNDROME AND HEREDITARY NON
remaining 24 patients received further chemotherapy. A total of 65% of POLYPOSIS COLORECTAL CANCER.
patients underwent liver resection. Those with primary resection only had A. M. Jarrar, J. M. Church, S. Fay and M. F. Kalady Colorectal Surgery,
shorter median survival than those with liver resection (15 vs 47 months; Cleveland Clinic Foundation, Cleveland, OH.
p=0.03). However, the two-year survival was 40% for those without liver
Purpose: Hyperplastic Polyposis Syndrome (HPS) is a rare colorectal
resection. There was no difference in survival in patients with synchronous
cancer syndrome characterized by multiple hyperplastic polyps (HPs)/ser-
or staged resections (p=0.6). Number of liver lesions (p=0.038) and pres-
rated polyps with an increased risk of colorectal cancer. The resulting can-
ence of extrahepatic disease (p= 0.03) were the greatest predictors of
cer is associated with BRAF mutations and CpG Island Methylation Phe-
resectability.
notype (CIMP +ve). Hereditary nonpolyposis colorectal cancer (HNPCC)
Conclusions: Surgical resection of liver metastasis remains the optimal
malignancy predisposition is due to germline mutations in DNA mismatch
treatment for stage IV rectal cancer. However, in patients who are not can-
repair (MMR) genes leading to MSI-H, and often CIMP +ve tumors. Some
didates for liver resection, resection of the primary lesion provides signifi-
patients with HNPCC have multiple serrated polyps and thus have a phe-
cant oncologic benefit. With today’s adjuvant chemotherapy many of these
notype that overlaps with that of HPS. This study describes patients and
patients may become eligible for resection or have improved survival.
families that are both HPS and HNPCC. No papers discussing such coex-
istence were found in the literature
Methods: A single institute hereditary colorectal cancer registry was ret-
rospectively reviewed for patients who fit HPS criteria. HPS is defined as
meeting one of the following 1)≥20 HPs anywhere in the colon, 2)≥ 5 HPs
proximal to the sigmoid colon, 3)≥ 2 HPs at least 10mm in size, 4)any HPs
and 1st degree relative with HPS. Details about each colonoscopy were
recorded. Patients meeting HPS and either HNPCC or Familial Colon Can-
cer (FCC) criteria were analyzed
Results: 12 patients from 7 families were identified. 4 families had more
than 1 person meeting criteria. 33% of involved were females. All were Cau-
casian. 7 of 12 patients fit Amsterdam-like criteria, 3 of 12 fit Amesterdam-
1, and 2 of 12 were diagnosed as FCC. Median cumulative number of HPs
resected per patient was 6 with a median size of 4 mm. 50% of HPs were
located in right colon. 7 of the12 patients developed colorectal cancer and
S51 2 patients had other cancers including basal cell carcinoma of the eyelid and
COMBINED RADIOLOGICAL AND ENDOSCOPIC prostate cancer. 11 patients had a family history of colorectal cancer and 8
APPROACH HAS A HIGHER SUCCESS RATE IN COLONIC had a family history of other cancers (prostate, breast, testicular, salivary
STENTING. gland, lung and Hodgkin’s disease)
Conclusions: HNPCC is sometimes associated with multiple, large, ser-
N. Wong, A. Venkatasubramaniam, S. Plusa, H. Gallagher, J. Hanson, rated polyps. Possible explanations include: 1)the presence of two hereditary
F. Bergin, D. Richardson and J. Graham Colorectal Surgery, Royal Vic- syndromes in the same patient, 2)serrated polyps being part of the pheno-
toria Infirmary, Newcastle upon Tyne, United Kingdom. type of HNPCC, or 3)some families potentially misdiagnosed as HNPCC
Purpose: Colonic stenting for obstructing cancer is widely used with a do in fact have HPS
reported success rate of only about 70% and a significant perforation rate.
Stents may be inserted purely endoscopically but we report good results with
a combined radiological and endoscopic approach. S53
Methods: All stenting procedures carried out from 2003 to 2008 were SENTINEL NODE BIOPSY IN SQUAMOUS-CELL CARCI-
analysed on intention to treat basis. The tumour site, stage of disease and NOMA OF THE ANAL CANAL.
successful deployment and complication rates were studied. All patients had P. De Nardi1, M. Carvello1, P. Passoni2, C. Canevari3, N. Slim2 and
a combined approach. The indications were acute and/or impending bowel C. Staudacher1 1Surgical Department, Scientific Institute S. Raffaele Hos-
obstruction, or palliation in advance disease. pital, Milano, Italy, 2Department of Radiation Therapy, Scientific Institute
Results: Stenting was attempted in 84 patients (50 male, 34 female), with S. Raffaele Hospital, Milano, Italy and 3Department of Nuclear Medicine,
a mean age of 72 years (range 43-95). Stent deployment was successful in 71
Scientific Institute S. Raffaele Hospital, Milano, Italy.
patients (83%). 11 patients (15%) were stented as a potential bridge to sur-
gery and 60 patients (85%) as a definitive palliative procedure. The distri- Purpose: Radiochemotherapy is the standard treatment for patients with
bution of the sites of stenting was 2% in rectum, 58% sigmoid, 19% rec- squamous-cell carcinoma of the anal canal. Since the presence of inguinal
tosigmoid, 7% descending, 5% splenic flexure and 7% in transverse colon. lymphnodes metastasis cannot be accurately predicted, by clinical and radi-
Perforation was reported in 5 patients (6%). Two patients had tumour ological modalities, the ideal approach to clinically negative inguinal lym-
125
Abstracts
phnodes is still controversial. The radiotherapy fields vary between Centers: type/duration of antibiotics were not statistically significant predictors of
some institutions exclude the inguinal region, with consequent under treat- treatment failure.
ment of patients with undetected inguinal metastasis, some others employ Conclusions: This is the largest study to date examining the effective-
prophylactic irradiation, thus over treating a large proportion of patients. ness of outpatient treatment of acute diverticulitis. We found that treatment
Aim of this study was to asses feasibility of the sentinel node technique in is effective for the vast majority (93.0%) of patients with mild diverticulitis.
patients with squamous-cell carcinoma of the anal canal, in order to provide Women and Hispanics appear to be at higher risk for treatment failure.
a more reliable tumor staging. Specific CT scan findings should also prompt caution, especially evidence
Methods: From April 2007 to October 2008, 7 patients (5 female), mean of free fluid or perforation.
age 59.6 (range 39-75), with histologically proven squamous-cell carcinoma Rates and Predictors of Treatment Failure
of the anal canal, and clinically and radiologically negative groin lymphn-
odes, were studied. The patients were staged with endorectal ultrasound, CT
scan and PET. One patient had T1, 3 had T2, and 3 had T3 tumor (UJCC
2002 Classification). A peritumoral, 1200µCi 99mTc colloid injection, fol-
lowed by lymphoscintigraphy, was performed 16-18 hours before surgery.
During surgery patent blue injection was carried out to aid intraoperative
detection. Under local anesthesia sentinel lymphnode, in the inguinal region,
was then identified by a hand-held gamma probe (Neoprobe 2000®). The
resected lymphnode was examined by hematoxylin-heosin stain.
Results: Sentinel lymphnode was detected in all the 7 patients, in 2 cases
bilaterally, by scintigraphy. All the patients underwent radioguided node
biopsy and a total of 11 blue-stained, radiolabeled, lymphnodes were removed.
The average diameter of the resected nodes was 5 mm (range 4-10 mm). No
intra- or postoperative complications occurred. In 4 patients metastatic squa-
mous carcinoma was identified in the sentinel lymphnode.
Conclusions: This procedure seems reliable in detecting metastatic dis-
ease, in the inguinal nodes, in patients with anal carcinoma. Its application
could improve tumor staging and could lead to a more accurate selection of
patients for inguinal irradiation.
S54
OUTPATIENT TREATMENT OF ACUTE DIVERTICULITIS:
RATES, PREDICTORS OF FAILURE.
D. A. Etzioni1, R. R. Cannom1, V. Y. Chiu3, R. J. Burchette3, P. I. Haigh2
and M. A. Abbas2 1Colorectal Surgery, University of Southern California,
Los Angeles, CA, 2Colon and Rectal Surgery, Southern California Kaiser
Permanente, Los Angeles, CA and 3Research and Evaluation, Southern Cal-
ifornia Kaiser Permanente, Pasadena, CA.
Purpose: Diverticulitis poses a significant clinical burden to the United
States population, with over 160,000 admissions per year. While inpatient
hospitalization is essential for some patients with acute diverticulitis, many
can be successfully managed on an outpatient basis. The success rate for out-
patient treatment of acute diverticulitis, however, is poorly characterized in S55
the literature to date. We hypothesized that outpatient treatment of acute DIVERTICULITIS; DOES AGE PREDICT COMPLICATED
diverticulitis is highly effective, and tested this hypothesis by analyzing a large DISEASE?
cohort of patients treated on an outpatient basis for an initial episode of acute
diverticulitis.
J. F. Hall1, P. L. Roberts1, R. Ricciardi1, C. Scheirey2, P. W. Marcello1,
Methods: We identified patients within the Southern California Kaiser C. Wald2, J. M. Sampson1 and d. Schoetz1 1Colon and Rectal Surgery,
Permanente system diagnosed with diverticulitis during an emergency room Lahey Clinic, Burlington, MA and 2Radiology, Lahey Clinic, Burlington,
visit in years 2006-2007, and who were treated as an outpatient with oral MA.
antibiotics. Each patient had the diagnosis confirmed with a CT scan, and Purpose: There is considerable controversy regarding the clinical course
each radiologic report was evaluated regarding presence of free fluid, micop- of young patients (age ≤ 50 years) with diverticulitis. Young patients are
erforation, and abscess. The cohort was restricted to patients continuously believed to have a more virulent course. The aim of our study is to deter-
enrolled in Kaiser for 5 years prior to ER evaluation, and without any diag- mine whether young patients are more likely to present with complicated
nosis of diverticulitis during that period. Treatment failure was defined as a diverticulitis.
return to ER or admission for a diagnosis of diverticulitis within a 60-day Methods: We analyzed the abdominal computed tomography (CT) scans
period. of 932 consecutive patients with an initial episode of diverticulitis from Jan-
Results: Our study included 697 patients, of which 54.1% were women, uary 2002 through June 2007. CT scans were re-interpreted by dedicated
and average age was 58.5 years. Of these 697 patients, 7.0% failed treatment gastrointestinal radiologists for evidence of complicated diverticulitis (extra-
according to our criteria. In multivariate analysis women and Hispanic luminal air, abscess, or fistula). The cohort was divided into two groups;
patients were at higher risk for treatment failure. CT scan documentation patients ages ≤ 50 years (Group 1) and patients ages > 51 years (Group 2).
of free fluid or microperforation was also correlated with worse outcome. CT scan characteristics were compared between groups using Student’s t test
Other factors, including age, white blood cell count, Charlson score, and and Fishers exact testing.
126
Abstracts
Results: The mean age of the cohort was 61 years (range, 22 - 106); 243
were < 50 (Group 1) and 689 were > 50 (Group 2). The mean ages of Group
1 and Group 2 were 42 (range, 22-50) and 68 (range, 51-106) years (p<0.001).
Group 1 patients were more likely to be male (63% versus 42%, p < .0001).
Extraluminal air was noted in 132 patients (14%), abscess in 111 patients
(11%), extraluminal air in 132 patients (14%), and fistulae in 29 patients
(3%). Group 1 had a higher proportion of scans with extraluminal air than
group 2 (19.7% versus 12.6%, p<0.008). There were no differences between
group 1 and group 2 in CT scans with free perforation (0.82% v. 2.76%,
p=0.63), abscess formation (12.3% v. 10.7%, p=0.56), or rate of fistula for-
mation (3.34% v. 2.27%, p=0.53).
Conclusions: In this large review of the initial clinical presentation of
S57
diverticulitis, the most common complications include the presence of extra-
A FAST TRACK RECOVERY PROTOCOL IMPROVES OUT-
luminal air and pericolic abscess. Young patients are more likely to present COMES IN ELECTIVE LAPAROSCOPIC COLECTOMY FOR
with evidence of complicated diverticulitis such as extraluminal air. These DIVERTICULITIS.
results suggest that young patients have a more virulent form of diverticuli- J. G. Touzios, D. W. Larson, R. R. Cima, J. H. Pemberton, H. K. Chua
tis on presentation to the hospital. and E. J. Dozois Division of Colon and Rectal Surgery, Mayo Clinic,
Rochester, MN.
Purpose: Fast-track (FT) post operative protocols have been shown to
S56 be beneficial in open colectomy. The efficacy of FT in laparoscopic colon
RISK ASSESSMENT OF CONSERVATIVE TREATMENT surgery has not been clearly demonstrated. The purpose of our study was to
FAILURE IN ACUTE LEFT COLONIC DIVERTICULITIS. evaluate the short term outcomes of FT recovery protocols on laparoscopic
O. Pittet1, N. Kotzampassakis1, S. Schmidt2, A. Denys2, N. Demartines1 colectomy for diverticulitis.
and J. M. Calmes1 1Visceral Surgery, Centre Hospitalier Universitaire Methods: Using a prospectively maintained database, all patients who
Vaudois, Lausanne, Switzerland and 2Radiology, Centre Hospitalier completed elective laparoscopic sigmoid resection for diverticulitis from 1998
Universitaire Vaudois, Lausanne, Switzerland. to 2008 were identified. Univariate analysis was performed to compare FT
Purpose: Management of acute diverticulitis varies from outpatient man- versus non-FT (NFT) with respect to short term outcomes.
agement and antibiotherapy to surgery and colostomy. Current guidelines Results: A total of 334 patients were included in the analysis: 99 (30%)
recommend CT-scan evaluation of the disease but strategy of treatment on FT protocol and 235 (70%) on a NFT protocol. There was no differ-
remain open based on patients’ conditions. Conservative treatment failure ence between the groups with respect to age, gender, BMI, ASA class, and
reach 10-30% and no clinical nor radiological criteria allows to predict it percentage of complicated diverticulitis. The time to tolerating soft diet
accurately, excepted one single CT-score published by Ambrosetti. The aim (mean 2.3 vs. 3.6 days) and time to first bowel movement (mean 2.6 vs 3.5
of the present study was to assess the risk of conservative treatment failure days) was shorter in the FT group (p<0.001). The median length of stay
at the time of diagnosis based on clinical and radiological parameters. (interquartile range) was 3 (3-4) days and 5 (4-6) days for the FT and NFT
Methods: Retrospective cohort study of 271 consecutive patients admit- groups, respectively (p<0.001). Morbidity was significantly lower in the FT
ted for diverticulitis confirmed by CT scan between 2001 and 2004. Sev- group compared to the NFT group (15% vs. 25%, p<0.05). The 30 day read-
enty four percent had successful conservative treatment (group S) and 26% mission rate was no different between the groups, 5.5% vs. 9.8% for FT
had failure (group F). Failure of conservative treatment was defined as need and NFT, respectively. No mortalities were observed in either group at 30
of surgery,radiological drainage, or recurrence within 30 days or death. days.
Twenty different clinical and 15 radiological parameters were analyzed. Uni- Conclusions: Fast-track recovery protocols improve speed of recovery,
variate and multivariate analysis was used to develop a comprehensive risk shorten length of hospital stay, and decrease morbidity in patients undergo-
index . ing laparoscopic colectomy for diverticular disease.
Results: Three clinical and 4 radiological parameters were identified in
the multivariate analysis to compose the index. Four risk classes were defined.
The risk of conservative treatment failure varies from 5 % in class I to 83%
S58
in class IV (see table 1). Compared to Ambrosetti criteria based on the risk
MANAGEMENT OF COLON INJURIES IN THE COMBAT
to need surgery, our risk index allows a 4- fold reduction of false negative THEATER.
assessment ( 4.1 vs 1.1%, p=0.04). D. Cho1, L. N. Kiraly1, S. F. Flaherty2, D. Herzig1 and M. A. Schreiber1
1
Conclusions: Our Risk index allows to stratify the risk of conservative Surgery, Oregon Health and Science University, Portland, OR and 2Surgery,
treatment failure in different risk classes that help the physicians to plan the Landstuhl Regional Medical Center, Landstuhl, Germany.
treatment modalities at the time of admission accurately. It permits to reduce Purpose: Combat injuries are associated with higher rates of blast, pen-
the risk of over- and –undertreatment. Risk index is correlated to the sever- etrating and high energy mechanisms resulting in greater tissue loss than
ity of the disease, with highest incidence of Hinchey III/IV in risk class IV. civilian trauma. Despite implementation of mandatory colostomy in WWII,
The stratification in risk classes permits also to standardise the severity of civilian data suggest that primary repair without diversion is safe and feasi-
the disease, which might be used by the medical community to analyse and ble. Differences between combat and civilian trauma have generated con-
compare protocols and outcome. troversy over the management of battle related colon injuries. The purpose
of this study was to describe the initial management of battle related colon
injuries and to determine if management strategy affects early complication
rate.
Methods: Records from the combat theater (downrange) and the terti-
ary referral center in Germany (LRMC) from 2005 and 2006 were retro-
spectively reviewed. Patient and injury characteristics, injury severity score
(ISS), management strategy, treatment course, and early complications were
recorded.
127
Abstracts
Results: 133 (97% male) patients sustained colon injuries from pene-
trating (72%), blunt (5%), and blast (23%) mechanisms. Average (±SEM)
S60
SIMULATED LAPAROSCOPIC SIGMOIDECTOMY TRAIN-
ISS was 21±1.3 and length of stay (LOS) at LRMC was 7.1±1.8 days. Injury
ING: RESPONSIVENESS OF SURGERY RESIDENTS.
distribution was: 21% ascending, 21% descending, 15% transverse,, 27%
sigmoid and 25% rectum. The complication rate was 12% overall and was R. Essani1, R. Scriven1, A. McLarty1, L. Merriam1, H. Ahn2 and R. Berga-
not related to type of management (p=0.172). Complications were linked to maschi1 1Surgery, Division of Colon and Rectal Surgery, State University
open abdomen (p=0.031), increased ICU days (p=0.015), gunshot wound of NewYork, Stony Brook, NY and 2Applied Mathematics and Statistics, State
(p=0.021), and number of downrange procedures (p=0.008), but not LOS, University of New York, Stony Brook, NY.
ISS, location of injury, or massive transfusion. Purpose: This study aimed to evaluate the responsiveness of surgery res-
Conclusions: Penetrating rectosigmoid injury occurs commonly in this idents to simulated laparoscopic sigmoidectomy (SLS) training.
population. Early complications were similar by ISS, massive transfusion, Methods: Residents underwent SLS training for previously tattooed can-
location of injury, and management strategy, supporting the equivalence of cer using disposable abdominal trays in a hybrid simulator (ProMIS). The
definitive repair and colostomy. six sequential steps included splenic flexure mobilization, division of inferior
mesenteric vessels (IMVs), identification of left ureter, mobilization of sig-
moid, transection of rectosigmoid, and anastomosis. After baseline testing
and training, residents were tested with previously determined passing scores.
Content validity was defined as the extent to which outcome measures
departed from clinical reality. Content valid measures from the trays were
evaluated by two blinded raters. Simulator generated metrics were path length
and smoothness of movements. Responsiveness was defined as change in per-
formance over time and was assessed by comparing baseline testing with
S59 un-mentored final testing. Values are given as medians.
ANASTOMOSIS IN EMERGENCY COLON SURGERY: A Results: Over 8 weeks, 8 PGY 3/4 residents performed 34 resections.
LARGE PROPENSITY SCORE MATCH ANALYSIS. Overall time (67 vs 37 min, p=0.005), flexure time (10 vs 5 min, p=0.005),
B. R. Swenson, T. L. Hedrick, R. G. Sawyer and C. M. Friel Depart- IMV time (8 vs 5 min, p=0.04), and ureter time (7 vs 1 min, p=0.003) improved
ment of Surgery, University of Virginia Health System, Charlottesville, VA. significantly. There was a linear relationship between advanced clinical laparo-
Purpose: Studies favoring primary colon anastomosis in gunshot victims scopic case volume and responsiveness (r=-0.7, p=0.04). IMA stump length
as well as favorable outcomes reported when mechanical bowel prep for colon (3 cm), anastomotic distance from anal verge (16 cm), angle of rectal tran-
surgery is omitted are often extrapolated to justify resection and primary section (81 degrees), specimen length (20 cm), proximal margin (6 cm), dis-
anastomosis in emergency colon surgery. We hypothesized that analysis of tal margin (12 cm), path length (26702 mm), and smoothness (2921 cm/sec3)
a large database of similar patients with or without an anastomosis would remained unchanged. There were 2 bowel perforations and 19 anastomotic
show similar outcomes between these two groups. leaks. Anastomotic leak rate decreased from 87% to 12.5%. A strong corre-
Methods: The National Surgery Quality Improvement (NSQIP) data- lation was found between path length and smoothness (r=0.9, p<0.001). Sim-
base for 2005-2007 was queried for emergency colon resection procedures ulator metrics were not correlated with content valid measures. Interrater
with an anastomosis (CPT codes: 44140, 44145) and without an anastomo- reliability was 1.0 for most measures except anastomotic leak (k=0.56).
sis (CPT codes: 44141, 44143, 44144). Patients with an anastomosis were Conclusions: SLS training resulted in significantly decreased operat-
1:1 propensity score matched to patients without an anastomosis on 39 demo- ing time and anastomotic leak rate for all residents.
graphic and perioperative variables using greedy methodology. Outcomes
for the two matched groups were then compared using Student’s t-test or
chi-squared analysis, where appropriate. S61
Results: 2,064 patients were matched (1,032 in each group). The groups ASCRS RESIDENCY TRAINING AFTER THE COST TRIAL:
were well matched in terms of age, gender, pre-morbid functional status, ARE OUR FELLOWS PRIMED TO PERFORM LAPARO-
comorbidities, steroid use, preoperative weight loss, wound class, ASA class, SCOPIC COLECTOMY?
and operative time. Select outcomes are listed in the table. Patients with an S. L. Stein1, J. J. Stulberg2 and B. J. Champagne2 1Section of Colon and
anastomosis exhibited a greater 30-day mortality (26% relative risk increase, Rectal Surgery, NewYork Presbyterian Weill Cornell Medical Center, New
95% CI 1.5% - 56%). York, NY and 2Division of Colorectal Surgery, University Hospitals/Case
Conclusions: These data call into question the increasing emphasis on Western Medical Center, Cleveland, OH.
primary anastomosis in emergency colon surgery. In this large database there Purpose: The ability to perform laparoscopic colectomy (LC) is an inte-
was a clinically relevant increase in mortality in patients having a primary gral part of a young colorectal surgeon’s practice. Whether new surgeons
anastomosis when compared with similar patients who were diverted. This feel comfortable performing LC upon completion of their fellowship is
mortality difference should be considered when contemplating a primary unknown. We aim to investigate the number of cases required in fellowship
colon anastomosis in an emergency setting. to feel comfortable and how that translates into post fellowship practice
Outcomes
patterns.
Methods: An electronic survey designed by ASCRS Young Surgeons
Committee was sent to 342 graduates of ASCRS fellowships from 2004–
2008. Data collected included demographics and number of laparoscopic
right (LR), laparoscopic left (LL) and hand-assisted left (HAL) colectomy
cases performed during residency. Trainees were asked to assess if they were
Continuous variables are reported as N ± standard deviation. Categorical variables are very comfortable, somewhat comfortable or not comfortable, with each case
reported as % (N) at the completion of their fellowship.
Results: 176 (51%) surgeons responded to the survey. 42 (24%) reported
performing <10 LRs during fellowship, 108 (61%) performed 10-30, and 24
(14%) performed >30. 13 (7.5%) respondents were not comfortable, 42 (21%)
were somewhat comfortable and 119 (68%) were very comfortable with
128
Abstracts
LR. For LL, 58 (34.8%) performed <10, 92 (52.6%) performed 10-30, and
S63
22 (12.6%) >30. Of those, 12.2% were not comfortable, 33.7% somewhat
IMPACT OF FAST TRACK SURGERY ON HEMODYNAMICS
comfortable, and 54.1% very comfortable. For HALS: 83 (47.4%) performed
AND RENAL FUNCTION: RESULTS OF A CONTROLLED
<10, 68 (38.9%) performed 10-30, 24 (13.7%) performed >30. 14.9% were
not comfortable, 31.6% somewhat comfortable, and only 53.4% very com- RANDOMIZED TRIAL.
fortable. 90% of fellows performing 30 or greater LR, LL or HALS were M. Hübner1, S. Muller1, P. A. Clavien2, N. Demartines1 and M. P. Zalu-
very comfortable, yet less than 50% of those performing fewer than 30 LR, nardo3 1Visceral Surgery, University Hospital Lausanne, Lausanne, Switzer-
LL or HALS procedures were very comfortable. Each year’s graduating fel- land, 2Visceral and Transplantation Surgery, Zurich University Hospital,
lows were more comfortable with LC than in previous years (p=0.02). Respon- Zurich, Switzerland and 3Anesthesiology, Zurich University Hospital, Zurich,
dents in practice 2-5 years recorded performing <10 cases LR 25%, LL 41%, Switzerland.
HAL 40.4%. Purpose: Important key factors of Fast Track (FT) programs are fluid
Conclusions: A significant number of fellows graduating from ASCRS restriction and an epidural analgesia (EDA). We aimed to challenge the pre-
fellowships are not very comfortable performing LC, despite requiring only conception that the combination of these measures might induce hypoten-
10 LR and 30 LL to obtain comfort. This translates to a significant number sion and renal dysfunction.
of young practioners who perform few LC in practice. These trends should Methods: A recent randomized trial (NCT00556790) showed a signif-
be examined to produce fellows who are primed for practice at the end of icant reduction of complications after colonic surgery in patients within a
the fellowship. FT program compared to standard care (SC). Adherence to the study pro-
tocol was carefully recorded and correlated in this study to postoperative cat-
echolamine requirements and renal function.
S62 Results: FT (n=76) and SC (n=75) group were comparable regarding
FLUID MANAGEMENT FOR LAPAROSCOPIC COLEC- demographics and operation characteristics. According to the study proto-
TOMY: A PROSPECTIVE RANDOMIZED ASSESSMENT OF col, FT patients received significantly less crystalloids intraoperatively
GOAL DIRECTED ADMINISTRATION OF BALANCED SALT (1875ml (range: 1100-5700) vs 2950ml (range: 1600-5900) P>0.0001). Addi-
SOLUTION OR HETASTARCH COUPLED WITH AN tionally, 61 FT and 59 SC patients had an effective EDA (thoracic level 6-
ENHANCED RECOVERY PROGRAM. 9). Both groups did not differ significantly regarding needs for colloids or
A. J. Senagore1, T. A. Emery3, M. Luchtefeld2, D. Kim2, N. Dujovny2, catecholamines during the intervention (23 vs 16 patients, P= 0.265, and 26
R. Hoedema2 and H. Slay2 1Spectrum Health, Grand Rapids, MI, 2Fergu- vs 17 patients, P=0.149, respectively). Fluid restriction was maintained in the
son Clinic/ Michigan Medical PC., Grand Rapids, MI and 3Anesthesiology, FT group postoperatively (700ml (range: 400-2400) vs 2300ml (range: 1800-
Anesthesia Medical Consultants, Grand Rapids, MI. 3800), P>0.0001). In total, 54 FT patients had postoperative fluid restriction
Purpose: No consensus exists regarding the optimal fluid (crystalloid in combination with a functioning EDA. However, postoperative cate-
or colloid) or strategy (liberal, restricted, or goal directed) for fluid man- cholamine requirements were similar among the two groups (eight FT vs
agement after colectomy. Prior assessments have utilized normal saline. This nine SC patients, P=0.803). Furthermore, pre- and postoperative creatinine,
study is the first assessment of standard perioperative fluid management Na+ and K+ levels did not differ and no patient developed renal dysfunction
(STD), and goal directed with either lactated ringers solution (GD-LR) or in either group. Only one of 82 patients having an EDA without a bladder
hetastarch/lactated ringers solution (GD-HLR) in laparoscopic colectomy catheter had a urinary retention.
with an enhanced recovery protocol (ERP) using esophageal Doppler (ED) Conclusions: Fluid restriction and an EDA in FT programs are not asso-
for guidance. ciated with postoperative hemodynamic instability or renal dysfunction. An
Methods: A double blinded, prospective, randomized, three armed study EDA (thoracic level 6-9) does not mandate a urinary catheter.
with IRB approval was used for laparoscopic segmental colectomy patients
(LC) assigned to STD, GD-LR and GD-HLR. A standard anesthesia and
basal fluid administration protocol was used in addition to the GD strate-
S64
HOSPITAL BASED FACTORS IN SPHINCTER PRESERVING
gies guided by ED.
SURGERY FOR RECTAL CANCER.
Results: 58 LC patients (19 STD, 18 GD-LR, 21 GD-HLR) had sim-
ilar operative times (STD-2.4 hrs; GD-LR-2.3 hrs; and GD-HLR-2.5). The I. M. Paquette, J. A. Kemp and S. Finlayson General Surgery, Dartmouth
LR group received the greatest amount of total and ml/kg/hr operative fluid Hitchcock Medical Center, Lebanon, NH.
(STD-3,000/20; GD-LR-3,825/23; GD-HLR-3,300/17; p<.05). The GD- Purpose: Sphincter preserving surgery for rectal cancer is associated with
HLR group had the longest stay. (STD-64 hrs; GD-LR-70 hrs; GD-HLR- higher patient satisfaction, equivalent oncologic outcomes, and less mor-
75 hrs; p<.05). The STD group received the greatest amount of fluid bidity than abdominoperineal resection. There have been no national stud-
(ml/kg/hr) during hospitalization (STD 2.69; GD-LR 2.13; GD-HLR 1.94; ies exploring trends in the use of sphincter preserving rectal resection over
p<.05). There was one instance of operative mortality in the GD-HLR group. time, while accounting for both hospital and patient factors.
Conclusions: GD fluid management with a colloid/balanced salt solu- Methods: Retrospective cohort study of 47,713 patients from the Nation-
tion offers no advantage and is more costly. However, GD individualized wide Inpatient Sample undergoing surgery for rectal cancer from 1988-2006.
intraoperative fluid management with crystalloid should be evaluated fur- Hospitals were stratified into quartiles based on procedure volumes. Uni-
ther as a component of ERP following colectomy due to reduced overall fluid variate and multivariate analyses were performed to identify patient and hos-
administration. pital factors associated with sphincter preserving surgery. We then compared
rates of sphincter preserving surgery over time across hospital strata.
Results: Patient characteristics associated with sphincter preservation in
multivariate analysis were age<60, female gender, and white race (p<0.001).
Among hospital factors associated with sphincter preservation, the most
important predictors were high procedural volume (OR 1.55, 95% CI 1.33-
1.79, p < 0.001), and urban location (OR 1.26, 95% CI 1.33-1.40, p <0001).
While sphincter preservation increased over time in the entire cohort, (35.4%
in 1988 vs. 60.5% in 2006), high volume hospitals had significantly higher
129
Abstracts
rates of sphincter preservation compared to the lowest volume hospitals. likely to report symptoms in the gastrointestinal tract area [16(11) vs 12(12);
(Figure 1). p=0.022].
Conclusions: Although adoption of sphincter preserving surgery was Conclusions: While CAA is associated with better physical functioning
observed across all hospital volume strata, overall rates of sphincter preser- and body image compared to APR, it leads to increased gastrointestinal symp-
vation were consistently higher in high volume and urban hospitals. Fur- toms and impaired sexual function. It is important to counsel patients under-
ther research is needed to determine whether these differences reflect dis- going surgery for low rectal cancers regarding these functional and quality
parities in quality of surgical care, or simply differences in case mix. of life outcomes.
EORTC QLQ-C30 and -CR38
S65
QUALITY OF LIFE AFTER COLOANAL ANASTOMOSIS
AND ABDOMINOPERINEAL RESECTION FOR LOW REC-
TAL CANCERS. SPHINCTER PRESERVATION VS QUALITY
OF LIFE.
M. S. Kasparek2, I. Hassan4, R. R. Cima1, D. W. Larson1, E. J. Dozois1,
R. E. Gullerud3, D. R. Larson3, J. H. Pemberton1 and B. G. Wolff1
1
Department of Colorectal Surgery, Mayo Clinic Rochester, Rochester, MN,
2
Department of Surgery, Ludwig-Maximilians-University Munich, Munich,
Germany, 3Division of Biostatistics, Mayo Clinic Rochester, Rochester, MN
and 4Department of General Surgery, Southern Illinois University School of
Medicine, Springfield, IL.
Purpose: Advances in surgical technique and adjuvant therapies made
sphincter preservation with coloanal anastomosis (CAA) the standard of care
in patients with low rectal cancers. This is based on the premise that a per-
manent colostomy has an adverse impact on patient quality of life (QOL).
However, functional outcomes following sphincter preservation are known
to affect QOL as well. The aim of this study was to determine differences
in QOL of patients with low rectal cancer undergoing CAA and APR.
Methods: At a single institution between 1995-2001, 85 patients under-
S66
went CAA and 83 patients underwent an APR for rectal cancer. QOL was CARING FOR OCTOGENARIAN AND NONAGENARIAN
evaluated using the EORTC QLQ-C30 (European Organization for COLORECTAL CANCER PATIENTS - WHAT SHOULD OUR
Research and Treatment of Cancer Quality of Life Questionnaire) and STANDARDS AND EXPECTATIONS BE?
EORTC QLQ-CR38. Data are on a 0-100 point scale [100=best function H. Kunitake1, D. S. Zingmond2 and C. Y. Ko1 1Department of Surgery,
(functional scales) or worst symptoms (symptom scales); mean(SD)]. David Geffen School of Medicine at UCLA, Los Angeles, CA and 2General
Results: Patients after CAA were younger (57 vs 62yr, p<0.001) with sim- Internal Medicine and Health Services Research, David Geffen School of
ilar gender distribution (males: 67 vs 77%, p=0.94) compared to APR patients. Medicine at UCLA, Los Angeles, CA.
On the EORTC-C30, QOL was better in CAA patients on the subscale phys- Purpose: To describe the outcomes of octogenarians and nonagenari-
ical functioning [91(14) vs 87(15); p=0.034] while symptom scores were ans following colorectal cancer resection in a large population cohort.
increased on the subscales constipation [15(23) vs 8(18); p=0.005] and diar- Methods: All patients undergoing surgical resection for colorectal can-
rhea [20(27) vs 13(21); p=0.011] compared to APR patients. The EORTC- cer in California (1994-2005) were retrospectively identified by ICD-9 pro-
CR38 demonstrated better QOL on the subscale body image [82(22) vs cedure codes (45.71-45.79, 45.8, 48.5, 48.61-48.69) using the California
73(25); p=0.035] in CAA patients. Gender-related subgroup analysis revealed Office of Statewide Health Planning and Development (OSHPD) Patient
that this difference was present in male [85(20) vs 71(26); p=0.01] but not in Discharge Database linked to the California Cancer Registry and 2000 US
female [77(25) vs 78(22); p=0.98] patients. QOL was worse on the subscale Census. Logistic multivariate analysis were used to determine significant out-
sexual functioning in male [33(25) vs 72(27); p<0.001] and female [14(16) vs come predictors.
88(21); p<0.001] patients after CAA. In addition, CAA patients were more
130
Abstracts
Results: Octogenarians and nonagenarians comprised 24% of all patients for treatment of GI failure and/or dehydration, whereas the non-POI group
undergoing colorectal cancer resection. Compared with patients < 65, this readmissions were for serious adverse events.
cohort had 116% more comorbidities but 51% less distant disease (p=0.000). Conclusions: The data indicate a ratio of 3:1 for patients without ver-
40% of their index admissions were unscheduled compared with 28% for sus with POI compared to 2:1 ratio in cost structure. This disproportionate
patients <65 suggesting that elderly patients underwent significantly higher impact on cost per patient with POI at the index admission for colectomy
rates of emergent colorectal surgery (p=0.000). Patients ≥ 80 traveled sig- was further magnified by the similar additional cost structure of readmis-
nificantly shorter distances to the hospital for surgery (9.4 mi vs. 14.5 mi, sion for GI failure compared to readmission for serious adverse surgical com-
p=0.000) and presented to low volume centers more frequently than younger plications. Safe and effective prophylaxis or treatment for POI offers the
patients (42.5% vs. 39.1%, p=0.000). Multivariate regression analysis con- potential of significant patient care and economic benefit post-colectomy.
firmed that older patients went to low volume centers more frequently while
controlling for unscheduled admission, revised Charlson, and cancer stage.
In-hospital mortality and one-year mortality were 5.6% and 28.1%. Regres- S68
sion analysis demonstrated that increasing age, revised Charlson score, CRC GHRELIN AGONIST TZP-101 FOR MANAGEMENT OF
stage, and small hospital volume were associated with an increased risk of POSTOPERATIVE ILEUS AFTER SEGMENTAL COLEC-
one year mortality. Patients ≥ 80 had a 71% higher readmission incidence TOMY: A MULTINATIONAL, RANDOMIZED, DOSE-RANG-
rate (160.3 per thousand patient years) than patients <65. However a smaller ING, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY.
proportion of these readmissions were due to CRC surgery-related compli- A. J. Senagore8, I. Popescu1, G. V. Rao2, S. Varshney3, p. Fleshner4,
cations (42.9% vs. 55.8%, p=0.000) or procedures (18.9% vs. 31.3%, S. Berry5, J. C. Pezzullo6, P. Charlton7 and G. Kosutic7 1Institutul Clinic
p=0.000). Fundeni, Bucharest, Romania, 2Asian Institute of Gastroenterology, Hyder-
Conclusions: Octogenarians and nonagenarians represent a large seg-
abad, India, 3Bhopal Memorial Hospital and Research Centre, Bhopal, India,
ment of colorectal cancer surgical patients with significant morbidity and 4
Cedars-Sinai, Los Angeles, CA, 5Berry Consultants, College Station, TX,
mortality mandating development of new guidelines to improve their qual- 6
Georgetown University, Washington, DC, 7Tranzyme Pharma, RTP, NC and
ity of care. 8
Table 1. Patients undergoing colorectal cancer resection 1994-2005 Spectrum Health, Grand Rapids, MI.
Purpose: This Phase 2b study evaluated safety and efficacy of TZP-101
in the prophylactic management of postoperative ileus following segmental
colectomy.
Methods: Patients undergoing segmental colon resection were adap-
tively randomized to TZP-101 (one of 7 doses from 20 to 600µg/kg) or
* Total LOS = sum of length of stay for CRC surgery and all readmissions in 1 year (up placebo (PBO) by 30-minute IV infusion within one hour of surgical clo-
to 5 readmissions) sure, then daily for up to 7 days. The primary efficacy endpoint was time to
GI recovery, measured by time to first bowel movement (BM). Patients were
followed for safety for 30 days after last dose.
S67 Results: 236 patients were treated with TZP-101 or PBO. The mean
POST-OPERATIVE ILEUS; IT COSTS MORE THAN YOU age was 55 years for PBO group and 59 for all TZP-101 doses combined,
EXPECT. and most patients were Caucasian (62% PBO, 70% TZP-101). The mean
T. Asgeirsson2, K. El-Badawi1, A. Mahmood2, J. Barletta1, M. Luchte- duration of surgery was ~2.5 hours. TZP-101 accelerated the median time
feld2, N. Dujovny2, D. Kim2, H. Slay2, R. Hoedema2 and A. J. Senagore1 to first BM in all TZP-101 treated groups, with 480µg/kg identified as the
1 most effective dose: Kaplan-Meier survival analysis showed a median time
Spectrum Health, Grand Rapids, MI and 2The Ferguson Clinic/ Michigan
to recovery of 68.0 hours (95% CI 63.3, 75.8) versus 89.6 hours for PBO
Medical PC, Grand Rapids, MI.
(95% CI 79.1, 93.2) – giving a difference from PBO of 21.6 hours, and a 95%
Purpose: Although the clinical impact of postoperative ileus (POI) after CI that did not overlap with PBO; this was corroborated by Cox PH model
colectomy is well known, it has been difficult to define the financial impact. where median time to BM and associated hazard ratio (HR) were 70.6 hours
POI is difficult to ascertain due to limited diagnostic coding in adminstra- and 1.67 (p=0.03), respectively; after accounting for multiple covariates,
tive sets, and there is limited single institutional cost information for POI. including country, type/duration of surgery, age, gender and opioid con-
Recently, a number of novel, first in class medications aimed at POI have sumption, the significant difference seen for the primary endpoint remained
been evaluated in clinical studies. Implementation of these treatments needs (Table A); time to recovery was similarly accelerated for the GI-2 endpoint
to be assessed for effect. The aim of this study was to assess the financial (Cox HR =1.61, p=0.04). Another clinically important endpoint, the per-
impact of POI following colectomy. centage of patients who had a BM within 72 hours, indicated an early effect
Methods: We reviewed all colectomy patients at our institution from of TZP-101 on GI recovery with a significant difference from PBO (p=0.004;
July 2007 through June 2008. Ileus during the index admission was defined 25% on PBO, 64% on 480µg/kg). The most common adverse events were
as >3 episodes of emesis and/or insertion of nasogastric tube. Readmission nausea and vomiting, with these two events observed less often on TZP-101
for gastrointestinal failure (nausea/vomiting/poor oral intake) was also defined than on PBO, and there were no evident dose-related safety trends.
as ileus, unless surgical or radiologic small bowel obstruction was identified. Conclusions: TZP-101 appears to safely accelerate GI recovery, repre-
Primary admission and readmission costs were assessed. Reason for read- senting a novel first in class pharmacologic approach to reduce postopera-
mission was also identified and any subsequent intervention was recorded. tive ileus following colectomy.
Length of stay, narcotic use, time to ambulation, and time to institution of Table A: TZP-101 Cox PH Covariate Analysis Time to BM 480µg/kg dose
enteral feeds were also noted.
Results: 191 colectomies were performed at our institution during this
time period. We identified 51 cases of POI during the index admission. The
total cost for the index admission was significantly higher for patients with
POI ($31800 vs $17626; p<0.05). Total readmission costs were not statisti-
cally different for POI and non-POI patients ($8742 vs $12946). The lack HR = hazard ratio
of cost difference occurred depite the fact that the POI group was admitted pval = p value
* = p value < 0.05
131
Abstracts
Poster Display Hours: Monday 9:00 am – 4:00 pm
Tuesday 9:00 am – 4:30 pm
Poster Walk Arounds with Authors Present: Monday: 5:00 - 6:30 pm
Table of Contents
Neoplasia P1 – P26 Anorectal Disease P68 – P80
Lymph Node in Colorectal Surgery P27 – P39 Laparoscopy P81 – P95
Inflammatory Bowel Disease P40 – P51 Potpourri P96 – P120
Diverticular Disease P52 – P55 General Surgery Forum GSF1 – GSF6
Pelvic Floor Disease P56 – P67 Research Forum RF1 – RF-7
P3
Posters EXPRESSION OF HAS-3 AND RHAMM IN PRIMARY AND
METASTATIC HUMAN COLON CANCERS.
B. Teng2, Y. Zhao1 and K. Bullard Dunn1 1Department of Surgical Oncol-
ogy, Roswell Park Cancer Institute, Buffalo, NY and 2Department of Sur-
P1 gery, University at Buffalo, Buffalo, NY.
RENAL CANCER AS PART OF THE PHENOTYPE OF MYH- Purpose: Hyaluronan (HA), hyaluronan synthases (HAS), and the HA
ASSOCIATED POLYPOSIS; THE EVIDENCE GETS receptor, Receptor for Hyaluronan-Mediated Motility (RHAMM) have been
STRONGER. implicated in the growth and progression of a variety of malignancies includ-
J. M. Church, L. LaGuardia, M. O’Malley and C. A. Burke Digestive ing colon cancer. The aim of this study was to investigate the expression
Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH. patterns of HAS isozymes (HAS-2 and HAS-3) and RHAMM in human
colon cancer tissue harvested from primary tumors and metastases.
Purpose: The full phenotype of MYH-Associated Polyposis (MAP) is
Methods: RNA harvested from primary tumors, liver metastases, and
still not known as the syndrome is relatively new and the number of affected
matching normal tissue (colon and liver) was obtained from a tumor tissue
families relatively sparse. The syndrome often seems to mimic attenuated
bank. RNA was analyzed by semiquantitative RT-PCR for the presence of
FAP except that the pattern of inheritance is recessive rather than domi-
HAS-2, HAS-3, RHAMM, and GAPDH. Resulting bands were normalized
nant. In 2006 a preliminary study of the tumor spectrum that was seen in 6
to GAPDH control bands, and bands from tumor tissue compared to bands
MAP families suggested that renal cancer may be found to excess. Now we
from normal tissue. Genes were considered to be upregulated if the tumor
have 7additional MAP families with information that more strongly impli-
band was brighter than the normal tissue band (tumor band intensity: nor-
cates renal cancer as part of the syndrome
mal band intensity greater than 1.0) or if the tumor tissue showed a band in
Methods: The families of thirteen probands with MAP were character-
the absence of a band in the normal tissue. Student’s t-test was used for sta-
ized by extensive pedigree building. Data was entered into the Polyposis reg-
tistical analysis.
istry database. Where available, pathology reports were requested to docu-
Results: 14 matched pairs of primary tumor and normal colonic mucosa
ment the reliability of the family history. All probands had biallelic mutations
and 11 matched pairs of liver metastasis and normal liver were analyzed. 57%
of MYH.
of primary tumors and 79% of liver metastases showed upregulation of HAS-
Results: Relatives under the age of eighteen and the spouses of at-risk
3 (Table). RHAMM was upregulated less often in primary tumors (43%), but
relatives are excluded. There were 247 at-risk relatives in the 13 families.
was upregulated in most liver metastases (97%). HAS-2 showed similar rates
There were 67 affected (27%), some with multiple tumors. The cancer spec-
of upregulation in both primary and metastatic tumors.
trum is shown in the table. The colorectal phenotype of these MAP families
Conclusions: Over half of primary colon cancer tumors studied
is as expected. 13.3% of relatives had adenomas although less than half of
showed upregulation of HAS-2 and HAS-3; fewer showed upregulation
the relatives had screening colonoscopy. Colon cancers were found in 23
of RHAMM. In contrast, over three-quarters of liver metastases showed
individuals, usually with an older age of onset. The spectrum of extracolonic
upregulation of HAS-3 and almost all showed upregulation of RHAMM.
cancers seen in these 13 families is unusual. Renal cancer occurred in six dif-
Although the sample size is extremely small, these results suggest that
ferent families. There were four cases of prostate cancer in one family and
HAS and RHAMM are expressed by both primary and metastatic colon
two with pancreatic cancer in another. 78% of patients with a cancer had at
cancers. Moreover, HAS-3 and RHAMM appear to show greater upreg-
least one Y165C mutation; 62% had at least one G382D mutation.
ulation in metastases than in primary tumors, suggesting that these mol-
Conclusions: : The phenotype of MAP is evolving. Detailed studies on
ecules may be important for disease progression. These data support
phenotype in much large numbers of families are needed. Renal cancer was
ongoing investigation to determine the roles that HAS and RHAMM
present 46% of these families and renal ultrasound is recommended as part
play in human colon cancer.
of the surveillance program. Upregulation Comparison of Primary Colon Tumors Versus Metastatic Liver Tumors
Cancers seen in members of MYH-Associated Polyposis Families
132
Abstracts
mitted to a different hospital than their index hospital. However, for patients
P4 who returned to their index hospital for their first readmission, there was
MOLECULAR GENETIC ANALYSIS AND CLINICAL FEA-
significantly lower one-year mortality (24% vs. 29%, p<0.001), 10% shorter
TURES IN CHINESE HNPCC.
first readmission mean length of stay (p<0.001), and 7% lower number of
Y. Xu and S. J. Cai Colorectal Surgery, Shanghai Cancer Hospital/Insti- total readmissions (p<0.001). This finding was borne out in a risk/case mix
tute, Shanghai, China. adjusted multivariate logistic regression because readmission to the index
Purpose: Hereditary non-polyposis colorectal cancer (HNPCC) is an hospital was significantly associated with improved one year mortality (Odds
autosomal dominant syndrome. At least five mismatch repair (MMR) genes, ratio: 0.87, p<0.001). For all patients who were readmitted, 26% of patients
including hMSH2, hMLH1, hPMS, hPMS2, and hMSH6, are associated required a CRC surgery-related procedure on first readmission. The most
with this syndrome. Around 90% of the detected mutations are located in common procedures were adhesiolysis, abdominal drainage, incisional her-
hMLH1, hMSH2 and hMSH6. However, in most of the studies, mutations nia repair, and wound revision.
in mismatch genes can only be detected in half of the HNPCC families. In Conclusions: Readmission rates in the population are higher than many
recent years, HNPCC families with negative mutation in MMR genes were published institutional series. While referral to certain hospitals likely occur
reported to have different clinical features compared with the positive ones for the primary resection, returning to the original index hospital results in
in several studies. In this study, we screened 91 probands of Chinese HNPCC lower long term mortality rates.
families for mutations in hMLH1, hMSH2 and hMSH6. Mutation types and
clinical characteristics of the patients were anaylized.
P OSTERS
Methods: 91 families fulfilled the Amsterdam criteria were collected. P6
Genomic DNA was extracted from the peripheral lymphocytes. Direct DNA DOES BRAF ANALYSIS AID IN HIGH RISK COLORECTAL
sequencing of hMSH2 and hMLH1 genes were performed on all 91 sam- CANCER ASSESSMENT?
ples for small mutation. In cases with negtive results in hMLH1 and hMSH2,
hMSH6 mutation analysis were performed. If no causative change were found
P. Wise, D. Sturgeon, R. Muldoon, A. Herline and C. Vnencak-Jones
with Direct DNA sequencing, Samples then been screened by Multiplex Lig- Vanderbilt University Medical Center, Nashville.
ation-dependent Probe Amplification (MLPA) for large deletion in hMLH1 Purpose: Microsatellite instability (MSI) testing is an increasingly pop-
and hMSH2. ular screening tool for Lynch Syndrome (HNPCC). Tumors that are MSI-
Results: 43 pathological germline mutations were identified by direct high (MSI-H) can be indicative of a mutation in a mismatch repair (MMR)
sequencing. 25/43 mutations were located in hMLH1, 16/43 located in gene and warrant further investigation. However, MSI-H status can also be
hMSH2 and 2/43 located in hMSH6. For each gene, mutations were fre- caused by MLH1 promoter methylation rather than a germline mutation.
quently located in exon 11 and 15 of hMLH1, exon 3 of hMSH2 and exon BRAF (V600E) mutations are associated with sporadic MSI-H colorectal
4 of hMSH6. Complete or partial gene deletions were identified in 15 cancers (CRC) due to MLH1 hypermethylation. Our aim was to perform
cases with 7/15 in hMLH1 and 8/15 in hMSH2. Compared with muta- BRAF testing on MSI-tested tumors to assess whether BRAF status corre-
tion positive patients, mutation negtive patients present with later age of lated with MSI results and to evaluate the clinical utility of adding V600E
onset (44.5yrs vs 38.7yrs), fewer synchronous or metachronous colorec- testing to our current protocol
tal cancers (14% vs 25%), distal colonic predominance (69% vs 43%), Methods: From January 2007 to October 2008, all patients undergoing
and later disease stage. colon resection for CRC and meeting Revised Bethesda Criteria had tumor
Conclusions: Mutations in hMLH1 gene were more often than in MSI testing. MSI studies were performed using fluorescent PCR for 5
hMSH2 in Chinese HNPCC patients. Large deletion was a very common mononucleotide markers coupled with capillary electrophoresis for detec-
event. genomic large deletion tests should be provided for mutation analy- tion. MSI-H, MSI-low (MSI-L), and microsatellite stable (MSS) were delin-
sis. Mutation negtive patients had distinct characteristics which indicate that eated as 4 - 5 out of 5, 1 - 3 out of 5, and zero out of 5 marker abnormali-
they might have different gene mutations other than MMR gene. ties, respectively. V600E mutation detection was performed using allele
specific fluorescent PCR followed by capillary electrophoresis
Results: 74 CRCs from patients that fulfilled Revised Bethesda Criteria
P5 underwent MSI testing, and 13 (17.5%) were found to be MSI-H, 1 was
READMISSION FOLLOWING RESECTION FOR COL- MSI-L, and the remainder MSS. Three of 13 (23%) MSI-H CRCs were pos-
ORECTAL CANCER: GOING BACK FOR BETTER OUT- itive for a V600E mutation
COMES. Conclusions: V600E testing may avoid the need for further testing
H. Kunitake1, D. S. Zingmond2 and C. Y. Ko1 1Department of Surgery, (immunohistochemistry and/or gene sequencing) in over 20% of MSI-H
CRCs. The addition of V600E mutation analysis may avoid unnecessary and
David Geffen School of Medicine at the University of California, Los Ange-
expensive tests for Lynch syndrome.
les, Los Angeles, CA and 2General Internal Medicine and Health Services
Research, David Geffen School of Medicine at the University of California,
Los Angeles, Los Angeles, CA. P7
Purpose: To determine whether readmission to the same hospital as the DOES CHRONIC IMMUNOSUPPRESSION INCREASE THE
index resection results in better outcomes. RISK OF DEVELOPING ADENOMATOUS COLON POLYPS?
Methods: All patients undergoing surgical resection for colorectal can- J. B. Adams, D. Beck, T. Hicks, A. Timmcke, C. Whitlow and D. Mar-
cer in California (1994-2005) were retrospectively identified by ICD-9 pro-
golin Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans,
cedure codes (45.71-45.79, 45.8, 48.5, 48.61-48.69) using the California
LA.
Office of Statewide Health Planning and Development (OSHPD) Patient
Discharge Database linked to the California Cancer Registry and 2000 US Purpose: Purpose: Chronic immunosuppression increases the risk of
Census. Univariate and multivariate logistic regression analysis were used cancer in many organ systems. This study explores the hypothesis that
to determine significant outcome predictors. immunosuppression also increase the risk of colon cancer in solid organ trans-
Results: 107,577 patients underwent resection for colorectal cancer. plant patients.
40,339 (38%) had at least 1 readmission within the first year (median time Methods: After obtaining IRB approval, the list of transplants performed
to first readmission 75 d). 58% of all first-time readmissions had a CRC at Ochsner Clinic Foundation (OCF) from 2001-2004 was obtained. The
surgery-related diagnosis or procedure. Of these patients, 17% were read- electronic medical record was reviewed, and patients who did not undergo
133
Abstracts
pretransplant or posttransplant colonoscopies were excluded. Data con- staff are vital to the identification of at-risk individuals appropriate for fur-
cerning polyp number and histology was recorded for both colonoscopies. ther counseling and testing for hereditary CRC syndromes.
Results: Seven hundred ninety nine transplants were performed at OCF
from 1/1/01 to 12/31/04. Of these, eighty nine patients had records of both
colonoscopies and are included in this study. The cohort is composed of 55 P9
(62%) males and 34 (38%) females with a mean age of 56.1 + 7.99 years. URETERIC OBSTRUCTION IN FAP ASSOCIATED
There are 47 liver, 21 kidney, 17 heart, three liver and kidney, and one lung DESMOID DISEASE.
transplant in this cohort At pretransplant colonoscopy, 24 (27%) patients E. D. Mignanelli, M. R. Joyce and J. M. Church Colon and Rectal Sur-
were found to have adenomatous polyps, 12 (13.5%) had hyperplastic polyps, gery, Cleveland Clinic Foundation, Cleveland, OH.
and 53 (59.5%) had no colonic polyps. Post transplant colonoscopies occurred
Purpose: Intra-abdominal desmoid disease affects up to 30% of patients
on average 59.6 + 22.4 months. Of the patients with pretransplant adeno-
with familial adenomatous polyposis (FAP). It is the second leading cause of
mas, seven (29.2%) developed a metachronous adenoma and one patient
death in FAP patients. Desmoid disease may lead to significant morbidity
(4.2%) developed carcinoma. In patients with pretransplant hyperplastic
from pressure effects on the abdominal wall, bowel, bladder and vascular
polyps, two (17%) developed adenomas. In the patients whose pretrans-
structures. Ureteric obstruction is uncommon but can lead to pain, sepsis or
plant colonoscopies were clear, thirteen (24.5%) developed adenomas and
renal failure and usually needs treatment. There are few reports in the lit-
one (1.9%) developed a malignancy. These results are compared to a his-
erature describing this problem. This study was performed to identify the
torical control of 428 patients with an adenomatous polyp discovered on
prevalence and treatment options for FAP associated intra-abdominal
screening colonoscopy. At a three year interval surveillance colonoscopy, 137
desmoids affecting the urological system.
(32%) of these patient contained a metachronous adenoma. No statistical
Methods: Clinical data from an IRB approved, prospectively maintained
difference between the two groups concerning the rates of metachronous
familial polyposis registry of 107 patients with FAP related intra-abdominal
adenoma formation could be found using the two tailed Z test for binomial
desmoid disease were analyzed to assess the prevalence and management of
proportions at a significance level of 0.05.
those with ureteric involvement.
Conclusions: Despite the increase in cancer risk for many organ sys-
Results: Of 107 patients with FAP related desmoid disease, 30 patients
tems, chronic immunosuppression does not appear to increase a patient’s risk
(28%) were identified as having ureteric obstruction with a 2:1 female pre-
of developing colon cancer.
dominance. 36.7% of these patients were identified as having ureteric obstruc-
tion at the same time as their initial diagnosis of desmoid disease and a major-
P8 ity of these presented with abdominal pain (66.7%) . Bilateral ureteric
obstruction occurred in 43.3% with the remainder having unilateral obstruc-
INCREASING HIGH RISK COLORECTAL CANCER
tion. Of the 30 patients medical management alone was used in 9 patients
PATIENT IDENTIFICATION THROUGH FAMILY CANCER
(30%). Medical treatment of consisted of Sulindac or Celecoxib in 96.7%,
HISTORY INVESTIGATION.
hormonal treatment in 83.3% and chemotherapy in 46.7%. 18 patients (60%)
P. Wise, D. Sturgeon, T. McCutcheon, R. Muldoon and A. Herline Gen- underwent retrograde ureteric stent insertion. In 5 patients (16.7%) retro-
eral Surgery, Vanderbilt University Medical Center, Nashville. grade ureteric stent insertion failed and percutaneous nephrostomy tubes
Purpose: Hereditary colorectal cancer(CRC) syndromes with identifi- were required. 3 patients (10%) underwent auto-transplantation of 4 kid-
able gene mutations attribute to up to 10% of all CRC diagnoses, with other neys and 4 patients (13.3) required nephrectomy. One patient underwent
familial cancer syndromes accounting for up to 30%.Patients being seen in ureterolysis and another underwent ureteric resection and re-implantation.
most surgical clinics often have limited or no familial cancer history docu- A third of patients underwent more than one procedure to relieve ureteric
mented.Our aim was to compare the numbers of patients seen in our aca- obstruction.
demic Colorectal Surgery Clinic (CrSC) for a diagnosis of CRC who were Conclusions: Ureteric obstruction by desmoid disease is common. It is
then referred for further genetic counseling and/or testing one year prior often present at the first diagnosis of intra-abdominal desmoid disease.
and one year after instituting a hereditary CRC registry and a policy of obtain- Patients with minimal symptoms can be treated medically but a majority of
ing a family cancer history patients require stenting and some require surgery.
Methods: From January 2006 to December 2006,patients(pts) being seen
in the CrSC for a diagnosis of CRC underwent “standard” familial cancer
history assessments.Any pts with concerning histories were recommended P10
for counseling and/or testing. These pts were retrospectively reviewed for TOTAL PELVIC EXENTERATION FOR PRIMARY AND
familial cancer risk factors. After instituting a universal policy for obtaining RECURRENT MALIGNANCIES.
familial cancer histories starting in January 2007, all pts seen in the CrSC F. T. Ferenschild, M. Vermaas, C. Verhoef, A. C. Ansink, W. J. Kirkels,
were prospectively assessed for possible need for further counseling and/or A. M. Eggermont and J. H. de Wilt Surgical Oncology, Erasmus Medical
testing. The numbers of pts referred for further assessment in the two time Center Daniel den Hoed, Rotterdam, Netherlands.
periods were compared
Purpose: Complete resection is the most important prognostic factor
Results: From January to December 2006,115 pts were seen in the CrSC
in surgery for pelvic tumors. In locally advanced and recurrent pelvic malig-
for a CRC diagnosis compared with 220 pts from January to December
nancies radical margins are sometimes difficult to obtain, because of close
2007.Review of the comparison group in 2006 showed that only four
relation to or growth in adjacent organs/structures. Total pelvic exentera-
pts(3.5%)went on for further assessment,whereas at least 22(19.1%) of this
tion (TPE) is an exenterative operation for these advanced tumors and
2006 group had concerning features for a hereditary cancer etiology.In con-
involves en bloc resection of the rectum, bladder and internal genital organs
trast,during 2007 after instituting standard assessments, 47 pts (21.3%) were
(prostate/seminal vesicles or uterus).
identified as being at risk for having a hereditary CRC syndrome and went
Methods: Between 1994 and 2008 a TPE was performed in 69 patients
on for further investigation.Of those 47 pts, 14 (6.3%) were identified as hav-
with pelvic cancer; 48 rectal cancer (32 primary and 16 recurrent), 14 cervi-
ing a genetic mutation associated with a familial CRC syndrome
cal cancer (1 primary and 13 recurrent), 5 sarcoma (3 primary and 2 recur-
Conclusions: Pts at high risk for a familial CRC syndrome may be over-
rent), 1 primary vaginal - and 1 recurrent endometrial carcinoma. Twenty-
looked because of incomplete history taking and lack of knowledge.Appro-
one patients were previously treated with radiotherapy. Ten patients were
priate familial history assessment and the education of nursing and medical
treated with neo-adjuvant chemotherapy. Two-third of patients received pre-
134
Abstracts
operative radiotherapy to induce downstaging and four patients received
post-operative radiotherapy. Eighteen patients received IORT because of an
P12
RECTOVAGINAL FISTULA AFTER SPHINCTER-PRESERV-
incomplete or marginal complete resection.
ING RECTAL CANCER SURGERY.
Results: The median follow up was 43 months (range 1-196). Median
operation-duration, blood loss and hospitalization were 448 min (range 300- U. Shin, C. Yu, C. Kim, J. Park, K. Jeong, S. Yoon, S. Lim and J. Kim
670), 6300 ml (range 750-21000) and 17 days (range 4-65). Overall major Department of Colon and Rectal Surgery, Asan Medical Center, Seoul, Korea,
and minor complication rates were respectively 34% and 57%. The in hos- South.
pital mortality rate was 1%. A complete resection was possible in 75% of all Purpose: Rectovaginal fistula (RVF) cause not only physical symptoms
patients, a microscopically incomplete resection (R1) in 16% and a macro- but also impact adversely on self esteem, intimacy, and long-term relation-
scopically incomplete resection (R2) in 9%. Five-year local control for pri- ship. This study was aimed to identify incidence, risk factors, and treatment
mary locally advanced rectal cancer, recurrent rectal cancer and cervical can- result of RVF after sphincter preserving rectal cancer surgery.
cer was respectively 89%, 38% and 64%. Overall survival after 5 year for Methods: We retrospectively reviewed the medical records of 1217
primary locally advanced rectal cancer, recurrent rectal cancer and cervical female patients who underwent sphincter preserving surgery for rectal can-
cancer was 66%, 8% and 45%. cer between November 1989 and March 2008. Of the 1217 patients, 21
Conclusions: Although total pelvic exenteration is accompanied with (1.7%) patients developed RVF clinically. We compared them with the 113
considerable morbidity, good local control and acceptable overall survival patients who were randomly selected among 1196 patients without leakage
justifies the use of this extensive surgical technique in patients with primary of anastomosis or RVF.
P OSTERS
locally advanced and recurrent pelvic tumors. Results: Median age of RVF group was 55 (28~76) years. RVF group was
not different from the control group in age, comorbidity and history of pre-
vious pelvic operation or inflammation. However, preoperative chemoradi-
P11 ation therapy was more frequently conducted in the RVF group (8 cases
RISK AND PROGNOSTIC FACTORS FOR PREDICTING (38.1%) vs 13 cases (11.5%), p=0.005). Median period of developing of RVF
RECURRENCES AND SURVIVAL OF COLORECTAL GAS- after surgery was 28 (7~894) days. Compared with control group, tumor
TROINTESTINAL STROMAL TUMOR. was more frequently located on the lower rectum and anterior side of rec-
P. Prathanvanich, J. Pattana-arun, P. Atithansakul, C. Sahakitrungruang tum (6 cases (28.6%) vs 33 cases (9.7%), p=0.003, 14 cases (66.7%) vs 42
and A. Rojanasakul Colorectal, Chulalongkorn University, Bangkok, Thai- cases (37.2%), p=0.005). Ultra-low anterior resection was more frequently
land. performed in RVF group (17 cases (81.0%) vs. 51 cases (45.1%), p=0.004),
but there was no difference in stapling methods. In a multivariate analysis,
Purpose: Purpose: This study was designed to review the clinical char-
preoperative chemoradiation therapy was the only independent risk factor
acteristics of surgically treated gastrointestinal stromal tumors of the
for RVF (OR 4.69, 95% CI 1.27 ~ 17.34, P=0.02). Diversion operations with
colon,rectum and anus, evaluate their immunohistochemical and patho-
or without primary repair were performed in 19 (90.5%) patients and only
logic features, and to identify the associated prognostic factors influencing
11 patients (52.4%) were resolved after treatment.
the outcome of curative resection.
Conclusions: Preoperative chemoradiation therapy is an independent
Methods: Methods: The clinicopathological factors and other tumor
risk factor for RVF after sphincter preserving rectal cancer surgery. Con-
aggressiveness influencing disease-free survival were assessed in 17 patients
sidering high diversion rate and relatively low cure rate, technical precau-
with gastrointestinal stromal tumors ( 8 rectum, 3 RV septum, 2 cecum, 1
tions to prevent RVF are needed, especially in patients who underwent pre-
ascending colon, 3 anal canal ), diagnosed and primarily treated at our insti-
operative chemoradiation therapy.
tution between 2000-2006.
Results: Results: There were eight men and nine women with a mean
age of 56 years (range, 38-73 years ) at the time of diagnosis. Tumors were
classified on basis of size and mitotic rate according to current National
P13
PREOPERATIVE IMAGING OF RECTAL CANCER: CAN WE
Institues of Health recommendations : 76% ( n = 13 ) were high-risk, 12%
AGREE?
( n = 2 ) were intermediate-risk, 12% ( n = 2 ) were low-risk. Five tumors
(29%) were negative in KIT staining. The median follow-up period was 39 J. Nordenstam1, J. Wikström2, D. Christoforidis1, D. Rothenberger1,
months (range, 2-96 months ). Recurrence was noted in 6 patients (4 local A. Mellgren1, T. Dhurairaj3 and R. Madoff1 1Division of Colon and Rec-
recurrence, 1 liver metastasis,1 lung metastasis). Overall median DFS was tal Surgery, University of Minnesota, Minneapolis, MN, 2Department of
34 months, and estimated one-year, two-year,three-year, four-year, and five- Radiology, Uppsala University, Uppsala, Sweden and 3Department of Radi-
year DFS rates were 100, 66, 46, 26, and 20 percent respectively. Overall 5- ology, University of Minnesota, Minneapolis, MN.
year survival was 29%. The independent prognostic factors that significantly Purpose: Planning of treatment for rectal cancer is largely based on pre-
associated with high tumor recurrence and poor survival were age < 60 year operative imaging. The choice between endorectal ultrasound (ERUS) or
( p = 0.018 ), mitotic count > 10/50HPF ( p = 0.025 ), histology pleomor- magnetic resonance imaging (MRI) is usually dictated by local availability
phism ( p=0.008 ), necrosis ( p = 0.045), Ki67 index > 10% ( p = 0.006 ), p53 and expertise. The utilization of neoadjuvant therapy disqualifies the patho-
> 50% (p = 0.006 ), CD117 negative ( p = 0.046 ). logical stage as a gold standard when comparing preoperative imaging modal-
Conclusions: Conclusions: The majority of colorectal gastrointestinal ities. The purpose of this study was to assess the agreement between ERUS
stromal tumors are high-risk. Patients with high-risk have a significant like- and MRI for staging of rectal cancer.
lihood of developing metastases that associated with poor prognosis. These Methods: 51 consecutive patients (15 women and 36 men), mean age
patients need to be closely followed for an extended period and should be 57 years, with newly diagnosed rectal cancer were examined with ERUS
considered for adjuvant therapy with tyrosine kinase inhibitors. and 3-Tesla MRI. Three colorectal surgeons performed the ERUS exami-
nations and two radiologists interpreted the MRI examinations; all had exten-
sive rectal cancer imaging experience. Kappa statistics were used to analyze
agreement (0= no agreement, 1= perfect agreement) between the two modal-
ities.
Results: ERUS was inconclusive for N stage in 5 of 51 patients. MRI
and ERUS agreed for overall tumor stage in 52% (Kappa=0.253), overall T-
stage in 65% (Kappa=0.317) and for N-stage in 59% (Kappa=0.218). Per-
135
Abstracts
cent and degree of agreement for stage 1-3 and each individual T-stage is
shown in table. 74% (Kappa=0.232) patients were staged ≥T3 or node pos-
P16
MODULATION OF TUMOR HYPOXIA PROTEINS IN REC-
itive by both ERUS and MRI.
TAL CANCER UNDERGOING PREOPERATIVE CHEMORA-
Conclusions: Agreement between rectal cancer staging by ERUS and
MRI is poor. These results suggest that choice of technique of preoperative DIATION.
tumor imaging may affect treatment recommendations irrespective of the S. Lee-Kong1, D. B. Chessin1, S. Pucciarelli2, J. Shia3, E. Riedel4,
true pathologic stage. H. Moore1, D. Nitti2 and J. Guillem1 1Surgery, Memorial Sloan-Ketter-
Agreement between ERUS and MRI in preoperative staging of rectal cancer¬ ing Cancer Center, NewYork, NY, 2Surgery, Padova University, Padova, Italy,
3
Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY and
4
Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center,
New York, NY.
Purpose: We have previously demonstrated the prognostic significance
of rectal cancer response to preoperative combined modality therapy (CMT).
Since recent studies in other cancers have reported the significance of hypoxia
in tumor response to neoadjuvant therapy, our aims were to: (1) character-
ize expression of markers of hypoxia in rectal cancer prior to CMT and (2)
determine the co-modulation of these markers relative to each other, patho-
logic response and oncologic outcome.
P14 Methods: 85 patients with locally advanced rectal cancer were treated
PREOPERATIVE CHEST CT IN PATIENTS WITH with radiation and 5FU-based chemotherapy followed by resection. Immuno-
ADVANCED MIDDLE OR LOWER RECTAL CANCER: ITS histochemistry (IHC) for markers of hypoxia (HIF-1-alpha, VEGF, GLUT-
ROLE IN STAGING AND IMPACT ON TREATMENT 1, CA-IX) were performed on pre-CMT tumor biopsies. Percentage of tumor
STRATEGY. cells stained was correlated with pathologic response (Mandard’s regression
grade) using Spearman correlation coefficients. The impact of hypoxia on
D. Choi, S. Kim, J. Kim and S. Woo Surgery, Korea University, Seoul,
outcome was evaluated using Cox proportional hazards model.
South Korea.
Results: HIF-1-alpha expression significantly segregated with VEGF
Purpose: Pulmonary metastasis is more frequent in middle or lower rec- (p=0.02) and GLUT-1 (p=0.001), while VEGF significantly segregated with
tal cancer than in upper rectal or colon cancer. Recently the NCCN guide- GLUT-1 (p=0.05). Correlations of protein expression with pathologic
lines v.1.2007 recommended chest computerized tomography (CT) instead response were: -0.04 (p=0.7), -0.02 (p=0.9), -0.04 (p=0.7), and -0.06 (p=0.6)
of chest X-ray (CXR) for preoperative staging workup in rectal cancer for HIF-1-alpha, VEGF, GLUT-1, and CA-IX, respectively. With a median
patients. But, there is no solid evidence to support this recommendation. follow-up of 54 months, the association between markers of hypoxia and
This study was designed to prospectively evaluate the role of chest CT on oncologic outcome is tabulated.
preoperative staging in patients with advanced middle or lower rectal can- Conclusions: Our data suggests that the expression of hypoxia-related
cer, and to assess the impact on treatment strategy. proteins may be significantly co-modulated in rectal cancer. In addition,
Methods: Data were prospectively collected from the 103 rectal cancer hypoxia in rectal cancer, as defined by CA-IX expression, may be associated
patients (tumor located within 12 cm from the anal verge; T3/T4 on pelvic with a worse long-term oncologic outcome following CMT. Our results
MRI; 69 men and 34 women) between September 2006 and October 2008 emphasize the need to further study the mechanisms governing the regula-
under IRB approval. Two radiologists reviewed all the images of CXR and tion of hypoxia and its role in rectal cancer response to preoperative CMT.
chest CT. The results were classified in 4 groups according to the CXR and Hazard Ratios for association of markers to overall survival and time to recurrence
chest CT findings; metastasis, indeterminate, benign, and negative. The
patients showing indeterminate nodule(s) took follow-up CT(s) on 3- to 6-
month interval.
Results: Of the 103 patients, nine (8.7%) patients had pulmonary metas-
tases detected on preoperative CT. Among these 9 patients, 4 patients did
not reveal any pulmonary metastatic lesion on CXR. Of these four patients,
treatment strategy was changed in three patients as a result of these find-
ings. Two patients underwent low anterior resection and pulmonary wedge
resection. One patient having resectable liver metastases underwent pallia-
tive low anterior resection. Forty (38.8%) patients had indeterminate nod- P17
ules only on chest CT. Of these, currently 25 patients have taken follow- RISK FACTORS AFFECTING POST-OPERATIVE RECUR-
up CT(s). Four of them (14.7%) showed interval changes, which were RENCE OF PATIENTS WITH PATHOLOGICALLY T1 (PSM)
radiologically diagnosed as metastasis. COLORECTAL CANCER.
Conclusions: Chest CT can preoperatively detect pulmonary metasta- S. Iida1, H. Hasegawa1, Y. Ishii1, T. Endo1, K. Okabayashi1, M. Mukai2
tic lesions which are not visualized in CXR. Moreover, CT may change the and Y. Kitagawa1 1Department of Surgery, Keio University, Tokyo, Japan
treatment strategy in some patients. In addition, it reveals more “indeter-
and 2Department of Pathology, Keio University, Tokyo, Japan.
minate nodules”, which can be diagnosed as metastasis in follow-up obser-
vation. Therefore, it seems reasonable to take chest CT for preoperative Purpose: The aim of this study was to analyze the characteristics and to
staging in patients with T3/T4 middle and lower rectal cancer. determine the risk factors that might affect recurrence in patients with patho-
Comparison between chest X-ray and chest CT logically T1 (pSM) colorectal cancer (CRC) treated with radical surgery.
Methods: Between January 1990 and December 2003, a total of 284 con-
secutive patients with pSM CRC underwent surgery with curative intent in
our institution. Clinicopathological factors associated with metastasis and
prognosis were analyzed.
Results: A total of 284 patients (200 men and 84 women) with the median
age of 62 years were included, and the median follow-up was 55 (1-170)
months. The overall 5-year and 10-year survival rates were 97.2% and 90.5%,
136
Abstracts
respectively. Postoperative recurrences were seen in 8 (2.8%) cases (lung: 3, Methods: : From 1999 to 2006, macroscopic quality of mesorectum
liver: 2, distant lymph node: 2, local: 1).The presence of lymphatic invasion and circumferencial resection margin (CRM) were prospectively collected
was significantly associated with recurrence (p=0.003). There was no statis- in 127 patients who underwent rectal cancer resection with curative intent
tically significant difference between recurrence and lymphnode metastasis (R0+R1). CRT was performed in 56 staged as locally advanced tumours (T3,
(p=0.431).The association of lymph node metastasis with lymphatic invasion T4, N+). Univariate analysis of time to local recurrence and cancer-free
in patients with recurrence is shown in Table 1. The 5-year and 10-year sur- survival were tested (Kaplan-Meier) and multivariate analysis calculated (Cox
vival rates for patients with N0ly0, N0ly1, N1 were 100%/ 96.9%, 96.3%/ model).
75.2%, 93.3%/ 93.3%, respectively. Patients with N0ly1 had a significantly Results: The mesorectum was incomplete in 35 (27%) patients. In the group
shorter overall survival compared to those with N0ly0 (p=0.039). Four (50%) with complete mesorectum the cumulative risk of local recurrence at 5 years was
of the 8 patients developed recurrence 5 years after the operation. 10% and increased to 43% when the mesorectum was incomplete (P<0.01).
Conclusions: Lymphatic invasion was an independent predictive factor The 5-year cancer-free survival was 65% when the mesorectum was complete
of recurrence in patients with pSM CRC. Patients with N0ly1 were consid- and decreased to 36% in the incomplete group (P<0.01). Multivariate analysis
ered to be at high risk of recurrence. It may be necessary to discuss the post- identified T status, CRM and mesorectum score as independent factors for local
operative surveillance system five years after the operation. recurrence and T, N status and mesorectum score as independent factors for
The association of lymph node metastasis with lymphatic invasion in patients with recur- disease-free survival.
rence Conclusions: Rectal cancer outcome with CRT is related to complete-
ness of mesorectum excision as an independent factor of the TNM classifi-
P OSTERS
cation.
Table 1
P20
T2 RECTAL CANCER: A COMPARISON OF RADICAL SUR-
GERY AND LOCAL EXCISION BY TRANSANAL ENDO-
P18 SCOPIC MICROSURGERY (TEM) FOLLOWING NEOADJU-
THERAPEUTIC STRATEGY FOR T1-T2 LOWER RECTAL VANT THERAPY.
CANCER: IS TME NECESSARY FOR ALL THESE PATIENTS? B. Mizrahi, J. Marks, G. Marks, D. Hunt, S. Dalane and I. Nweze Col-
H. Kobayashi1, H. Mochizuki2, T. Kato2, T. Mori2, S. Kameoka2, K. Shi- orectal Surgery, Lankenau Hospital and Institute for Medical Research,
rouzu2, Y. Saito2, M. Watanabe2, T. Morita2, J. Hida2, M. Ueno2, Wynnewood, PA.
M. Ono2, M. Yasuno2 and K. Sugihara2 1Department of Surgical Oncol- Purpose: Interest is growing regarding the best treatment of markedly
ogy, Tokyo Medical and Dental University, Tokyo, Japan and 2Japanese Soci- or completely downstaged rectal cancer following neoadjuvant therapy. We
ety for Cancer of the Colon and Rectum, Tokyo, Japan. retrospectively analyzed similar T2 cancers treated with radical surgery and
Purpose: The goal of this multicenter study was to clarify the determi- local excision after neoadjuvant therapy.
nants of local excision for patients with T1-T2 lower rectal cancer. Methods: From 1984 to 2007, in a prospective database, 86 consecutive
Methods: The data of 567 consecutive patients with radical resection for patients prospectively staged as T2 rectal cancer were treated with neoadju-
T1-T2 lower rectal cancer in 12 institutions between 1991 and 1998 were vant therapy and surgical resection. Excluded were patients uN+, distant metas-
reviewed. The rates of lymph node metastasis were investigated by a tree tases at presentation and ypT3 tumors leaving 72 patients for the study. Thirty
analysis hierarchized by the independent risk factors of nodal involvement. patients underwent TEM and 42 underwent radical proctectomy with total
Results: The independent risk factors for lymph node metastasis were mesorectal excision (TME). All TEM patients were mobile and < 4cm after
female gender, tumor depth of invasion, histology other than well differen- treatment and were selected on the basis of therapy response and comorbid
tiated adenocarcinoma, and lymphatic invasion. When the former three conditions. Of the 42 who underwent TME, 7 received a low anterior resec-
parameters which can be obtained preoperatively were used, only 0.99% of tion (LAR) and 36 had a hand-sewn coloanal anastomosis. There were no
the patients with no risk factor had lymph node metastasis. On the other APRs. Gender: TEM: 19 men, 11 women; TME: 30 men, 12 women. Mean
hand, even if T1 lower rectal cancer was found, female patients without well age: TEM: 66.0 years (29-85); TME: 58.4 years (33-78). Mean pretreatment
differentiated adenocarcinoma had approximately 30% chance of lymph node size of tumor: TEM: 2.6cm (1.0-6.0); TME: 2.9cm (1.0-8.0). External beam
metastasis. As for patients with T2 lower rectal cancer, lymphatic invasion radiation: TEM: median=5400cGy (4140-5580), 25 with chemo; TME:
was most useful to predict nodal involvement. The rates of lymph node metas- median=5400cGy (4500-6600), 24 with chemo.
tasis in patients with and without lymphatic invasion were 9.1% and 32.9%, Results: Mean follow-up: TEM: 42.5 mos (2.5-111.7 mos); TME: 70.5
respectively. mos (3.8-245.6). There were no perioperative mortalities. Morbidity: TEM:
Conclusions: Gender was one of the most important predictors for 43% (13 wound separations treated with conservative mgt); TME: 26% (7
lymph node metastasis in patients with early distal rectal cancer in this study. minor, 4 major requiring surgeries). Path T stage: TEM: complete response
These parameters are useful as determinants of local excision for T1 cancer. (CR)=14, ypT1=7, ypT2=9; TME: CR=18, ypT1=14, ypT2=10; ypN+=3
However, further trials will be necessary for establish the optimal minimum (7.1%; ypT1=2, ypT2=1). Local recurrence (L/R): TEM: 3.3% (1/30); TME:
treatment for T2 lower rectal cancer. 2.4% (1/42) (p>.05). Dist metastases: TEM: 3.3%; TME 2.4% (p>.05). Over-
all 96.7% (29/30) of TEM patients and 95.2% (40/42) of TME patients lived
without a stoma (p>.05). KM5YAS: TEM: 95%; TME: 97% (p>.05).
P19 Conclusions: Local excision of select T2 rectal cancer after neoadjuvant
CLINICAL SIGNIFICANCE OF MACROSCOPIC COM- therapy can be performed with comparable oncologic outcomes to radically
PLETENESS OF MESORECTAL RESECTION IN RECTAL resected rectal cancers. Prospective trials will be needed to determine whether
CANCER. wider applicability of this approach.
J. Leite and F. Castro-Sousa Coimbra University Hospital, Coimbra, Por-
tugal.
Purpose: To study the prognostic value of macroscopic evaluation of rec-
tal cancer resection with preoperative radio-chemotherapy (CRT).
137
Abstracts
similar for both groups. Grp B patients had a significantly greater number
P21 of mesenteric lymph nodes retrieved(20.5±17.4 vs 16.4±11, p=0.003) when
PREOPERATIVE CLINICAL NOMOGRAM TO PREDICT
compared with Grp A. Overall postoperative morbidity and long term qual-
DISEASE RECURRENCE FOR EARLY STAGE RECTAL
ity of life were also similar for Grps A and B(27.9% vs 23.4%, p=0.6, and
CANCERS. 46.1 vs 45.9, p=0.89, respectively). On multivariate analysis, both group A
A. da Luz Moreira1, M. Kattan2, J. D. Vogel1, I. C. Lavery1 and and B had comparable long term cancer specific mortality(19.8% vs 17.5%,
M. F. Kalady1 1Cleveland Clinic, Cleveland, OH and 2Quantitative Health p=0.51) and local recurrence(p=0.43).
Sciences, Cleveland Clinic, Cleveland, OH. Conclusions: Early and longterm outcomes for patients undergoing rec-
Purpose: Although clinicopathologic staging of colorectal cancer defines tal resection for cancer by speciality trained surgeons at a tertiary, high vol-
cancers according to prognosis, up to 20% of early stage rectal cancers recur ume, colorectal surgery center are not further improved by increasing volume.
after “curative” surgery. This study attempts to refine prognosis of early stage
rectal cancers by constructing a preoperative clinical prognostic nomogram.
Methods: Clinical data and oncologic follow-up for 571 patients with P24
Stage I and II rectal cancer treated by surgical resection at a single institu- GEOGRAPHIC VARIATION IN THE SURGICAL MANAGE-
tion were modeled for prediction of disease recurrence. Patients receiving MENT OF RECTAL CANCER IN ONTARIO CANADA.
preoperative radiation or chemotherapy were excluded. Treatment failure R. Nenshi1, M. Simunovic5, N. Baxter4, N. Gunraj3, E. Kennedy2,
was recorded as clinical evidence of disease recurrence or initiation of adju- S. Schultz3, D. Wilton3 and D. Urbach2 1University of Toronto, Toronto,
vant chemotherapy or radiotherapy. Factors in the model included patient ON, Canada, 2University Health Network, Toronto, ON, Canada, 3Institute
age, gender, family history of colorectal cancer, T stage, tumor size, dis- of Clinical and Evaluative Sciences, Toronto, ON, Canada, 4St. Michael’s
tance to anal verge, tumor differentiation, and type of surgical treatment. Hospital, Toronto, ON, Canada and 5Hamilton Regional Cancer Centre,
Predictors were used in Cox proportional hazards regression which formed Toronto, ON, Canada.
the basis of a nomogram to predict the probability of disease recurrence.
Purpose: Population-based patterns of treatment for rectal cancer were
Accuracy of the nomogram was assessed by examining discrimination and
determined in Ontario, Canada.
calibration with bootstrapping.
Methods: Data from administrative health databases (Canadian Insti-
Results: The 5-year probability of treatment failure for the cohort was
tute for Health Information [CIHI] and the Ontario Health Insurance Plan
15%. Disease recurrence was noted in 57 of 571 patients. Eighteen recur-
[OHIP]) were linked to a population-based cancer registry (the Ontario Can-
rences were local only, 39 recurrences were distant only, and 3 were both
cer Registry [OCR]) to measure hospitalizations and surgical treatment
local and distant. An additional 29 patients received adjuvant therapy post-
received by all patients with a new diagnosis of rectal cancer in Ontario
operatively. The median follow-up was 5.2 years (2.2-13.7, IQR). The pre-
from March 1 2003 to April 30 2004. Data were evaluated at the level of
dictions from the nomogram appeared accurate with a concordance index
Local Health Integration Networks (LHINs), 14 geographical hospital refer-
of 0.742, compared to 0.68 if prediction was based on AJCC T-stage only.
ral regions in the province of Ontario (pop. 13 million).
Conclusions: A preoperative nomogram has been developed and can
Results: 1642 residents of Ontario were newly diagnosed with rectal can-
be used to predict the probability of treatment failure for an individual patient
cer during the study period. 59.1% were men and 18.3% were <55 years
with early stage node-negative rectal cancer. The nomogram provides
old. 77.7% (1277) of all patients had a surgical procedure. Various types of
improved predictive accuracy compared to using T stage alone and may be
definitive surgery were used among patients, these included: resection with-
considered in discussions with patients about prognosis and treatment.
out stoma 29% (366); resection with potentially reversible stoma 29% (366);
resection with permanent stoma 26% (344); and, palliative procedures 16%
P23 (210). There was variation in the type of definitive surgery received accord-
ing to the patients’ LHIN of residence (p for difference=0.006). The per-
ARE THERE SURGEON-RELATED VARIATIONS IN OUT-
centage of patients with rectal cancer who underwent resection with per-
COMES FOR PATIENTS WITH RECTAL CANCER UNDER-
manent stoma ranged from 16% to 43%. 65% of patients who had surgery
GOING RESECTION AT A TERTIARY CENTER?
also had a radiation oncology consultation, and 21.6% underwent planning
W. Khoury, I. C. Lavery and R. P. Kiran Cleveland Clinic, Cleveland, OH. for pre-operative radiation. Among LHINs, the proportion of surgical
Purpose: Surgeon volume and speciality training have previously been patients who saw a radiation oncologist ranged from 52% to 82% and the
reported to affect outcomes for patients with rectal cancer undergoing resec- proportion of surgical patients who underwent planning for pre-operative
tion. Whether variations in the volume of rectal resections performed by dif- radiation ranged from 10% to 40%.
ferent surgeons within a high volume colorectal cancer are associated with Conclusions: We observed important differences in the types of surgery
oncologic outcomes has not been previously studied. provided and in the use of radiation therapy for patients with rectal cancer
Methods: Data for all patients undergoing rectal resection for cancer according to the region of patient residence. Such regional variations likely
from 2000-2007 were retrieved from a prospective cancer database. The reflect differences in treatment approaches to rectal cancer that existed at
median number of rectal resections performed for cancer per surgeon per the time of the study (and may still exist). There may be an opportunity for
year during this period was determined. Surgeons were classified as high or regional quality improvement efforts that focus on standardizing the surgi-
low-load volume, if they were above or below the median, respectively. Patient cal approach to patients with rectal cancer.
and tumor characteristics and early and long term outcomes, local cancer
recurrence and quality of life were compared for patients undergoing sur-
gery by low volume (Group A) and high volume surgeons (Group B). A mul- P25
tivariate analysis of factors was performed controlling for gender, ASA class, QUALITY IMPROVEMENT: BENCHMARK COMPLICA-
cancer T and N stage and grade, chemoradiotherapy use, and level of tumor. TION RATES FOLLOWING RESECTION FOR RECTAL
Results: The study included 13 surgeons. Median rectal resections per CANCER - SYSTEMATIC REVIEW -.
surgeon per year were 11. 829 patients were operated on by high volume and B. Paun, S. Cassie, E. Dixon, A. MacLean and W. D. Buie Department
242 by low volume surgeons, during the study period. Median follow up of Surgery, University of Calgary, Calgary, AB, Canada.
was 1.9 yrs for Grp A and 2.9 yrs for Grp B. Age(p=0.2), gender(p=0.99),
Purpose: Quality improvement (QI) requires acceptance of benchmark
ASA class(p=0.2), use of preoperative and postoperative chemoradia-
outcomes. Universally accepted complication rates following rectal cancer
tion(p=0.9), stage of disease (p=0.9) and operation performed (p=0.12) were
138
Abstracts
surgery have not been reported. This systematic review was designed to deter- complete response was 42.3% and 95.1% for EUS, and 42.3% and 93.1%
mine post-operative complication rates following low anterior resection for MRI with positive and negative predictive values, respectively of 64.7%
(LAR) and abdominoperineal resection(APR) for rectal cancer to establish and 86.4% for EUS, and 61.1% and 83.6 % for MRI. Sensitivity and speci-
benchmark outcomes for QI. ficity in detection presence of lymph node metastasis were 61.8% and 82.8%
Methods: All prospective studies of rectal cancer receiving radical sur- for EUS and 35.3% and 83.9% for MRI with positive and negative predic-
gery published between 1990 to August 2008 were obtained by searching tive values for lymph node metastasis of respectively, 56.8% and 85.6% for
Ovid MEDLINE, EMBASE, as well as ASCO GI, CAGS and ASCRS meet- EUS, and 44.4% and 78.0% for MRI. Staging accuracy of EUS and MRI
ing abstracts from 2004 to 2008. There was no language restriction. Extracted was associated with both histological T staging (EUS, P=0.001; MRI, P=
outcomes included anastomotic leak, pelvic sepsis, post-operative death, 0.019) and N staging (EUS, P=0.007; MRI, P<0.0001).
wound infection, and fecal incontinence. Summary complication rates were Conclusions: A trend toward a better accuracy rate for T-restaging rec-
obtained using a random effects model. tal cancer was observed for EUS when compared to MRI. A good predic-
Results: 52 prospective cohort studies and 44 randomized controlled tion of node-negative rectal cancer was obtained with both the imaging
studies with 40,327 patients (24,765 patients had an anastomosis) were eli- modalities, as were as for predictive value for pathologic complete response.
gible for inclusion. The studies found were based in continental Europe The risk of under staging should always be considered when EUS and MRI
(59%), followed by Asia (24%), United Kingdom (9%), North America (5%) are performed.
and Australia/New Zealand. The anastomotic leak rate (82 studies) was 0.11
[95% CI 0.10, 0.12]; pelvic sepsis rate (28 studies) was 0.12 [0.09, 0.16]; post-
P OSTERS
operative death (69 studies) was 0.02 [0.02, 0.03]; wound infection rate (47 P27
studies) was 0.07 [0.06, 0.09]. Fecal incontinence rates were reported in too IMPACT OF PREOPERATIVE COLORECTAL TATTOO
few studies and so heterogeneously that numerical summarization was inap- MARKING ON SPECIMEN LYMPH NODE IDENTIFICA-
propriate. Year of publication, use of preoperative radiation, use of a pro- TION.
tecting stoma and method of detection (clinical vs. radiological) were not A. Pena1, D. A. Etzioni1, A. Garza2, A. M. Kaiser1, K. A. Frankel2,
significant variables to explain heterogeneity in anastomotic leak rates. Year G. Ault1, R. W. Beart1 and P. Vukasin2 1Colorectal Surgery, University of
of publication was not significant with respect to wound infection and pelvic Southern California, Keck School of Medicine, Los Angeles, CA and 2Glen-
sepsis rates, but was a significant variable to explain heterogeneity in post- dale Memorial Hospital and Health Center, Glendale, CA.
operative death rates (see table 1).
Conclusions: Benchmark complication rates for radical rectal cancer Purpose: Evidence exists correlating number of lymph nodes identified
surgery were obtained for QI. These rates may be of use in sample size cal- in resected specimens of colorectal neoplasia to the validity of assigned stag-
culations in future prospective studies. Reported post-operative death rates ing. India ink colonic tattooing is increasingly used for lesion localization in
following rectal cancer surgery may have improved in recent years. anticipation of laparoscopic procedures. Incidentally, tattooing has also been
Table 1 – Post-operative complication rates for radical rectal surgery as reported in stud- noted to make draining lymph nodes more evident visually. We hypothe-
ies published 1990-2002 compared to studies published 2003-2008 sized that this effect of preoperative colon tattoo marking would facilitate
lymph node identification in resected specimens.
Methods: All colorectal resections for neoplasia performed by a single
surgeon and evaluated by a single pathology group in a community hospital
setting form November 1996 through March 2008 were included in this ret-
rospective study. Specimens were grouped into tattooed (TAT+) vs. non-tat-
tooed (TAT-) and correlated with the number of lymph nodes identified.
Other data collected included demographics, neoplasm location, and
2002/2003 was chosen as the cut-off because 2003 was the median year of publication colonoscopy performance.
numbers in solid brackets represent the 95% confidence intervals Results: 224 patients were placed in to the study. 20 patients did not have
preoperative colonoscopy. Of the 204 receiving colonoscopy, 27 (13%) had
a tattoo placed. Specimens of TAT+ patients yielded an average of 13.3 +/-
P26 5.7 lymph nodes, while those of TAT- averaged 10.7 +/- 6.8 (p=0.03). 179 of
RESTAGING RECTAL CANCER AFTER NEOADJUVANT the patients had invasive carcinomas yielding 13.7 +/- 9.0 lymph nodes from
THERAPY : COMPARISON OF ENDOANAL ULTRASOUND TAT+ and 11.1 +/- 6.9 from TAT- (p=0.06). Of the 116 patients with inva-
AND MAGNETIC RESONANCE IN 127 PATIENTS. sive colon cancers (the remaining being rectal) TAT+ specimens provided an
A. Vignali1, P. De Nardi1, L. Ghirardelli1, G. Radaelli2, E. Orsenigo1 and average of 13.9 +/- 9.6 while those of TAT- averaged 12.5 +/- 7.3 (p=0.23).
C. Staudacher1 1Department of Gastrointestinal Surgery, IRCCS San Raf- Conclusions: There is a statistically significant increase in the number
faele, Milan, Italy and 2Units of Statistics, San Paolo Hospital-University of lymph nodes identified from specimens that have undergone preopera-
of Milan, Milan, Italy. tive tattoo marking. Since this difference is in the range identified by some
studies to be of clinical significance in patient care, consideration should be
Purpose: To compare the diagnostic value of endorectal ultrasonogra- given in performing this procedure in all planned cancer resections.
phy (EUS) and magnetic resonance imaging (MRI) in predicting T, N-stage
and pathologic complete response in 127 consecutive rectal cancer patients
after preoperative neoadjuvant chemoradiation (CRT). P28
Methods: Patients with initial locally advanced rectal cancer were EXTENDED VERSUS NON-EXTENDED LYMPHADENEC-
prospectively evaluated over a four year period by EUS and MRI after pre- TOMY FOR RECTAL CANCER: A META-ANALYSIS.
operative chemoradiation and just before surgery. The findings on the post-
P. Georgiou1, N. Gouvas1, E. Tan1, A. Antoniou1, G. Brown2 and
CRT, MRI and EUS were compared with histological examination of the
surgical specimen. P. P. Tekkis1 1Chelsea and Westminster Campus, Imperial College, Lon-
Results: The overall accuracy in T-restaging was 58.5 % by EUS and don, United Kingdom and 2Department of Radiology, The Royal Marsden
49.6 % by MRI ( P= 0.07). The overall accuracy of EUS and MRI in N- Hospital, London, United Kingdom.
restaging was 77.2% and 70.9%, respectively. T-under staging rates were Purpose: To compare post-operative and long-term outcomes for patients
17.3% for ERUS and 20.5%,for MRI. N-under staging rates were 12.8% undergoing extended (ELD) versus non-extended lymphadenectomy (N-
for ERUS, and 10.2% for MRI. Sensitivity and specificity for pathologic ELD) following oncologic resection for rectal cancer.
139
Abstracts
Methods: Comparative studies published between 1984 to 2007 evalu- research establishes reliable histopathologic patterns of predictors for
ating extended versus non-extended lymphadenectomy for colorectal can- LNM, caution should be exercised when basing treatment decisions solely
cer, were included. End-points evaluated were overall survival, disease-free on these factors.
survival, morbidity and recurrence rates. A random effect meta-analytical
model was used and between-study heterogeneity assessed.
Results: Nineteen studies (1 RCT, 1 prospective and 17 retrospective
studies) evaluating 5200 patients were included in the analysis. 2489 patients
underwent ELD and 2711 N-ELD. Operation time was significantly longer
in the ELD group by 106.79 minutes (95% CI: 85.59-127.99, Q=4.26,
P<0.00001). There was no significant difference in the incidence of anasto-
mostic dehiscence between the two groups. Sexual dysfunction was higher
in the ELD vs N-ELD group (64.2% vs 23.0%, p=0.05). There were no
significant differences regarding 5-year survival between the two groups
(Odds Ratio (OR)=1.41, 95% CI: (0.82-2.41) with significant heterogeneity
Q=55.67, p=0.21). There was no significant difference in 5-year disease-
free survival (OR=1.05, 95% CI: (0.55-2.00), Q=14.68, p=0.74). There was
no significant difference for local recurrence (OR=0.91, 95% CI: (0.59-1.43),
Q=50.33, p=0.69). The difference approached statistical significance for dis- P30
tant recurrence (0R=1.30, 95% CI: (0.99- 1.70), Q=4.03, p=0.06). LYMPH NODE INVOLVEMENT HAS A GREATER ADVERSE
Conclusions: Extended lymphadenectomy did not appear to confer a AFFECT ON SURVIVAL IN YOUNGER PATIENTS WITH
survival advantage following oncologic resection for rectal cancer. There are COLON CANCER.
currently no randomized control studies commenting on the role of neo-
adjuvant chemoradiotherapy as a substitute for ELD. At present ELD may
D. B. Stewart1, L. Wang2 and W. Koltun1 1Surgery/Division of Colorec-
be indicated in a selective group of patients with recurrent rectal cancer and tal Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA and
2
in patients with persistent pelvic side wall lymphadenopathy despite use of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Her-
neo-adjuvant chemoradiotherapy in primary rectal cancer. shey, PA.
Purpose: To test the hypothesis that the number of involved nodes in
colon cancer influences cancer-specific survival to a greater degree in younger
P29 patients.
DO HISTOPATHOLOGIC FEATURES PREDICT LYMPH Methods: Data from the Surveillance, Epidemiology and End Results
NODE METASTASES? A META-ANALYSIS. (SEER) Program from 1992-2004 was studied. Patients undergoing resec-
S. C. Glasgow1, J. I. Bleier2, S. Duval4, L. Burgart3, C. O. Finne1 and tion for colon cancer were divided into two age groups at the time of their
A. C. Lowry1 1Colon & Rectal Surgery, University of Minnesota, Min- surgery: <40 (younger) and ≥40 (older). A Cox regression proportional haz-
neapolis, MN, 2Surgery, University of Pennsylvania, Philadelphia, PA, ards model was used to test the influence that factors such as gender, age,
3 cancer stage, the total number of nodes identified in the resection specimen
Pathology, Abbott Northwestern Hospital, Minneapolis, MN and 4Epi-
(node yield), and the number of involved nodes had on cancer-specific sur-
demiology & Community Health, University of Minnesota, Minneapolis,
vival. Only those patients who died from cancer related causes were included
MN.
in the analysis.
Purpose: Treatment decisions for rectal cancer vary based on lymph Results: A total of 72,850 patients were identified with a median age of
node status. We sought to identify histopathologic characteristics of pri- 69 years. There were 2055 patients (2.8%) who were younger than 40 years
mary colorectal adenocarcinomas that reliably predict lymph node metas- of age. The median node yield for younger patients was 15 ± 14 nodes and
tases (LNM). was 10 ± 9 nodes for older patients (p<0.001). The younger group had a
Methods: An inclusive, systematic literature search was performed using higher mean number of involved nodes (2.5 ± 4 vs. 1.8 ± 3, p<0.001). Gen-
EMBASE and Ovid MEDLINE databases for articles correlating LNM with der, marital status, overall stage, node yield, and age were significant pre-
all-stage colorectal cancer (CRC) from 1984 to 2008. Exclusions included dictors of survival (p<0.001). However, the risk of death from cancer was
IBD and polyposis patients, and those treated with neoadjuvant therapy or greater per positive node in the younger group than the older group (HR
local excision without LN resection. A random effects meta-analysis model 1.02, p=0.002) and this affect was independent of these other factors. Younger
was used for pooled estimates. patients had a 2% greater chance of death from colon cancer per positive
Results: The initial search yielded 602 abstracts. From these, 117 arti- lymph node identified compared to older patients. When analyzing those
cles were reviewed in full; data were included from 76. Forty-three patients with node positive disease who had at least 12 nodes in the resec-
histopathologic risk factors for LNM were described. The factors were sorted tion specimen (n=33,026), younger age was also associated with decreased
by number of tumors tested, with pooled totals ranging from 34 to 120994 cancer-specific survival (HR 1.04, p<0.001). When patients had distant metas-
with a median of 263. Limited data existed for many predictors, with 62.7% tases, the influence of positive nodes was not significantly different than in
of risk factors reported in 2 or fewer articles. Of the 11 most widely-studied older patients (HR 1.01, p=0.12).
risk factors, ten correlated with positive LNM (odds ratios (OR) depicted in Conclusions: For patients less than 40 years of age, there is a greater
Table). The false-negative rate for the major risk factors ranged from 4.4 to adverse affect on survival per positive node such that for 5 positive nodes a
38.2%. When separately reported, data from rectal cancer were compared younger patient has a 10% greater chance of death. Adequate nodal staging
to data from all CRC. The ability of certain features of rectal cancer to pre- and appropriate use of adjuvant chemotherapy is of even greater impor-
dict LNM differed from all CRC; the largest differences were noted for lym- tance in this age group.
phatic invasion (OR 8.84 [1.0, 77.3] vs. 6.71 for all CRC) and differentiation
at the invasive front (11.8 [2.5, 56.3] vs. 6.46).
Conclusions: No single histopathologic risk factor reliably predicts
LNM. Standard pathology reports do not routinely include all the well-
tested markers with significant ORs. The impact of certain characteris-
tics varies based upon location of the primary tumor. Until further
140
Abstracts
lymph nodes along the right and middle colic arteries were most commonly
P31 metastatic lymph nodes. In transverse colon cancer, the middle colic node was
DWORAK CLASSIFICATION OF RECTAL CANCERS AFTER
the most commonly involved lymph node. Approximately 10% of patients
NEOADJUVANT THERAPY AS A PREDICTOR OF NODAL
had metastases to the right colic nodes.
STATUS. Conclusions: Metastasis to lymph nodes along the right colic artery
N. Fanaian1, T. Bollinger1, B. Loh2, S. Li3, P. Williamson2, J. Gallagher2 occurred in approximately 10% of the patients with transverse cancer, indi-
and A. Ferrara2 1Orlando Regional Medical Center, Orlando, FL, 2Colon cating the need for great care in deciding the extent of segmental resection
and Rectal Clinic of Orlando, Orlando, FL, and 3MD Anderson Cancer Cen- for these patients.
ter Orlando, Orlando, FL.
Purpose: We hypothesize that the Dworak Classification used to stage
rectal cancers after neoadjuvant therapy is a useful predictor of lymph node
status in total mesorectal excision specimens
Methods: A retrospective analysis of 68 patients with locally advanced
rectal cancer who underwent neoadjuvant therapy and subsequent total
mesorectal excision(TME) between Feb 1995 to Nov 2005. Pathologic and
clinical features including neoadjuvant Dworak classification, nodal status,
and disease free survival(DFS) were examined. We compared Dworak Clas-
P OSTERS
sification Grade 4 (complete response,no tumor cells), Grade 3 (few cells dif-
ficult to find microscopically), Grade 2 (dominant fibrotic change and few
tumor groups, Grade 1 (dominant tumor mass with fibrosis/vasculopathy)with
node status as predictors for DFS and cancer related death (CRD). We also
correlated Dworak classifications with nodal status. The patients were fol-
lowed from from a range of 6 to 116 months, average 42 months.
Results: 68 patients with locally advanced rectal cancer underwent neoad-
juvant therapy followed by TME. 36(53%)of patients Dworak Class 1(D1),
13(19%)Dworak Class 2, 4(5.8%) Dworak Class 3, and 15(22%), Dworak
Class 4. DFS 57% for D1&2, compared to 89% for D3&4(p=0.012) DFS
37% for node+ patients, compared to 76% for node- patients(p=0.003). CRD
was 31% for D1&2, 0% for D3&4(p=0.007). CRD 42% for node+ patients,
14% for node- patients (p=0.021) Patients with a Dworak classification D1&2
were 13.1 times more likely to be node positive compared to D3&4 patients
(p=0.0001). 69.4% of D1&2 patients were node+, compared to 5.3% of D3&4 Lymph node metastasis in transverse colon cancer
patients (p=0.0001) Of the complete clinical response group (D4), 1 of 15
patients(6.6%) had positive lymph nodes. In D4, no local recurrences seen.
2 patients had distant lung metastasis at 52 and 116 months. P33
Conclusions: Dworak classification correlates significantly with lymph PREOPERATIVE ENDOSCOPIC TATTOO IS ASSOCIATED
node status. Patients with D1&D2 are 13.1 times more likely to be node+ WITH HIGHER LYMPH NODE YIELD IN COLON CANCER
than D3&D4 patients. Also, Dworak classification is a significant predictor RESECTION.
for CRD (31% for D1&D2 patients, compared to 0% for D3&D4 patients).
D. Row1, J. Shia2, J. Ho1, P. B. Paty1, M. R. Weiser1, L. K. Temple1,
Dworak classification may play a role in selection of patients for local exci-
sion of rectal cancer. J. G. Guillem1, W. D. Wong1 and G. M. Nash1 1Colorectal Service, Memo-
rial Sloan-Kettering Cancer Center, New York, NY and 2Pathology, Memo-
rial Sloan-Kettering Cancer Center, New York, NY.
P32 Purpose: The literature has conflicting recommendations for the min-
LYMPH NODE METASTASIS PATTERNS IN RIGHT-SIDED imum number of lymph nodes (LNs) to be pathologically examined after
COLON CANCERS: IS SEGMENTAL RESECTION OF colon cancer resection. The aims of this study are 1) to assess the impact of
TRANSVERSE COLON CANCER ONCOLOGICALLY SAFE? patient, tumor, and operative factors on LN yield and 2) to develop a pre-
I. Park1, G. Choi2 and S. Jun2 1Surgery, Vievis Namhu Hospital, Seoul, Korea, dictive model for the number of LNs retrieved for colon neoplasm resec-
tions.
South and 2School of Medicine, Kyungpook National University, Daegu, Korea,
Methods: Clinical, histopathologic, and operative data were extracted
South.
from a prospective database of patients treated at a single cancer center
Purpose: The type of surgery and the extent of lymphadenectomy depend from April to October 2008. Non-metastatic, elective, single colon neoplasm
on the tumor location, and should be based on the extent of lymphatic spread resections were included. Each individually ligated vascular pedicle was dis-
and the oncologic outcome.The aim was to analyze patterns of lymph node sected with its mesentery and rigorously examined for its lymph nodes. The
metastasis in patients with right-sided colon cancer. pedicle nearest to the tumor was designated the primary pedicle. Multivari-
Methods: Between 1996 and 2007, 419 patients underwent curative able linear regression analysis was performed to create a predictive model of
resection for right-sided colon cancer. Lymph nodes were grouped imme- the LN yield.
diately after surgery based on the location of the tumor. Results: 94 patients were analyzed (46 cecum, 8 right, 8 transverse, 8
Results: There were 75, 208, 78, and 58 tumors in the cecum, ascending left, and 24 sigmoid colon specimens). The overall median number of LNs
colon, at the hepatic flexure, and in the transverse colon, respectively. Of the harvested was 20 and 95% of patients had ≥ 12 LNs pathologically exam-
58 patients with transverse colon tumors, 43, 11, 3, and 1 underwent right hemi- ined. The median number of LNs harvested in the primary, secondary, and
colectomies, transverse colectomies, left hemicolectomies, and a subtotal colec- tertiary pedicles was 13, 4, and 2, respectively. In 65% of patients, ≥ 12 LNs
tomy, respectively. Patients with cecal and ascending colon cancers most fre- were identified in the primary vascular pedicle alone. In the linear model,
quently had metastases in the ileocolic lymph nodes. Metastasis to the lymph no patient factor was a significant predictor of LN yields (see table). Among
nodes along the right branch of the middle colic artery occurred in 6.1% of the tumor factors, size was more important than T stage; for every centimeter
patients with cecal cancer. In patients with hepatic flexure cancers, the epicolic
141
Abstracts
increase in size, LN yield increased by 1.3. LN yields were lower for more
distally located tumors. Among the operative factors, number of pedicles and
P35
NEOADJUVANT THERAPY FOR STAGE III RECTAL CAN-
preoperative placement of a tattoo had a significant impact on LN yield (38%
CER NEGATES THE EFFECT OF ENLARGED LATERAL
of patients had tattooing).
Conclusions: LN yield in colon resection is associated with both tumor PELVIC LYMPH NODES.
and operative factors. Tumor size, location, number of resected pedicles, and S. Dharmarajan1, D. Schuai2, A. D. Fajardo1, E. Birnbaum1, S. Hunt1,
preoperative tattooing were independently associated with higher LN yields. M. Mutch1, J. Fleshman1 and A. Lin1 1Surgery, Washington University in
Other, unmeasured, factors are likely to play important roles. St. Louis, St. Louis, MO and 2Radiology, Washington University School of
Medicine, St. Louis, MO.
Purpose: The significance and management of lateral pelvic lymph nodes
(LPLN) in rectal cancer remains unclear. Although some surgeons favor
LPLN dissection in lieu of neoadjuvant therapy, this is associated with sig-
nificant morbidity including urogenic and sexual dysfunction. The purpose
of this study was to determine the outcome of patients with LPLNs identi-
fied on pretherapy imaging who were treated with neoadjuvant therapy fol-
lowed by proctectomy without LPLN dissection.
Methods: Pretherapy imaging of patients with stage III rectal cancer
from our prospectively maintained institutional database was reviewed by a
radiologist to determine perirectal and LPLN enlargement. Data was col-
1. Determined by nearest vascular pedicle to tumor
lected on preoperative therapy, operative resection, adjuvant therapy and
(ileocolic, right colic, right/middle/left branch of middle colic, left colic, sigmoidal) patient outcomes and correlated to presence or absence of preoperatively
identified LPLNs (LPLN+ and LPLN-). Statistical analysis was performed
using two-tailed unpaired t test and Fisher’s exact test with significance set
P34 at p<0.05.
THE CLINICAL SIGNIFICANCE OF FAT CLEARANCE Results: Of 53 patients identified who were treated between 2000 and
LYMPH NODE HARVEST FOR INVASIVE RECTAL ADENO- 2005, 21 (40%) were LPLN+ on preoperative imaging. Pathologic down-
CARCINOMA FOLLOWING NEOADJUVANT THERAPY. staging occurred in 28% of patients (12/32 LPLN-; 3/21 LPLN+). pCR was
5.6%. There was no statistically significant difference between LPLN+ and
H. Wang, B. Safar, S. D. Wexner, P. I. Denoya, M. Cruz-Correa and
LPLN- patients with respect to gender, age, BMI, distance of tumor from
M. Berho Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
anal verge, preoperative CEA or presence of perirectal lymphadenopathy on
Purpose: Lymph node status is the single most important prognostic pretherapy imaging. Additionally, no difference was found in the two groups
predictor in colorectal carcinoma without distant metastasis. Fat clearance with regards to neoadjuvant or adjuvant therapy. Local recurrence was 12%
techniques have been shown to increase lymph node harvest; but its role in and there was no difference related to LPLN status. Comparison of overall
clinical practice remains controversial. Aim of this study was to investigate and disease–free survival in patients with and without enlarged LPLNs
the application of fat clearance in cases of rectal cancer following neoadju- revealed no difference.
vant chemoradiation. Conclusions: LPLNs identified on pretherapy imaging do not affect
Methods: Patients who underwent proctectomy (R0 resection) were overall or disease-free survival after neoadjuvant therapy and proctectomy
included. Neoadjuvant therapy consisted of a median dose, 50.4Gy of radi- in stage III rectal cancer. Lateral pelvic lymph node dissection does not appear
ation and 5-Fu based chemotherapy. The lymph node harvest and tumor to be justified in stage III patients with LPLNs on pretherapy imaging who
stage were recorded and compared. N1 and N2 stages were regarded as N+ receive neoadjuvant therapy.
stage.
Results: From January 1998 to September 2007, 237 patients were iden-
tified, including157 cases in the neoadjuvant therapy group and 80 cases in P36
the non neoadjuvant therapy group. In both groups, patients were divided CANCER FIBROTIC STROMA IN PT2 COLORECTAL CAN-
into traditional method group and fat clearance method group. In the non CER: AN INDEPENDENT PREDICTIVE FACTOR FOR
neoadjuvant therapy group, there was no significant difference in the num- LYMPH NODE METASTASIS.
ber of positive lymph nodes (P=0.235) or patients with N+ stage (P=0.332)
H. Uchida1, H. Hasegawa1, Y. Ishii1, T. Endo1, K. Okabayashi1,
between the two methods, even though the total lymph node harvest was
Y. Masugi2 and Y. Kitagawa1 1Department of Surgery, Keio University
increased significantly by utilizing the fat clearance method (P<0.001). In
contrast, the total lymph node retrieval (P<0.001), number of positive lymph School of Medicine, Tokyo, Japan and 2Department of Pathology, Keio Uni-
nodes (P=0.007) and patients with N+ stage (P=0.006) were all increased by versity School of Medicine, Tokyo, Japan.
fat clearance in the neoadjuvant group. Moreover, the number of cases with Purpose: Cancer fibrotic stroma has an important role in cancer devel-
N+ stage was compared at different T stage levels (T0-T4) to eliminate the opment and invasion. Tumor budding at the invasive front of colorectal
background bias and the results were confirmed. There was no significant cancer, which is well-known as an important predictive factor for nodal and
difference in N+ stage between the two methods in the non neoadjuvant distant metastasis, morphologically shows epithelial-to-mesenchymal tran-
group (P=0.196); however, fat clearance significantly upgraded N+ stage in sition (EMT). The aim of this study was to investigate the relation between
neoadjuvant group (P=0.014). cancer fibrotic stoma and tumor budding, and evaluate predictive signifi-
Conclusions: In our experience, utilization of fat clearance technique cance for lymph node metastasis.
significantly influences lymph node staging in rectal cancer following neoad- Methods: In 132 pT2 colorectal cancers operated between 1990 and
juvant chemoradiation. The findings suggest that fat clearance may repre- 1996, collagen fiber irregularity in the cancer invasive front, tumor budding
sent a useful tool in all cases receiving neoadjuvant therapy; a more gener- and other histopathological findings were reviewed and predictive signifi-
alized application in colorectal carcinoma specimens remains controversial cance for lymph node metastasis were evaluated for each factor. Three cat-
and warrants further investigation. egories of stroma were used: regular—when the stroma was composed of
fine and elongated collagen fibers into multiple layers; intermediate-con-
sisting of separated and crossed fine fiber; and irregular—consisting of a small
142
Abstracts
mixed fiber fragments. High-grade tumor budding was defined as 5 or more rently used as an indicator of the quality of resection. However, the factors
foci in a ×200 microscopic field. influencing the total number of lymph nodes examined remain unclear. This
Results: Lymph node metastasis was found in 35 (27%) of 132 pT2 col- study analyzes the factors affecting the number of lymph nodes examined.
orectal cancers. Irregular fibrotic stroma and high-grade tumor budding were Methods: A retrospective chart review of 155 patients was performed. 120
found in 34 (26%) and 26 (20%) respectively. Correlation coefficient between colon and 35 rectal resections for cancer were performed by a single colorec-
collagen fiber irregularity and tumor budding was 0.616 (p<0.0001). Among tal surgery practice at three different hospitals over a three year period from
the factors analyzed, irregular fibrotic stroma, high-grade tumor budding 2005 to 2007. Statistical analysis was carried out using unpaired T test and
and lymphatic invasion were significantly associated with lymph node metas- ANOVA test between the variables and the number of lymph nodes examined.
tasis (p<0.0001, p<0.0001, p<0.0001, respectively). Multivariate analysis Results: 12 or more lymph nodes were examined in 86.67% of colon can-
showed that irregular stroma was an independent predictive factor for lymph cer specimens and 88.57% of rectal cancer specimens. The hospital where the
node metastasis (Odd’s ratio 10.181; 95% confidence interval 3.30-31.45) operation was performed significantly affected the number of lymph nodes
together with lymphatic invasion (Odd’s ratio 3.48; 95% confidence inter- examined in colon cancer. (p < 0.05) The location of the colon cancer, opera-
val 1.18-10.29). tive techniques used (laparoscopic vs open), the T stage, and the age did not
Conclusions: Tumor fibrotic stroma correlated with tumor budding, significantly affect the number of lymph nodes examined. For rectal cancers,
and was an optimal predictive histopathologic factor for lymph node metas- administration of neoadjuvant therapy decreased the number of lymph nodes
tasis in patients with pT2 colorectal cancer . examined and was the only significant factor. (p < 0.05) The hospital, opera-
tive techniques used (laparoscopic vs open), the T stage, and the age did not
P OSTERS
contribute significantly to the number of lymph nodes examined.
P37 Conclusions: The total number of lymph nodes examined in the col-
CLINICAL SIGNIFICANCE OF LYMPH NODE RATIO AS A orectal cancer specimens is affected by hospital for colon cancer and by neoad-
PROGNOSTIC INDICATOR IN COLON CANCER STAGING. juvant therapy for rectal cancer.
Y. Hashiguchi, H. Ueno, Y. Kajiwara, J. Yamamoto, H. Mochizuki and
K. Hase Surgery, National Defense Medical College, Tokorozawa, Japan.
Purpose: Recently the lymph node ratio (LNR), the number of LNs
P39
LYMPH NODE CLEARANCE FOLLOWING LAPARO-
involved (NLNI)divided by total number of LNs examined, has become a
SCOPIC-ASSISTED SURGERY FOR COLORECTAL CAN-
topic of interest. We investigated the clinical significance of LNR in colon
cancer staging with comparison to NLNI. CER: THE INFLUENCE OF REQUESTING A PATHOLOGI-
Methods: We reviewed the clinical records of 376 node-positive patients CAL RE-EVALUATION OF THE SPECIMEN.
who had undergone potentially curative surgical treatment for localized colon M. L. Torres1, E. Haas2 and T. Pickron2 1General Surgery, UTMB, Galve-
cancer from 1980 to 2002. The optimal breakpoint for the LNR was calcu- ston, TX and 2University Of Texas, Medical School, Houston, TX.
lated by receiver operating characteristic curve (ROC) analysis and the sig- Purpose: We report our experience related to lymph node clearance to
nificance was tested by area under the curve (AUC) analysis. Patients were determine if adequate lymph node sampling was achieved during laparo-
stratified into groups based on various parameters, and univariately and mul- scopic resection. In cases where fewer than 12 lymph nodes were reported,
tivarietly analyzed with respect to cause-specific survival (CSS). The param- we evaluated the efficacy of re-review from the pathologist.
eters were categorized as follows: Age [≤64=0; ≥65=1], Gender [male=0; Methods: All patients who underwent elective laparoscopic surgical resec-
female=1], NLNI [1-3=0; ≥4=1], LNR [<0.2=0; ≥0.2=1], Depth [T2=0; T3=1; tion over a 4 year period for colorectal cancer with curative intent were
T4=2], Grade [well differentiated adenocarcinoma=0; moderately differen- entered into a prospective database. Analysis of surgical pathology includ-
tiated adenocarcinoma=1; others=2], Size [<5cm=0; ≥5cm=1], Tumor site ing number of lymph nodes was reviewed. In a subset of patients in which
[right=0; left=1;rectosigmoid=2] fewer than 12 lymph nodes were identified, a request was made to the pathol-
Results: The ROC and AUC analysis indicated that LNR is a signifi- ogist for a second look to identify additional lymph nodes. Comparison of
cant prognostic predictor (AUC 0.571, p=0.0106), and identified 0.193 as a number of lymph nodes reported before and after pathology review was per-
cutoff value with best accuracy. Thus, patients were divided into two groups formed using the pair t-test. Adequacy of lymph node harvest was com-
(<0.2; n=257 vs. 0.2≤; n=119) and were subsequently analyzed. The overall, pared between the university and community hospital setting.
cause-specific, and relapse-free survival for patient with high and low LNR Results: A total of 251 patients were analyzed. The mean age was 65.7
were 69.3% vs. 52.7% (p=0.0003), 74.1% vs. 57.1% (p=0.0002), and 64.6% and 55% were male. There were a total of 9 cases converted to open surgery
vs. 49.4% (p=0.0011), respectively. Multivariate analysis with stepwise regres- with bulky tumor as the most common reason. The specimen was evaluated
sion by Cox proportional hazard model selected LNR (HR 1.58, p=0.0177) in a university setting in 136 patients and a community setting in 113 patients.
and tumor depth, but not LNI as significant and independent risk factors. All surgical specimens were noted to have negative distal and radial margins.
The impact of LNR in patients with N1 and N2 cancer of TNM-staging Nine patients had local invasion (T4)and underwent en bloc resection. The
were separately evaluated. Although the impact of LNR in N1 patients were average number of lymph nodes retrieved in all surgical specimens was 17.1
not significant (n=287, 73.1% vs. 65.4%; p=0.1354), there was a significant ± 7.9. The total number was not significantly different in academic institu-
difference in CSS in patients with N2 disease (n=89, 88.2% vs. 51.3%, tions (17.7 ± 8.1) compared to community hospitals (15.0 ± 7.1). A total of
p=0.0073). 33 patients were found to have fewer than 12 lymph nodes. Following a request
Conclusions: LNR may be a better prognostic factor than NLNI in for re-evaluation, significantly more lymph nodes were identified: see table.
colon cancer staging. The impact of LNR is still significant in N2 patients In two patients, the requested pathology review resulted in identification of
within the confines of the current TNM-staging. at least one positive lymph node which affected the stage of disease.
Conclusions: In cases in which reported lymph nodes are below expected
yield, a request by the surgeon for a second look may result in a significant
P38 increase number of lymph nodes and alter the pathologic staging.
LYMPH NODE RETRIEVAL IN COLORECTAL CANCER:
SURGICAL TECHNIQUE IS NOT THE ONLY FACTOR.
H. Chern, K. Wilkins, T. Eisenstat, J. Notaro, G. Oliver and B. Chinn
Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ.
Purpose: Extensive nodal resection correlates with improved survival in
colon cancer. The number of lymph nodes in a pathologic specimen is cur-
143
Abstracts
Results: There were 6 patients in the secondary mucosectomy group (5
P40 females, median age 37 years) and 30 patients in the primary mucosectomy
OUTCOMES AFTER IPAA: DOES GENDER MAKE A DIF-
group (25 females, median age 36 years). The groups were well matched for
FERENCE?
clinical, demographic, and pathologic variables. One patient in the second-
M. Rottoli, R. P. Kiran, F. Remzi and V. W. Fazio Colorectal Surgery, ary mucosectomy group and none in the primary mucosectomy group had
Cleveland Clinic Foundation, Cleveland, OH. their pouch excised. The median FISI (22 vs. 12.5,p<0.05) and CGQOL (.62
Purpose: Little is known whether outcomes after IPAA are associated vs. .80,p<0.005) were significantly worse in the secondary mucosectomy
with gender differences. group. The table compares functional outcomes.
Methods: Outcomes for all patients undergoing IPAA from 1983-2008 Conclusions: Patients undergoing secondary mucosectomy for
were evaluated. Differences between male and female patients for demographic, intractable cuffitis have significantly worse fecal continence and quality of
patient and disease related variables and perioperative factors were evaluated. life compared to those who undergo primary mucosectomy. Secondary muco-
Complications and long-term outcomes including functional results and qual- sectomy is associated with a significantly higher number of bowel movements
ity of life (QOL) were compared. Fisher’s exact, chi-squared, Wilcoxon tests in 24 hours. While secondary mucosectomy may offer a solution to intractable
were used as appropriate. For outcomes, an adjusted p value was calculated with cuffitis, long-term functional results following this procedure are signifi-
follow-up time as covariate. QOL was evaluated using Short Inflammatory cantly inferior to those of primary mucosectomy.
Bowel Disease Questionnaire (SIBDQ), Cleveland Global Quality of Life Comparison of Long-Term Functional Outcome
(CGQL), Fecal Incontinence Quality of Life (FIQL) and Fecal Incontinence
Severity Index (FISI) scores.
Results: 1495 (43.9%) female and 1912 (56.1%) male patients underwent
IPAA. Male patients were significantly older (39.1 vs 36.9 years, p<0.001), had
significantly greater comorbidity (p=0.03), intraoperative blood loss (462 vs
387 ml, p<0.001) and higher rate of ileostomy (89.1 vs 83.5%, p<0.001) than
female patients. Mean length of hospital stay (p=0.052) and cumulative 30 day
complication rates (p=0.1) were similar. A significantly higher proportion of
male patients had anastomotic dehiscence (3.8 vs 1.8%, p=0.001) although NS=Not Significant
pelvic sepsis rate (5 vs 3.7%, p=0.06) was similar. Over a mean follow-up of
7.9 years, female patients were more likely to develop bowel obstruction (20.8
vs 16.7%, p=0.002) and fistula (10.9 vs 7.6%, p=0.001), and reported worse P42
daily bowel frequency (6.1 vs 5.5, p=0.001), higher rate of urgency (10.9 vs ILEAL POUCH ANAL ANASTOMOSIS (IPAA) IN THE ELD-
8.1%, p=0.009), daytime seepage (24.7 vs 20.9%, p=0.01), day (28.5 vs 15.8%, ERLY: IS THERE A DIFFERENCE IN THE MORBIDITY
p<0.001) and night (33.6 vs 23.2%, p<0.001) pad use, and dietary (31.4 vs COMPARED TO YOUNGER PATIENTS?
24.8%, p<0.001) and work (17 vs 14%, p=0.02) restrictions. Despite this, QQL
R. Pinto, J. Canedo, S. M. Murad-Regadas, F. S. Regadas, E. Weiss and
was comparable between groups.
S. D. Wexner Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
Conclusions: There are relevant differences in male and female patients
undergoing IPAA pertaining to operative and postoperative outcomes, which Purpose: The preferred surgery for management of Ulcerative Colitis
need to be taken into consideration. Long-term outcomes including func- (MUC) and Familial Polyposis is restorative proctocolectomy with ileal J-
tional outcomes and restrictions are worse in female than male patients. QOL pouch anal anastomosis (IPAA). The aim of this study was to review the recent
is high for both groups and does not seem to be associated with gender. results of IPAA in elderly patients compared with younger patients.
Methods: Retrospective evaluation based on a prospective database of
patients who underwent IPAA from 2001 to 2008 was performed. Patients
P41 aged ≥ 65 years were matched with a group of patients aged < 65 years by
SECONDARY MUCOSECTOMY AFTER STAPLED ILEAL gender, date of procedure, diagnosis and type of procedure performed. Pre-
POUCH-ANAL ANASTOMOSIS FOR INTRACTABLE CUF- operative and intra-operative data, and early postoperative complications
FITIS: FUNCTIONAL COMPARISON WITH A PRIMARY were assessed. Student’s t and Fisher tests were used.
MUCOSECTOMY. Results: Thirty-three patients (22 females), 32 with MUC were in each
group. The elderly group had a mean age of 68.7 (65 – 78), BMI of 27, dura-
J. Karas, A. Grucela, S. Khaitov, J. J. Bauer, S. R. Gorfine and tion of disease of 17.4 years, high ASA (II-20/III-13), high incidence of
D. B. Chessin Surgery, Mount Sinai Medical Center, New York, NY. comorbid conditions (87.9% had one or more) and dysplasia was the most
Purpose: Many cases of “cuffitis” following stapled restorative procto- common indication for the surgery (36.4%) followed by refractory disease
colectomy (RP) respond to medical treatment, but some require surgery. (24.4%). The matched younger group had a mean age of 36.9 (18-60), BMI
Long-term functional outcome data concerning patients converted from a of 25.4, shorter time of disease (8.1 years; p=0.001), lower ASA (I-17/II-
stapled anastomosis to a secondary mucosectomy and hand-sewn anasto- 14/III-2; p=0.0001), lower comorbidities (42.4%; p=0.0002) and refractory
mosis are limited. Therefore, we compared functional outcome in patients disease was the indication for the majority of the surgeries (81.7%). Surgi-
with ulcerative colitis and an RP who had a primary mucosectomy with hand- cal data were similar for both groups with a mean length of operation of 224
sewn anastomosis to those who had a secondary mucosectomy for intractable minutes, blood loss of 323.3ml for the elderly and 290.1 ml for young patients,
cuffitis. incision length of 27.9 vs. 25.6cm, and mean pouch length of 18.8 vs. 19.2cm.
Methods: We queried our prospective database of patients with an RP The elderly group had higher re-hospitalization for dehydration (p=0.02).
for demographic, clinical, and pathologic data. We identified two groups; Other medical complications (30 vs. 27%) and surgical postoperative com-
(1) primary mucosectomy and hand-sewn anastomosis and (2)secondary plications (33 vs. 24%) were similar for both groups.
mucosectomy for medically refratory cuffitis. We sent a questionnaire to Conclusions: Elderly patients who underwent IPAA had more comor-
patients containing long-term functional questions, including the validated bid conditions then did younger patients. However, except for incidence of
fecal incontinence severity index (FISI) and Cleveland Global Quality of Life re-hospitalization for dehydration, the rates of both medical and surgical
(CGQOL). Patients who underwent a secondary mucosectomy were matched postoperative complications did not differ from that rate seen in younger
with patients who underwent a primary mucosectomy. The two groups were patients. Therefore, IPAA seem as safe in elderly as in younger patients.
compared to determine if there was any difference in long-term functional
outcome.
144
Abstracts
Results: We identified 16 patients (6 females, median age: 41 years). Nine
P43 (56.3%) RPCs were performed in one-stage, 5 (31.2%) in two stages, and 2
EFFECTS OF POSTOPERATIVE POUCH COMPLICATIONS
(12.5%) in three stages. There were 5 (31.2%) major complications, includ-
AFTER RESTORATIVE PROCTOCOLECTOMY ON LONG-
ing 2 anastomotic leaks, 1 pelvic abscess, and 2 small bowel obstructions.
TERM FUNCTIONAL OUTCOMES, QUALITY OF LIFE AND Pathologic analysis of the colon and rectum revealed 4 (25.0%) patients with
POUCH FAILURE. adenocarcinomas, 4 (25.0%) with low grade dysplasia, 3 (18.8%) with high
M. Rottoli, R. P. Kiran, F. Remzi, E. Corrao, J. M. Church and grade dysplasia, and 3 (18.8%) indefinite for dysplasia. 10 (62.5%) patients
V. W. Fazio Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, had pouchitis, all treated medically. Six (37.5%) patients had incontinence
OH. (2 (12.5%) for solid stool and 4 (25.0%) with nighttime leakage). Eleven
Purpose: Ileo anal pouch anastomosis (IPAA) generally results in good (68.8%) patients required antidiarrheals. Six (37.5%) patients had liver trans-
function and quality of life (QOL). The effects of 30 day postoperative com- plants, two of whom required a second transplant due to recurrent PSC.
plications on functional outcome, QOL and pouch failure have not been well Conclusions: Patients with CUC and PSC treated with an RPC have an
studied. 87% rate of malignancy or dysplasia in the colon and rectum. In addition,
Methods: Data of all patients undergoing IPAA from 1983-2008 were over 60% develop pouchitis. Although liver transplantation treats hepatic
evaluated. Patients who developed postoperative pouch complications includ- failure from PSC, 33% develop recurrent hepatic disease requiring a sec-
ing sepsis, anastomotic separation, fistula and hemorrhage after IPAA (PC) ond transplant. Patients with CUC and PSC represent a distinct patient pop-
were compared to those without complication (NPC) for patient, disease, ulation with a worse inflammatory, oncologic, and hepatic outcome.
P OSTERS
preoperative and postoperative factors using Fisher’s exact or Chi-squared
tests for categorical and Wilcoxon test for ordinal variables. Pouch failure
rate was evaluated using Kaplan Meier method. Adjusted p values based on P45
linear or logistic regression model was calculated with follow-up time and FACTORS PREDICTING EARLY READMISSION AFTER
age as covariates for functional outcomes and QOL. ILEOANAL POUCH SURGERY.
Results: There were 293 PC and 3114 NPC patients. PC had signifi- E. Ozturk, R. P. Kiran, F. Remzi and V. W. Fazio Colorectal Surgery,
cantly more male patients (64.5 vs 55.3%, p=0.003). The two groups had The Cleveland Clinic Foundation, Cleveland, OH.
comparable age (p=0.8), diagnosis (p=0.38), anastomosis type (p=0.67) and Purpose: There is a paucity of data assessing factors determining early
defunctioning ileostomy (p=0.82) at IPAA. Pouch failure rate at 5 and 10 readmission after ileal pouch–anal anastomosis (IPAA). The aims of this study
years was 11.1% and 13.2% in PC and 3.3% and 4.5% in NPC groups were to determine the indications for readmission following IPAA, to inves-
(p<0.001) (hazard ratio: 3.3; 95%CI 2.27, 4.77 for PC). Median follow-up tigate early and long term outcomes of these patients and to explore factors
for PC and NPC groups was 4 (0-23) and 8 (0-24.2) years (p<0.001). For that might be predictive of readmissions by comparing them with non–read-
patients with a retained pouch, at the most recent follow-up, bowel frequency mitted patients.
(p=0.78), incidence of urgency (p=0.87), incontinence (p=0.56), seepage Methods: Data for patients readmitted within 30 days after IPAA were
(p=0.4) and pad use (p=0.55) were similar. QOL (p=0.08), Short Inflamma- compared with those of non-readmitted patients. Reasons and outcomes after
tory Bowel Disease Questionnaire (p=0.58), Fecal Incontinence Quality of readmission were determined. A multivariate model was used to find out fac-
Life (p=0.38) and SF-36 score (p=0.52) were also similar. A higher propor- tors that may be predictive for readmission. Long term outcomes were
tion of PC patients reported social (22.5% vs 14.9%, p=0.006) and sexual assessed for readmitted and non-readmitted patients.
restrictions (21.4% vs 15.8%, p=0.048). Results: 410 (12%) patients undergoing IPAA from 1984 to 2008 were
Conclusions: 30 day postoperative pouch complications are associated readmitted. Reasons for readmission included ileus, obstruction or dyselec-
with long-term pouch failure. Even those patients who have a retained pouch trolytemia (54.9%), surgical site infections (20.3%), anastomotic problems
suffer worse function manifest as social and sexual restrictions. This suggests (9.8%), hemorrhage (3.2%), thrombotic (3.4%), infectious (2.9%), cardiac
that postoperative complications should be minimized by expert technique (1.2%) and miscellaneous (4.3%) complications. Median time from discharge
and wise surgical strategy. to readmission was 8 (1-30) days. 32 (7.8%) patients were reoperated, 74
(18%) required invasive non-operative interventions. Median length of stay
for readmissions was 4 (1-52) days. No mortality occurred following read-
P44 missions. Multivariate analysis revealed that comorbidity (p=0.014; OR=1.36),
PATIENTS WITH ULCERATIVE COLITIS AND PRIMARY
to have proctocolectomy (PC) and IPAA rather than having subtotal colec-
SCLEROSING CHOLANGITIS TREATED WITH A tomy and then IPAA (p<0.001; OR=1.55), post-operative blood transfusion
RESTORATIVE PROCTOCOLECTOMY HAVE A WORSE (p=0.02; OR=1.54) and laparoscopic technique (p=0.008; OR=1.8) were asso-
INFLAMMATORY AND ONCOLOGIC OUTCOME. ciated with readmission. Over a median follow-up of 7 (IQR: 2-8) years, anas-
E. Steinhagen, A. Grucela, J. J. Bauer, R. M. Steinhagen, S. R. Gorfine tomotic stricture (p=0.06), pouchitis (p=0.22) and pouch failure (p=0.49) were
and D. B. Chessin Surgery, Mount Sinai Medical Center, New York, NY. similar between groups.
Purpose: There is limited data regarding outcomes of patients with Conclusions: Early readmission after IPAA is significant but acceptable.
chronic Ulcerative Colitis (CUC) and Primary Sclerosing Cholangitis Requirement of postoperative blood transfusion, patients with associated
(PSC) who undergo a Restorative Proctocolectomy with ileal J-pouch- comorbidity, laparoscopic approach and reconstruction of the IPAA at the
anal anastomosis (RPC). There is some evidence that patients with both time of index surgery significantly increase this risk.
conditions have a more severe inflammatory disease process. Therefore,
our purpose was to comprehensively characterize patients with CUC and
PSC who are treated with RPC and determine their long-term clinical
and functional outcomes.
Methods: We queried our prospectively maintained database of patients
with CUC who were treated with an RPC for patients who also were diag-
nosed with PSC. We extracted clinical, pathological, and functional data for
this cohort of patients. We determined long-term inflammatory complica-
tions and oncologic outcome for the cohort. We also evaluated the long-
term hepatobiliary outcomes.
145
Abstracts
tissues were sectioned at ~10-15 µm for mounting onto either metal or con-
P46 ductive glass target plates (the glass plates allowing for histologic and MALDI
TYPE OF PROCEDURE DOES NOT AFFECT POST-OPER-
MS analysis on the same section). Sinapinic acid was used to give the best
ATIVE RECURRENCE RATES FOLLOWING ILEOCOLIC
combination of uniform crystal coverage and signal quality for direct tissue
RESECTION. protein analysis.
J. Fleshman2, D. Schoetz3, T. Phang4, H. MacDonald5, W. Koltun6, Results: MALDI MS achieved high mass accuracy (± 0.5 Daltons) in the
C. Vasilevsky7, W. D. Buie8, N. H. Hyman9, B. G. Wolff10, R. McLeod1 lower mass range (< 15 kDa). Several mass-to-charge ratio (m/z) values dif-
and S. Strong11 1University of Toronto, Toronto, ON, Canada, 2Washington ferentiated between control vs the inflammatory colitides and more strik-
University, St. Louis, MO, 3Lahey Clinic, Burlington, MA, 4University of ingly between CC vs UC (p< 0.0001) using Significance Analysis of Microar-
British Columbia, Vancouver, BC, Canada, 5Queens University, Kingston, ray (SAM) and False Discovery Rate (FDR) tests. There were eleven
ON, Canada, 6Penn State, Hershey, PA, 7McGill University, Montreal, QC, statistically significant discriminative m/z peaks observed in CC vs UC sub-
Canada, 8University of Calgary, Calgary, AB, Canada, 9University of Ver- mucosa. These peaks ranged from 3000 to 14000 m/z, all with > 2-fold induc-
mont, Burlington, VT, 10Mayo Clinic, Rochester, MN and 11Cleveland Clinic tion in CC. The mucosa did not yield such distinctive peaks. Both the mucosa
Foundation, Cleveland, OH. and submucosa provided signatures that differentiated IBD (CC or UC))
from control tissues (p< 0.001).
Purpose: to determine whether a laparoscopic approach to ileocolic
Conclusions: MALDI MS tissue profiling as described distinguished the
resection affects post operative recurrence rates
inflammatory colitides. The methodology revealed 11 m/z peaks of inter-
Methods: 170 patients who had an ileocolic resection for Crohn’s dis-
est. Analyses are underway to identify these potentially discriminative pro-
ease as part of a multicentre randomized controlled trial assessing the effect
teins in IBD.
of the anastomosis on recurrence rates were included in this study. All patients
had a colonoscopy at one year. Endoscopic recurrence, defined as disease>
i, 2 on a Modified Rutgeert’s score, was the primary endpoint. Symptomatic
recurrence was defined as symptoms plus endoscopic evidence of disease.
P48
THE IMPACT OF PREOPERATIVE IMMUNOMODULA-
Results: Ninety-four (55.3%) patients (34 males:60 females; mean age
TORS ON POSTOPERATIVE COMPLICATIONS IN
41.5 years) had an open and 76 (44.7%) patients (28 males:48 females, mean
PATIENTS WITH CROHN’S DISEASE.
age 36.6 years) had a laparoscopic assisted procedure. The conversion rate
was 30%. Those in the open group were more likely to have had previous D. B. Chessin, D. Greenwald, E. Roth, S. R. Gorfine and J. J. Bauer Sur-
resections (46% vs. 20%, p=0.0005), have an abscess or fistula (36% vs 28% gery, Mount Sinai Medical Center, New York, NY.
p<0.05) and require additional procedures (20% vs. 9%, p=0.043). The mean Purpose: Many patients with Crohn’s disease requiring operative inter-
duration of their operation was shorter (115 vs 139 mins, p=0.002) but their vention are treated with immunomodulators prior to surgery. However, there
median hospital stay was longer (6 vs. 5 days, p=0.011). In total, 139 patients is limited data concerning the impact of preoperative medication on post-
had a colonoscopy performed at mean 11.1 months post operatively. The operative complications in this patient population. Therefore, we evaluated
endoscopic recurrence rate was 43.0% in the open compared to 35.5% in a large cohort of patients treated with surgery for Crohn’s disease to deter-
the laparoscopic group (p=0.65). The symptomatic recurrence rate was 20.3% mine if preoperative immunomodulators increase the incidence of postop-
in the open compared to 24.2% in the laparoscopic group (p=0.80). On mul- erative complications.
tivariate analysis, procedure type was not predictive of recurrence. Methods: We queried our prospectively maintained database of patients
Conclusions: Laparoscopic ileocolic resection offers potential benefits with Crohn’s disease who underwent a surgical procedure from 1995-2008
to patients with Crohn’s disease without affecting the risk of post operative for clinical, pathological, and outcome variables. We identified patients who
recurrence had postoperative complications to characterize this cohort. We compared
those with and without a postoperative complication to determine if preop-
erative immunomodulators resulted in an increased rate of postoperative
complications. We stratified the groups based upon specific medications and
P47 postoperative complications.
PROTEOMIC PATTERNS OF COLONIC SUBMUCOSA DIS- Results: We evaluated 321 patients (168 females, median age: 39 years,
CRIMINATES INFLAMMATORY COLITIDES. median duration of disease: 22 years) who underwent 328 surgical proce-
A. E. M’Koma1, P. Wise1, E. H. Seeley2, M. K. Washington3, dures. Surgical procedures included abdominoperineal resection [n=4 (1.2%)],
D. A. Schwartz4, A. J. Herline1, R. L. Muldoon1 and R. M. Caprioli2 gastrojejunostomy [n=1(0.3% )], ileocolic resection [n=242 (73.8%)],
1
General Surgery, Vanderbilt University, Nashville, TN, 2Biochemistry, Van- ileostomy [n=8 (2.4%)], low anterior resection [n=2 (0.6%)], left hemi-
derbilt University, Nashville, TN, 3Pathology, Vanderbilt University, colectomy [n=9 (2.7%)], right hemicolectomy [n=4 (1.2% )], small bowel
resection [n=35 (10.7%)], subtotal colectomy [n=12 (3.7%)], and total proc-
Nashville, TN and 4Gastroenterology, Vanderbilt University, Nashville, TN.
tocolectomy [n=11 (3.4%)]. There were 54 (16.5%) total complications in
Purpose: Differentiating Crohn’s colitis (CC) and ulcerative colitis (UC) 44 patients. The most common complications were anastomotic leak [n=11
can be challenging even with clinical, endoscopic, radiologic, and histopatho- (3.4%)], bleeding requiring intervention [n=9 (2.7%)], pelvic abscess [n=7
logic evaluations. Biomarker studies have thus far been unsuccessful for dis- (2.1%)], wound infection [n=7 (2.1%)], and small bowel obstruction [n=7
ease delineation. We aim to use unique tissue proteomic methods to evalu- (2.1%)]. The impact of preoperative medications on postoperative compli-
ate colonic tissue layers for potential biomarkers to differentiate CC vs UC. cations is summarized in the table.
Methods: Fresh-frozen colon specimens from resections for inflamma- Conclusions: Patients undergoing surgery for Crohn’s disease have an
tory bowel disease (IBD) and/or colorectal cancer (CRC) performed between overall complication rate of 16.5%. The anastomotic leak rate is 3.4%. We
2003 and 2006 were prospectively retrieved. De-identified surgical pathol- identified no preoperative medication or immunomodulator that increases
ogy reports and hematoxylin and eosin slides were available on each of these the risk of overall or infectious postoperative complications.
patients. Colitis diagnoses were histologically re-confirmed by a blinded gas-
trointestinal pathologist. Three sample groups (n = 5 each group) were exam-
ined: normal colon from CRC specimens (control), UC, & CC. Matrix
assisted laser desorption/ionization-mass spectometry (MALDI MS) was
used to profile mucosal and submucosal compartments individually. Frozen
146
Abstracts
Impact of Preoperative Medications on Postoperative Complications in Patients with
Crohn’s Disease P50
RESTORATIVE PROCTECTOMY IN OBESE AND NON-
OBESE PATIENTS: RESULTS FROM SECOND DECADE OF
EXPERIENCE.
J. Canedo, R. Pinto, E. McLemore, L. Rosen and S. D. Wexner Col-
orectal Surgery, Cleveland Clinic Florida, Weston, FL.
Purpose: Restorative proctocolectomy with Ileal Pouch Anal Anasto-
mosis (IPAA) is often the procedure of choice for patients with ulcerative
NS= Not Significant colitis and familial adenomatous polyposis (FAP). However, in some patients
a proctectomy and stoma is indicated. Obesity increases the complexity and
technical difficulty of many surgical procedures. The aim of this study was
P49 to assess the outcomes following 20 years of experience with IPAA in obese
LONG-TERM OUTCOME OF ADVANCEMENT FLAP patients as compared to a matched cohort of patients with a BMI < 25 kg/m2.
REPAIR OF ANORECTAL FISTULA IN CROHN’S DISEASE Methods: Retrospective review of all obese patients who underwent IPAA
IN THE ERA OF INFLIXIMAB: PREDICTORS OF SUCCESS. from 1998 to 2008 was performed. Obesity was defined as BMI ≥ 30. A con-
trol group of patients with BMI < 25 was used for comparison. Primary end-
P OSTERS
S. Khaitov, J. Karas, S. R. Gorfine and D. B. Chessin Surgery, Mount
Sinai Medical Center, New York, NY. points included days of hospitalization, operative time, operative blood loss
and complications. Postoperative complications were categorized into < 6
Purpose: Patients with perianal Crohn’s disease often have anorectal fis-
weeks and > 6 weeks. Student’s t and Fisher test were used for analysis.
tulas that are difficult to treat. Due to concern about healing after lay-open
Results: Obese patients had a mean age of 47 years and mean BMI of
fistulotomy, endorectal advancement flaps may provide for optimal treat-
35. The mean BMI of the control group was 22 (p<0.0001). Age, gender,
ment. However, there is limited data on the long-term outcomes and bene-
ASA classification, diagnosis, type and time of the procedure were well
fit over other medical and surgical treatment of the disease. Therefore, we
matched between the two groups. The obese patient population had a higher
compared patients with anorectal fistula secondary to Crohn’s disease treated
incidence of pre-operative co-morbidities (p=0.04) and disease severity meas-
with an advancement flap to those treated with other interventions in the era
ured in steroid and immunomodulatory medical therapy (p=0.049). Forty-
of infliximab.
five patients underwent IPAA, 20 had completion proctectomy IPAA, 2
Methods: We queried our prospectively maintained database of patients
patients underwent pouch repair, and 1 patient had a re-do pouch. The oper-
with fistulizing perianal Crohn’s disease who underwent surgery from 2000-
ative time was longer and the blood loss greater in the obese group (243 vs.
2007 for clinical, treatment, and outcome variables. We identified patients
209 min, p=0.007; 359 vs. 251 mL, p=0.01). The mean length of stay was
treated with an advancement flap to comprehensively characterize this cohort
longer in obese patients (10 vs. 8 days; p=0.01). There was no significant
of patients. We compared this group to those treated with interventions other
difference in the postoperative complications, except for incisional hernia
than a flap to determine if there were differences between the groups in heal-
in obese compared to control patients (17% vs. 3%; p=0.03).
ing and outcome. We also evaluated predictors of fistula healing after advance-
Conclusions: Blood lost, operative time, length of stay and incisional
ment flap.
hernia were significantly higher in obese patients who underwent IPAA.
Results: We identified 19 patients with Crohn’s disease and an anal fis-
Obese patients should be informed about these risks prior to surgery. Weight
tula treated with a flap (12 females, median age: 40 years) and 71 patients not
reduction prior to protectomy may be helpful.
treated with a flap (34 females, median age: 39 years). In the flap group, 10
(52.6%) patients had isolated anorectal disease, 1 (5.3%) also had small bowel
disease and 8 (42.1%) also had colonic disease. The group treated with a P51
flap had a significantly higher rate of infliximab use (p<0.05). Isolated anorec- UNSUSPECTED ADENOCARCINOMA IN PATIENTS WITH
tal disease, steroid use, 6-MP use, more than one attempt at repair, and fecal PSC AND UC UNDERGOING COLECTOMY WITH IPAA.
diversion was not different between the groups. After a median of 2 flap
procedures (range: 2-4), 14 (73.7%) patients healed their fistula. The heal- K. L. Mathis, L. A. Benavente-Chenhalls, E. J. Dozois, H. Chua,
ing rate in the flap group was not different than the no flap group (73.7% B. G. Wolff and D. W. Larson Surgery, Mayo Clinic, Rochester, MN.
vs. 67.6%, p=NS). The table compares predictors of healing in the flap group. Purpose: To correlate pre-operative findings with operative pathology
Conclusions: In properly selected patients, endorectal advancement flaps in a large group of patients with primary sclerosing cholangitis (PSC) and
heal 73.7% of perianal fistulas in Crohn’s disease. Patients treated with a flap ulcerative colitis (UC) undergoing total proctocolectomy with ileal pouch-
are more likely to be treated with infliximab. We identified no clinical or anal anastomosis (IPAA) and to identify risk factors associated with neopla-
treatment variables that were predictors of healing. sia.
Predictors of Healing in Patients with Fistulizing Anorectal Crohn’s Disease Treated Methods: We identified all patients with PSC and UC who underwent
with Advancement Flap colectomy with IPAA at a single institution between 1994 and 2005. Clini-
cal charts were retrospectively reviewed, and data regarding demographics,
disease histories, pre-operative therapies, and operative pathology was col-
lected.
Results: 100 patients (62 male) with PSC and UC underwent IPAA dur-
ing the study period. Pre-operative histology revealed dysplasia in 50, ade-
nocarcinoma in 8, and no dysplasia in the remaining 42 patients. Histologic
analysis of the colectomy specimen revealed pancolitis in 93% of patients.
The disease was considered mild or inactive in 53% and moderate or severe
in 47%. Postoperative pathology revealed no dysplasia in 37 specimens, low
NS= Not Significant
grade dysplasia in 43, high grade dysplasia in 5, and adenocarcinoma in 15
(T1N0 in 2, T2N0 in 3, T3N0 in 5, T3N1 in 3, T3N2 in 2). Of the 15 ade-
nocarcinomas, 6 (40%) were found in those with preoperative pathology
showing dysplasia only, and 1 (7%) was found in a patient with no dysplasia
147
Abstracts
on preoperative pathology. Factors associated with adenocarcinoma in the short term outcomes in a cohort of patients undergoing laparoscopic colec-
colectomy specimen included older age at IPAA (p=0.0045), pancolitis, and tomy for complicated and uncomplicated diverticulitis.
mild/inactive disease activity (compared to patients with moderate/severe Methods: Using a prospectively maintained database, all patients who
disease activity). Duration of PSC, duration of UC, and gender were not sig- underwent elective laparoscopic colectomy for diverticulitis from 2003 to
nificantly associated with cancer risk. 2008 were identified. Laparoscopic colectomy was performed as laparoscopic-
Conclusions: The results suggest that patients with UC and PSC are at assisted (LAP) or as hand-assisted (HALS). Univariate analysis was performed
a high risk of unsuspected adenocarcinoma despite modern screening. Older to compare patients with complicated versus uncomplicated diverticulitis
patients with pancolitis and inactive/mild disease activity are at the highest with respect to safety and short term outcomes. Complicated diverticulitis
risk. Therefore, future improvements in screening may be needed to specif- was defined as diverticular disease associated with abscess, fistula, obstruc-
ically target older patients with both PSC and UC in the setting of mild/inac- tion or bleeding.
tive disease and pancolitis. Results: A total of 361 patients (145 complicated, 216 uncomplicated
diverticulitis) were included in the analysis. There were 130 (36%) LAP and
231 (64%) HALS resections. There was no difference between the two groups
P52 with respect to age, gender, BMI, type of laparoscopic approach, post-oper-
THE DIAGNOSIS OF DIVERTICULITIS IN OUTPATIENTS: ative recovery protocol, or percentage with previous open surgery. The only
ON WHAT EVIDENCE? difference included a higher ASA class (p<0.004) in the complicated cohort.
E. S. O’Connor, G. Kennedy and C. P. Heise Surgery, University of Wis- With respect to short term outcomes, there was no difference between the
consin School of Medicine and Public Health, Madison, WI. two groups with respect to time to tolerating soft diet, time of first bowel
Purpose: Despite the high prevalence of diverticular disease among the movement, overall morbidity rate (9.4% for complicated vs. 13.3% for
aging population, rigorous study of the care patterns surrounding this con- uncomplicated), and median hospital length of stay (4 vs. 4 days). Conver-
dition is currently limited to hospitalized patients. Many patients present sion rates were not significantly different: 4.4% vs. 8% for complicated and
symptomatically in the outpatient setting, yet the methods employed for uncomplicated, respectively. No mortalities were observed in either group
diagnosis and management are less well described. The goal of this study is at 30 days.
to characterize the clinical assessment generating the diagnostic label of diver- Conclusions: Laparoscopic colectomy is safe and feasible for patients
ticulitis in outpatients. with uncomplicated and complicated diverticulitis. Despite higher ASA sta-
Methods: The electronic medical record system for a tertiary referral tus in patients with complicated disease, outcomes were equivalent to those
hospital and its regional clinics was queried for outpatient encounters with with uncomplicated disease. Elective laparoscopic resection should be offered
the associated diagnosis of diverticulitis (ICD-9 diagnosis codes to patients with both complicated and uncomplicated diverticulitis.
562.11/562.13). Demographic and clinical variables, including comorbid
conditions, imaging, laboratory tests, and interventions, were documented
for each patient. The frequencies of these elements at each individual’s first
P54
COLONIC DIVERTICULITIS AFTER KIDNEY TRANS-
chronological visit were compared between those presenting in the emer-
gency room or in an outpatient clinic.
PLANTATION : INCIDENCE, SEVERITY AND IMPACT ON
Results: Between 2003 and 2008, 2576 patients met inclusion criteria, GRAFT PRESUMPTION SURVIVAL.
including 328 patients in the ER (12.7%) and 2248 patients in the clinic V. De Franco1, G. Meurette1, A. Meurette2, M. Giral-Classe2,
(87.3%). Patients seen in the ER, compared to those seen in the clinic, were E. Letessier1 and P. A. Lehur1 1CHU Nantes Hotel Dieu, Institut des Mal-
younger (56.1 years vs. 60.0 years, p<.0001), often male (53.1% vs. 44.75%, adies de L’appareil Digestif, Nantes, France and 2CHU Nantes Hotel Dieu,
p=.02), and were more likely to have a comorbid condition (23.8% vs. 12.4%, Institut de Recherche en Transplantation, Nantes, France.
p<.0001). Urgent abdominal imaging was utilized more frequently in the ER, Purpose: Colonic diverticulitis (CD) after kidney transplantation is not
including abdominal x-ray (27.2% vs. 8.9%, p<.0001) and abdominal/pelvic clearly reported in terms of occurence and severity questioning the ration-
CT scan (85.1% vs. 14.2%, p<.0001). When accessible, individuals present- ale of a systematic screening for diverticular disease before kidney trans-
ing in a clinic had lower mean WBC counts (9.6 vs. 11.6, p<.0001). Colec- plantation.The aim of the study was to evaluate the incidence of CD flare-
tomy within 1 week of the encounter was rare in both groups: 2.74% for ER up after kidney transplantation, its severity and impact on the graft survival.
patients vs. 0.98% for clinic patients. Ultimately, 54.3% of individuals seen Methods: Since 1990, all patients receiving a kidney transplant have been
in the ER had a subsequent hospitalization during the analysis period, com- enrolled in a declared registry (DIVAT). Data concerning the occurrence of
pared to 34.6% of clinic patients (p<.0001). CD, its management, related morbidity and mortality, renal function and
Conclusions: Patients labeled with diverticulitis are frequently seen in graft survival were compiled.
an outpatient setting. This diagnosis is often applied without a CT scan in Results: Among 3900 patients, 15 (0.38%) suffered from CD in an
the clinic and rarely requires urgent surgery. These findings suggest that median 17 months (0.2-112) after transplantation. The median age was 60
many outpatients are given a diagnosis of diverticulitis despite a lack of objec- years (36-72). According to Hinchey classification, the CD was severe (stage
tive evidence. III and IV) in 8 cases (54%). Seven patients were operated on emergency (6
Hartmann’s procedures), 1 patient died (septic shock)(7%). For the rest of
the group, the 10-year graft survival rate did not differ from the cohort of
P53 transplanted patients (85% vs 85%) and the creatinin variation was not sig-
COMPLICATED DIVERTICULITIS DOES NOT COMPRO- nificant after CD.
MISE RECOVERY OR INCREASE COMPLICATIONS IN Conclusions: This study demonstrates that CD is a rare event after kid-
LAPAROSCOPIC COLECTOMY. ney transplantation despite the use of immunosuppressive drugs. Its occur-
J. G. Touzios, D. W. Larson, R. R. Cima, H. K. Chua and E. J. Dozois rence did not compromise the graft survival. Under these conditions, nei-
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN. ther a systematic screening of diverticular disease nor prophylactic surgery
Purpose: Laparoscopic colectomy is rapidly becoming the gold standard is indicated in the pre kidney transplantation work-up.
for uncomplicated, elective colon resections. However, its role in compli-
cated disease is still being elucidated. The aim of this study was to compare
148
Abstracts
P55 P56
FUNCTIONAL OUTCOMES FOLLOWING SURGERY FOR THE ROLE OF REPROGRAMMING IN SACRAL NERVE
DIVERTICULITIS MAY BE WORSE THAN PREVIOUSLY STIMULATION FOR FECAL INCONTINENCE.
APPRECIATED. B. Govaert, M. P. Rietveld, W. G. van Gemert and C. G. Baeten Maas-
M. Levack1, L. Savitt1, D. Berger1, P. Shellito1, R. Hodin1, D. Rattner2, tricht University Medical Center, Maastricht, Netherlands.
S. Goldberg2 and L. Bordeianou1 1Gastrointestinal Surgery, Massachu- Purpose: After permanent sacral nerve stimulation (SNS) implantation
setts General Hospital, Boston, MA and 2Colon and Rectal Surgery, Uni- for fecal incontinence (FI), patients are subjected to a rigid follow-up sched-
versity of Minnesota, Minneapolis, MN. ule with outpatient clinic visits at 1 month, 3 months, 6 months, 1 year and
Purpose: Bowel function after surgery for diverticulitis has not been sys- yearly thereafter. At each follow-up the symptoms and stimulation parame-
tematically described. We surveyed 379 patients who underwent laparoscopic ters are assessed and in case of symptom recurrence or stimulation sensation
or open sigmoid colectomy with anastomosis(6/01-2/08)to assess frequency, alterations, reprogramming of stimulation parameters may be needed. The
severity and predictors of suboptimal function ≥6 months after surgery. purpose of this study was to assess the need for reprogramming in patients
Methods: Of 379 patients, 207 (54.6%) completed most of a 70-ques- with SNS after implantation.
tion survey, including the validated Fecal Incontinence Severity Index (FISI), Methods: We analysed all patients with a permanent SNS for FI. IN our
Fecal Incontinence Quality of Life Scale (FIQL) and Memorial Bowel Func- database we collect parameter changes in every follow-up visit. The param-
tion Instrument (MBFI). Responders and non-responders were similar (chi eter settings used for this analysis were: stimulation voltage, polarity set-
P OSTERS
square, t-test) in all but age and rates of splenic flexure takedown (table). ting, and stimulation frequency. We looked at the voltage level at each fol-
Responders with suboptimal bowel function (urgency, fecal incontinence, low-up because this is an important factor in battery life. Furthermore we
incomplete emptying, need for dietary, medical or life-style adjustments to looked at the number of patients that needed parameter setting reprogram-
control symptoms) were compared to those with good function (chi square, ming and determined which setting was changed at each follow-up visit.
t-test). A logistic regression model was used to determine predictors of poor Results: We analysed 156 patients (11 males). Mean age was 57.7 ±
function. 11.9years (range 18.2-83.5). Mean follow-up time was 34.1 ± 23.1 months
Results: 193 (94%) responders had ≤ 4 bowel movements/day. 144 (range 0.5-93.6). In one patient the stimulator had to be replaced due to
(69.6%) had mostly solid bowel movements. However, 51 (24.4%) reported battery depletion at 7 years follow-up. The mean voltage increased over time
moderate fecal incontinence (FISI≥ 24); 40 (19.1%) reported symptoms of from 1.8V at 1 month to 2.0V at 3 months and up to 2.2V at 3 years. 39
fecal urgency (MBFI Urgency Subscale ≥ 4); 66 (31.8%) needed to modify patients (25.5%) required no reprogramming in any follow-up visits, 51
diet to regulate their bowel function (MBFI Diet Subscale ≥ 4); 41 (19.6%) patients (32.9%) required reprogramming at 1-25% of their visits, 42 patients
reported incomplete emptying (MBFI Emptying Subscale ≥ 4) and 37 (27.1%) at 26-50% of their visits, 14 (9.0%) at 51-75% of their visits, and 9
(17.8%) reported a decreased quality of life (FIQL≤ 3). On logistic regres- (5.8%) at 76-100% of their visits. Mean follow-up is not significantly dif-
sion, only female gender (OR=2.5, p= 0.008) was predictive of suboptimal ferent between these groups. 15 leadrevisions were performed in 13 patients.
function. Age, need for diversion, length of bowel removed, splenic flexure 6 because of technical problems or dislocation and 9 because of symptom
takedown and postoperative anastomotic leaks were not predictive. recurrence not responding to reprogramming. These 9 occurred after an
Conclusions: This is the first study using validated instruments to look average period of 20.0 ± 17.7 months.
at the question of bowel function following surgery for diverticulitis. We Conclusions: Physicians and patients need to be aware of the fact that
found that one fifth of patients asked to fill a confidential questionnaire fol- reprogramming of the stimulator because of symptom recurrence or stimu-
lowing their surgery reported fecal urgency, fecal incontinence, or incom- lation sensation alterations, needs to be done in roughly 75% of all patients.
plete evacuation. These results are worse than previously appreciated, espe- Therefore we use this strict follow-up protocol in our clinic.
cially in women. Nevertheless, a prospective study will be needed to account
for preoperative function to further delineate actual impact of surgery in
these patients.
Comparison of Responders to Non-responders
Reprogramming(%): percentage of patients that required reprogamming of the stimu-
lator due to symptoms recurrence or stimulation sensation alterations
P57
SACRAL NERVE STIMULATION IN THE MANAGEMENT
OF FAECAL INCONTINENCE – MEDIUM TERM FOLLOW-
UP.
M. J. Capon, I. Ibbett, A. Read, B. Aspin, A. Sharpe and S. M. Plusa Col-
orectal Unit, Royal Victoria Infirmary, Newcastle upon Tyne, United King-
dom.
Purpose: Sacral nerve stimulation (SNS) is an increasingly used inter-
vention in the management of faecal incontinence. Initial success rates are
quoted as 40-75% for complete symptom control. There is less data for
* Statistically significant
longer follow-up. This study assesses the success of sacral nerve stimulation
in patients suffering from faecal incontinence in the medium term.
Methods: The case notes of patients who had SNS performed for fae-
cal incontinence between 2001 and 2008 were examined.
Results: 57 patients (51 female, 89%, mean age 52 years, range 22-73)
underwent temporary SNS. 50 patients had a successful trial (88%) and 45
patients have gone on to have a permanent SNS inserted to date. Four patients
are waiting for a permanent implant and one patient has declined. Follow-
149
Abstracts
up was a median of 48 months (range 2-75). Of the 45 with a permanent
implant seven patients (16%) had significant incontinence requiring other
P59
SACRAL NERVE STIMULATION FOR FECAL INCONTI-
treatment options including four patients who developed infection requir-
NENCE: RESULTS OF A 120-PATIENT PROSPECTIVE
ing the removal of the SNS device. 84% of those undergoing permanent
implant had a good result. Five of six males (83%) had a successful outcome MULTI-CENTER STUDY.
compared to 33 of 51 females (65%) (p=0.6, Fisher’s exact test). 38 of the S. D. Wexner1, J. Coller2, G. Devroede3, T. Hull4, R. McCallum6 and
original 57 patients who underwent temporary SNS went on to have a good A. F. Mellgren5 1Colorectal Surgery, Cleveland Clinic Florida, Weston, FL,
2
long term outcome from permanent SNS (intention to treat 67%). There Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA,
3
were 11 (29%) complications with successful implants, four patients required Université de Sherbrooke, Eastman, QC, Canada, 4Cleveland Clinic Ohio,
stimulator repositioning due to pain (one) or rotation (three). Two required Cleveland, OH, 5University of Minnesota, Minneapolis, MN and 6KU Med-
lead replacement due to migration, one for diathermy-related device failure ical Center, Kansas, MO.
and one had temporary removal followed by re-implantation due to infec- Purpose: Sacral nerve stimulation (SNS) has been approved for use in
tion. treating urinary incontinence in the U.S. since 1997, and in Europe for both
Conclusions: On an intention-to-treat basis two-thirds of patients had urinary and fecal incontinence (FI) since 1994. Aims of this study were to
a good result with a permanent implant. As follow-up increases there is an assess the safety and effectiveness of SNS for FI in a large population.
increased re-operation rate due to migration. There is no indication that Methods: Candidates for SNS who provided informed consent were
the benefit of SNS deteriorates with time. enrolled in this IRB-approved multi-centered prospective trial. Patients show-
ing ≥ 50% improvement during test stimulation received chronic implanta-
tion of the InterStim® (Medtronic; Minneapolis, MN) Therapy system.
P58 Patients with prior rectal surgery (>12 months prior to enrollment) and failed
ROLE OF ANTERIOR SPHINCTEROPLASTY IN THE ERA sphincteroplasty were included (28%). The primary efficacy objective was
OF SACRAL NEUROMODULATION. to demonstrate that ≥50% of subjects would achieve therapeutic success,
D. M. Oom, M. P. Gosselink and W. R. Schouten Surgery, Erasmus Med- defined as ≥50% reduction of incontinent episodes per week at 12 months
ical Center, Rotterdam, Netherlands. compared to baseline. The following results represent complete case analy-
Purpose: Anterior sphincteroplasty is considered to be the surgical treat- ses.
ment of choice for patients with faecal incontinence, due to anterior anal Results: 129 patients underwent test stimulation with a 93% success rate,
sphincter defects. However, some studies suggest that the results deterio- and 120 (110 females) of a mean age of 60.5 years and a mean duration of FI of
rate with time. Recently, it has been reported that sacral neuromodulation 6.8 years received chronic implantation. Mean follow-up was 23 (range 2.2 –
is beneficial for patients with faecal incontinence, even in those with ante- 61) months. At 12 months, 83% of subjects achieved therapeutic success (95%
rior anal sphincter defects. Aim of the present study was to investigate the CI: 74%-90%; p<0.0001), and 41% achieved 100% continence. Therapeutic
long-term outcome of anterior sphincteroplasty in order to determine the success was 86% at 24 months. Incontinent episodes decreased from a mean
role of this procedure in the era of sacral neuromodulation. of 9.4 per week at baseline to 1.9 at 12 months and 2.9 at two years. Similar pos-
Methods: Between 1990 and 2007, a consecutive series of 172 patients itive results were shown for incontinent days per week and urgent incontinent
underwent anterior overlapping sphincteroplasty. A standardized question- episodes per week (Table 1). SNS positively impacted quality of life, as evi-
naire concerning current continence status, overall satisfaction, and quality denced by significant improvements in all four scales of the Fecal Inconti-
of life was used to assess the long-term outcome. nence Quality of Life (FIQOL) instrument at 12 months (p<0.0001 for each).
Results: Long-term follow-up data were obtained from 75% of the 160 The most common device/therapy-related adverse events during follow-up
patients who were still alive. After a mean follow-up of 107 months (range: average 23 months included implant site pain (26%), or infection (11%), or
12-207), the outcome was still good to excellent in 44 patients (37%). In 28 parasthesia (11%) with over 25% of events being resolved with non-surgical
patients (23%) the result was classified as moderate, since these patients still treatment. There were no reported unanticipated adverse device effects asso-
encounter incontinence for solid stool. However, they assessed the outcome ciated with InterStim Therapy.
as good to excellent based on a significant reduction of incontinence episodes. Conclusions: Sacral nerve stimulation using InterStim Therapy is a safe
The outcome was poor in 40% of the patients. Predictors of worse outcome and effective treatment for patients with FI.
were older age at surgery (>50 years), occurrence of a serious wound infec- InterStim Therapy Success Rates across Measures
tion, and isolated external anal sphincter defects.
Conclusions: Anterior sphincteroplasty results in an acceptable to excel-
lent long-term outcome in 60% of the patients, especially in those patients
under the age of 50 years at surgery. Based on this finding, anterior sphinc-
teroplasty still deserves a place in the surgical treatment of faecal inconti-
nence, even in this era of sacral neuromodulation. All analyses were conducted using complete case data.
* p<0.0001 p=0.049 p=0.0002 § p=0.0127
P60
MR DEFECOGRAPHY: CINE LOOP VERSUS NON-CINE
LOOP IMAGING IN PATIENTS WITH DEFACATORY DIS-
TURBANCE.
N. Gandhi1, S. Teeger2 and L. Gottesman1 1Colorectal Surgery, St. Luke’s-
Roosevelt Hospital, NewYork, NY and 2Radiology, Private Practice, NewYork,
NY.
Purpose: Fluoroscopic defecography images the pelvic floor in patients
with defecatory disturbance but does not provide a global view of pelvic vis-
cera and musculature. MR defecography (MRD) visualizes the interaction
of all pelvic compartments, making it the test of choice for evaluating defe-
150
Abstracts
catory disorder. Non-cine loop MRD takes an image every two seconds, preoperatively underwent colonoscopy, colon transit time, manometry and
whereas cine loop MRD has no intervening non-imaging time. Our study cinedefecography. Follow-up was scheduled for 1 month, 3 month and 1 year
compares real-time cine loop to non cine-loop MRD in patients with defe- after the surgery with the Cleveland Clinic Florida (CCF) constipation score
catory disorder, in order to test the hypothesis that non cine loop MRD often and Satisfaction grade (excellent, good, fairly good, poor). Most patients had
misses or underestimates pathology. taken cinedefecogram and manometry at postoperative three months. To
Methods: 25 patients with defecatory disturbance underwent supine evaluate mid-term functional outcome, we interviewed 58 of 71 patients with
closed-magnet MRD after rectal insertion of ultrasound gel. Midsagittal T2- questionnaires for CCF score and Satisfaction grading by telephone on Octo-
weighted single-shot fast spin echo non-cine loop and fast imaging employ- ber 2008.
ing steady state acquisition cine-loop images were obtained during attempted Results: Median follow-up period was 34 (27-46) months. The mean
defecation, with non-cine loop images taken every two seconds, and cine age and sex ratio were 56.4 (19-85) years and 9:62 (M:F). Postoperative
loop images taken without intervening non-imaging time. Images were ana- complications were fecal urgency in 11 cases (15.5%), which improved
lyzed for the degree of rectal, bladder, vaginal vault/prostatic decent, anorec- after 3 months, bleeding in 7 (9.9%), stenosis in 1 case (1.4%), persist-
tal angle (ARA) opening/closing, and the presence and extent of rectocele, ent pain in 1 case (1.4%). According to the postoperative three-month
enterocele, peritoneocele, and sigmoidocele. defecography, rectocele and rectal intussusception had been completely
Results: The degree of pelvic organ descent and ARA opening/closing corrected in most patients. The mean CCF constipation scores were 17.5
was greater with cine loop versus non-cine loop imaging. 64% of patients before the surgery, 9.3 at 3 month, 9.6 at 1 year in 71 patients, and 10.3
had rectocele, 31% of which were missed on non-cine loop imaging, and at the time of latest interview in 58 patients. Satisfaction grade rated as
P OSTERS
63% were underestimated by it; only 6% of patients had rectocele underes- excellent and good (37.8%) at the time of latest interview was worse than
timated by cine loop MRD. 12% of patients had enterocele; 33% were missed that at 3 month (63.4%).
on non-cine MRD. 16% of patients had sigmoidocele; 25% were missed on Conclusions: Although STARR was a safe and feasible procedure for
non-cine loop MRD and 25% were underestimated by it. 16% of patients ODS patients and showed favorable short-term results, the patients’ satis-
had peritoneocele; 50% were missed on non-cine loop MRD and 25% were faction tends to be reduced beyond 1 year after STARR. More careful selec-
underestimated by it; cine loop MRD underestimated the extent in 25%. tion for ODS patients and more precise information about the long-term
Conclusions: Significant pathology is often missed or underestimated results of STARR may enhance patients’ satisfaction.
during the non-imaging time of non-cine loop MRD, and the degree of pelvic
organ descent and ARA opening/closing is better imaged by cine loop MRD;
therefore, real-time continuous cine loop MRD should be performed when P62
evaluating patients with defecatory disturbance. SEXUAL FUNCTION AFTER STAPLED TRANSANAL REC-
TAL RESECTION (STARR).
L. T. Sta.Ana, A. Ferrara, P. Williamson, J. Gallagher, S. DeJesus and
R. Mueller Colorectal Clinic of Orlando, Orlando, FL.
Purpose: The STARR procedure is currently an accepted treatment for
obstructive defecation syndrome in selected patients. In this study, we looked
at the effects of the STARR procedure on sexual function.
Methods: We collected data from patients that underwent the STARR
procedure from February 2006 to June 2008. Patients were asked to com-
plete the Pelvic Organ Prolapse/Incontinence Sexual Function Question-
naire (PISQ 12), which is a validated sexual function analysis for women with
pelvic floor dysfunction. This questionnaire looks at three areas that can
cause sexual dysfunction. These areas are behavioral, physical, or partner
related. Higher PISQ 12 scores are associated with better sexual function.
Results: Twenty out of forty-six women who were contacted completed
the sexual function survey. Nine out of twenty (45%) were not sexually active
before or after the STARR. These women ranged from ages 41 to 82 with a
mean age of 65. Two out of twenty (10%) refused to complete the survey,
but said they had not experienced any changes in their sexual function since
the procedure. Seven out of twenty (35%) women felt there was no change
in their sexual function since the STARR. Their average score on the PISQ
Rectal Descent 12 was 38.6 with a range of 26 to 44. The average age was 47 with a range
of 38 to 55. Two out of twenty women (10%) said their sexual function was
worse after surgery. Their average PISQ 12 score was 29.5. Of the two women
who said their sexual function was worse after the surgery, one was because
P61 of increased pain during sexual intercourse and the other was because of
MID-TERM RESULTS OF A STAPLED TRANSANAL REC- decreased excitation during sexual activity.
TAL RESECTION (STARR) IN OBSTRUCTED DEFECATION Conclusions: We interviewed our patients who have undergone the
SYNDROME (ODS). STARR procedure and compared their PISQ12 scores to a control group,
K. H. Song1, D. S. Lee1, J. K. Shin1, S. J. Lee2, J. B. Lee1, E. G. Youk1, which is the group of women evaluated to validate the PISQ 12 question-
D. H. Lee1 and D. S. Kim1 1Surgery, Daehang Hospital, Seoul, Korea, naire. Women between the ages of 42 to 66 with pelvic floor dysfunction
South and 2Radiology, Daehang Hospital, Seoul, South Korea. have an average PISQ 12 score of 34 +/- 6. Our results show that the aver-
age PISQ 12 score after the STARR procedure is 36.5, which is above the
Purpose: This study was prospectively designed to assess mid-term out-
control average. We therefore conclude that even though sexual dysfunction
comes of STARR in ODS patients with a rectocele or rectal intussuscep-
is prevalent in women with pelvic floor dysfunction, the STARR procedure
tion.
has no obvious impairment in sexual function.
Methods: Between January 2005 and June 2006, 71 patients diagnosed
with ODS, who underwent STARR were enrolled in this study. All patients
151
Abstracts
ured by standardized questionnaire as well as chart review, with a mean fol-
P63 low-up time of 4.5 months (range 1-23 months).
THE ANAL BAND FOR SEVERE FAECAL INCONTINENCE:
Results: Preoperatively, all 12 patients reported difficulty with evacua-
A MULTI-CENTRE EXPERIENCE.
tion and feeling of incomplete emptying. 5 patients also reported digital
D. R. Chatoor1, M. Abdel-Halim3, A. V. Emmanuel1, S. A. Taylor2, manipulation during defecation. 4 patients reported the feeling of lower
C. R. G Cohen3 and U. Baumgartner4 1Gastroenterology, University Col- pelvic pressure or bulging of tissue in the vaginal vault. Of the patients who
lege London, London, United Kingdom, 2Specialist Imaging, University Col- underwent defecography (6), all showed evidence of a rectocele with reten-
lege Hospital, London, United Kingdom, 3Colorectal Surgery, University tion of contrast. Postoperatively 10/12 (83%) noted resolution of the feel-
College Hospital, London, United Kingdom and 4Chefarzt der Abteilung All- ing of incomplete evacuation. All 4 patients who reported low pelvic pres-
gemein- und Viszeralchirurgie mit Koloproktologie, Kreisklinik Ottobeuren, sure or bulging of tissue in the vaginal vault noted resolution. Immediate
Ottobeuren, Germany. post-operative complications included urinary retention (3), bleeding (1),
Purpose: For patients with severe faecal incontinence who fail conser- and c. difficile infection (1). There was persistent residual rectocele on phys-
vative and minimally invasive treatments there is a need for salvage proce- ical exam in 1 patient (8.3%) and 3 reports of new-onset dyspareunia (25%).
dures. The previously available artificial bowel sphincter was plagued with Conclusions: Rectocele repair with Alloderm® is a successful surgical
infection, erosion, device malfunction and evacuation difficulty. Our multi- approach. Almost all patients had significant resolution of their symptoms
centre experience of a new device which has become available is reported in with a very small rate of recurrence, however dyspareunia continues to be a
this study. challenging problem.
Table 1. Summary of Functional Outcomes Preoperatively and Postoperatively
Methods: 14 patients (10 female) with severe faecal incontinence were
treated in two tertiary units; all failed optimum conservative treatment with
biofeedback and 9 had been deemed suitable for sacral nerve stimulation
but had failed this. As an alternative to stoma formation, these patients under-
wenbt implantation of a subcutaneous soft anal band system. It is composed
of a soft silicone band that encircles the anal sphincter, attached to a valve
that controls bidirectional flow of fluid from the balloon implanted under
the skin of the anterior abdominal wall, and a calibration port used for adjust-
ing the fluid in the system. P65
Results: Mean patient age was 59 (39 -71), mean duration of follow up EFFICACY OF ELECTROGALVANIC STIMULATION IN
13 months (3- 40). The aetiology of incontinence was post colorectal resec- TREATMENT OF LEVATOR ANI SYNDROME REVISITED.
tion in 6 patients, obstetric in 4, scleroderma-related in 2, post-radiother- B. Paris, N. Mantilla Farfan, H. Abcarian, J. Cintron, A. Zavala and
apy in 1 and spinal injury associated in 1. Self reported quality of life improve-
M. Singer Division of Colon and Rectal Surgery, University of Illinois at
ment of 70-100% was reported in 7/14 patients, 30-70% improvement in
Chicago Medical Center, Chicago, IL.
4/14 (no data was available in 3/14). Wexner incontinence scores improved
from a median of 16 (12-18) pre treatment to 2 (0-6) post operatively Purpose: Electrogalvanic stimulation (EGS) has been established as a
(P<0.0001). Complications occurred in 7/14 patients: 5 had device-related safe and effective treatment for the management of levator ani syndrome.
problems requiring revisional procedures (for repositioning, haematoma or There is a paucity of recent literature regarding this treatment modality. The
device failure); 1 had chronic pain requiring explantation and 1 had minor purpose of this study is to review recent experience with EGS in the treat-
evacuation difficulty requiring regular suppositories. Of note there were no ment of levator ani syndrome at a single center.
infections or erosions. Methods: A retrospective review of patients treated with EGS for
Conclusions: This largest reported series of the new anal band device levator ani syndrome from 07/04 to 08/08 was performed. The EGS pro-
is a promising salvage procedure for severe refractory faecal incontinence. tocol begins with 30 minute sessions. Voltage is adjusted based on patient
Though complications (mostly device-related) occurred, requiring revisional tolerance (range 100-330 volts) and is delivered at a frequency of 100
surgery, quality of life improved significantly in tandem with improved incon- pulses per sec (pps). Length of treatment is gradually increased accord-
tinence scores. ing to patient tolerance, from 30 to 60 min. Each session starts with min-
imal voltage and is slowly increased to maximum tolerance, held for 15-
20 minutes, and then gradually reduced from the peak of 100-330 volts
P64 to a minimum of 10-100 volts.
INITIAL EXPERIENCE OF RECTOCELE REPAIR USING Results: 22 patients were treated (72% males). The mean age was 56
CADAVERIC ACELLULAR DERMAL MATRIX (ALLO- years. The mean duration of symptoms was 60 months (range 3-240). 41%
DERM®). of patients had additional anorectal pathology. Over 60% of patients were
taking concomitant muscle relaxants and/or analgesics. In this cohort, 59%
J. L. Frenkel, D. A. Cherry, L. D. Pranitis, S. H. Brown, W. P. Pennoyer,
of patients had previous treatment, including biofeedback (32%), botox injec-
D. L. Walters and S. R. Banerjee Surgery, St. Francis Hospital, Hartford,
tion (14%) and epidural injection (14%). The mean number of sessions was
CT. 7.5 (range 2-15). The average of duration of each session was 29 minutes for
Purpose: This study was designed to review the clinical outcomes of the initial visit and 46 minutes for the concluding visit. The intensity was
the surgical management of rectocele using cadaveric acellular dermal matrix 70% at initial visit, and 88% by the last treatment (330 volts=100%). Patient
(Alloderm®), and if the use of the graft can minimize rates of recurrence and assessment of results at the last treatment session: complete relief or signif-
dyspareunia. icant improvement 36% (8); moderate improvement 9% (2); slight improve-
Methods: A retrosepective review of 12 patients who underwent trans- ment 32% (7); and no improvement or worsening of pain 23% (5). The mean
vaginal repair of their rectocele with Alloderm® between September 2004 follow up was 11 months (range 0.4-38). There were no complications asso-
and September 2007 was performed. All patients were female (mean age 57, ciated with the EGS.
range 34-76). Pre-operative assessment included physical examination in all Conclusions: EGS is a moderately effective treatment option in a selected
patients and defecography in 6. At the time of surgery, repair with Alloderm® group of patients with levator ani syndrome. It offers significant or complete
was performed when there was insufficient rectovaginal fascia available to relief in 45% of patients with essentially no risk. Due to its safety profile
perform placation without significant tension. Clinical outcomes were meas- and moderate efficacy, it should continue to be considered as a treatment
operation for levator ani syndrome.
152
Abstracts
distribution, we stratified patients into early (11-62 years of age) or late (63-
P66 104 years of age) presentation of rectal prolapse. The age-adjusted relative
ADJUVANT CHEMOTHERAPY AFTER MINIMALLY INVA-
risks of associated diagnoses were then calculated and compared within these
SIVE SURGERY FOR COLON AND RECTAL CANCER – ARE
groups. All statistical analyses were performed using SPSS version 16.0 sta-
WE MISSING THE OPPORTUNITY FOR EARLIER THER- tistical software.
APY? Results: In 12,096,267 discharges, there were 1,438 with primary diag-
L. S. Norcross1, A. Ferrara1, P. Williamson1, O. Kayaleh2, S. DeJesus1, nosis of rectal prolapse. Females represented 90% of these diagnoses. Bimodal
R. Mueller1 and J. T. Gallagher1 1Colon and Rectal Cancer, Colon and age distribution was noted for both males and females. After stratification
Rectal Clinic of Orlando, Orlando, FL and 2Oncology, M.D. Anderson into early or late groups, univariate analysis all diagnoses demonstrated five
Orlando, Orlando, FL. that appeared related to accelerated presentation of rectal prolapse as fol-
Purpose: Postoperative chemotherapy is widely used in the management lows: tobacco dependence (RR=4.5), myalgia/myositis (RR=3.6), asthma
of colon and rectal cancer. We hypothesize that among the benefits of min- (RR=2.3), depression (RR=1.8), and convulsions (RR=1.8).
imally invasive (LAP) colon resection, such as shorter length of stay and Conclusions: We have demonstrated that rectal prolapse carries a
return of bowel function, also should be shorter time to beginning adjuvant bimodal incidence with “early” and “late” presentation. Age-adjusted rela-
chemotherapy. tive risk of tobacco dependence, myalgia/myositis, asthma, depression, and
Methods: We performed a retrospective review of patients undergoing convulsions are increased in patients with early presentation of rectal pro-
LAP and open resection of colon and rectal cancer within a private colon lapse. This is the first demonstration that tobacco use may be important in
P OSTERS
and rectal surgical group, between August 2005 and September 2007. All the pathogenesis of a pelvic floor disorder.
patients were scheduled for postoperative chemotherapy. Data included day
of surgery, first date of postoperative chemotherapy, surgery and cancer stage.
Data was compared between groups using a t-test, accounting for variances.
Results: 34 patients had LAP resection followed by chemotherapy. 20
were female and 14 were male, average age of 61.7 years old. The average
number of days between surgery and the first chemotherapy dose was 54.32
days (median 48 days; range 27–128). 42 patients underwent open colectomy,
including 15 females and 27 males, with an average age of 57 years old. The
average number of days from surgery to the first dose of chemotherapy in
the open group was 53.38 days (median 48 days; range 26-118). There was
no statistical difference in time to starting postoperative chemotherapy
between these groups, p=0.8. Data was then subdivided into colon cancer
and rectal cancer. 19 LAP patients had colon cancer and 15 rectal cancer.
The open group consisted of 15 colon cancer and 27 rectal cancer patients.
When comparing colon cancer and rectal cancer separately, still no signifi-
cant difference in time to starting chemotherapy was found(p=0.5 and p=0.4
respectively).
Conclusions: There was no significant difference in LAP or open tech-
niques in time between the date of surgery and the first dose of adjuvant
chemotherapy. Earlier administration of postoperative chemotherapy may
be beneficial based on the potential tumor promoting effects of surgical
trauma. Although LAP results in earlier recovery, unless we establish a pro- Bimodal incidence of rectal prolapse in U.S. hospital population.
tocol of early postoperative chemotherapy between surgeons and oncolo-
gists, this opportunity may be missed.
P68
A SINGLE ADMINISTRATION OF DEPOBUPIVACAINE™
P67 INTRAOPERATIVELY PROVIDES THREE-DAY ANALGESIA
FACTORS ASSOCIATED WITH ACCELERATED DEVEL- AND REDUCTION IN USE OF RESCUE OPIOIDS IN
OPMENT OF RECTAL PROLAPSE: NEW LOOK AT AN OLD PATIENTS UNDERGOING HEMORRHOIDECTOMY.
PROBLEM. H. Miller1, T. M. Terem2, K. Kheladze3 and B. Mosidze4 1Women’s Hos-
K. Emmett and J. W. Cromwell Surgery, University of Tennessee, Mem- pital of Texas/Fannin Surgicare, Houston, TX, 2Mt. Ranier Surgical Associ-
phis, TN. ates, Tacoma, WA, 3JSC Imereti Regional Clinical Hospital, Kutaisi, Geor-
Purpose: The etiology and risk factors for the development of rectal pro- gia and 4JSC K. Eristavi National Center of Experimental and Clinical
lapse are poorly understood. Using the Healthcare Cost and Utilization Proj- Surgery, Tbilisi, Georgia.
ect National Inpatient Sample (HCUP-NIS) database, we have previously Purpose: This study evaluated the efficacy and safety of a single admin-
demonstrated that the age distribution of patients discharged from U.S. hos- istration of liposomal extended-release bupivacaine (DB) compared with
pitals with rectal prolapse is bimodal, with distinct early vs. late presenta- bupivacaine HCl with epinephrine (Bup/epi) in patients undergoing two-
tion of rectal prolapse. We sought to examine the presence of co-morbidi- or three-column excisional hemorrhoidectomy.
ties within these two populations to identify conditions associated with the Methods: Three doses of DB were compared with Bup/epi in a ran-
early onset of rectal prolapse. domized, double-blind, parallel-group, dose-ranging study. During surgery,
Methods: The 2001 HCUP-NIS includes all discharge data from 986 tissue surrounding the wound was infiltrated with DB 75mg (n=25), DB
hospitals in 33 states and approximates a 20% stratified sample representa- 225mg (n=25), DB 300mg (n=25) or Bup/epi 75mg (n=25). All subjects also
tive of community hospitals in the United States. The primary diagnosis and received one dose of IV ketorolac 30mg and oral acetaminophen 1000mg
up to 14 other diagnoses are recorded for each patient discharge. Query of three times daily through 96h. Rescue medication consisted of parenteral
the database was performed to identify all discharges associated with the pri- opioid followed by oral oxycodone. After surgery, the following outcomes
mary diagnosis of rectal prolapse. Based upon the previously obtained bimodal
153
Abstracts
were assessed: pain at rest, pain on first bowel movement (BM), and pain on Although, smoking cigarettes and Crohn’s disease were strongly associated
all BMs within a calendar day; time to first opioid rescue; total opioid res- with RVF recurrence (p=0.02).
cue; and fraction of subjects requiring opioid rescue. Conclusions: Despite a relatively low initial success rate of 60% most
Results: DB reduced pain on first BM and pain of all BMs within each RVFs can be successfully repaired, with subsequent operations. Crohn’s dis-
calendar day dose-dependently by intensity and duration. All DB doses ease and smoking were associated with adverse outcomes.
decreased pain at rest throughout the 4-day observation period. DB increased
the fraction of subjects avoiding opioid rescue (16%, 20%, 32% for 75, 225,
300 mg, respectively) compared with Bup/epi (8%). DB 300mg significantly P70
reduced opioid consumption by 59% and significantly increased the time to PUS SWABS IN INCISION AND DRAINAGE OF PERIANAL
first opioid rescue compared with Bup/epi (19 vs 8h, respectively; P<0.05) ABSCESSES: WHAT IS THE POINT?
and also decreased total opioid consumption vs Bup/epi (13 vs 33mg mor- E. C. Leung, M. Yazbek Hanna, V. Bedi and J. Eccersley General Sur-
phine equivalents, respectively). Postoperative nausea and vomiting (PONV) gery, Queen’s Hospital, Burton-on-Trent, United Kingdom.
was not noted with the 300-mg DB dose, a significant improvement when Purpose: The clinical effectiveness of pus swabs for microbiological
compared with Bup/epi (P=0.0349). There were no serious adverse events analysis during incision and drainage of perianal abscess is controversial. Its
(SAEs) attributable to DB. Wound healing was normal. cost implication is often overlooked. The study aimed to determine if sub-
Conclusions: A single intraoperative administration of DB resulted in mission of pus swabs can be avoided.
3 days of analgesia in subjects undergoing hemorrhoidectomy, and was asso- Methods: All consecutive cases of incision and drainage of perianal
ciated with decreased opioid use and a reduction in commonly associated abscess between January 2004 and 2008 were retrospectively reviewed. Patient
side effects (ie, PONV). Wound healing was normal and there were no SAEs demographics, microbiological results and clinical outcome with a follow-
attributable to DB. up of 6 months were assessed.
Results: 235 cases (59F:176M) were identified (age ranged 6-99, median
= 37). 38 cases had no swab taken. 66(28%), 115(48.9%) and 16(6.9%) swabs
were skin flora, coliform / bacteroides and sterile respectively. Within 6
months follow-up, 185 cases healed up leaving 39 cases of fistulas (25 had
setons in-situ 6 months on). 11 patients were lost from follow-up. Fistulas
were not associated with coliforms / bacteroides found on microbiological
analysis (p>0.05). Only 4(1.7%) cases had its swab result mentioned in fol-
*Pain intensity score, mean (n); n too small for statistical comparison; P<0.05 compared low-up.
with Bup/epi. Conclusions: Surgeons tend not to review microbiological results in
patient follow-ups. Furthermore, the preliminary finding suggests that micro-
biological results bear no correlation with presence of fistulas or prognosis.
P69 Randomised controlled trials are warranted to assess if abandoning submis-
ARE THERE PREDICTORS OF OUTCOME IN RECTO- sion of pus swabs against not affects clinical effectiveness in patients with
VAGINAL FISTULA REPAIR? perianal abscess.
R. Pinto, T. Peterson, W. Davila and S. D. Wexner Colorectal Surgery,
Cleveland Clinic Florida, Weston, FL.
Purpose: Rectovaginal fistula (RVF) is a distressing condition the treat-
P71
ROLE OF THREE-DIMENSIONAL ANORECTAL ULTRA-
ment of which continues to be challenging. The aim of this study was to
SONOGRAPHY IN THE ASSESSMENT OF ANTERIOR
assess the results of rectovaginal fistula repair to identify factors predictive
of poor outcome. TRANS-SPHINCTERIC FISTULA.
Methods: Retrospective analysis of patients who underwent RVF repair S. M. Murad-Regadas, F. S. Regadas, L. V. Rodrigues, E. C. Holanda,
from January 1988 to July 2008 was performed. Chi-square and logistic L. Oliveira and D. M. Pereira Surgery, School of Medicine of the Federal
regression were used to analyze outcome according to etiology, size and University of Ceara-Brazil, Fortaleza, Brazil.
height of fistula, age, number of prior repairs, number of vaginal deliveries, Purpose: The three-dimensional anorectal ultrasonography (3-DAUS)
body mass index (BMI), smoke, presence of diabetes, steroids and immuno- allows to view the entire fistulous tract length and its relation to the sphinc-
suppressive usage, and presence of fecal diversion. ter muscles, the exact position of the internal opening (IO) and any second-
Results: 184 procedures were performed in 125 patients. Inflammatory ary tracts and/or cavities. The aim of this study was to evaluate the anterior
bowel disease was the most common indication for surgery (45.6%) followed trans-sphincteric fistulous tract position and its relation to the percentage
by obstetric injury (24%) and other surgical trauma (16%). The mean dura- of sphincter muscle transected during the surgery in both genders using the
tion of the presence of the fistula was 31.2 months and procedures included 3-DAUS.
endorectal advancement flap (35.3%), gracilis muscle interposition (13.6%), Methods: 33 patients with primary criptoglandular anterior trans-sphinc-
seton placement (13.6%), transperineal (8.7%) and transvaginal repair (8.1%). teric fistulas were prospectively evaluated with 3-DAUS from January 2005
Overall success rate per procedure was 60%. Patients with Crohn’s disease to April 2008. 18 patients were male, mean age 42 and 15 were females, mean
had more recurrent episodes (44.2% success/procedure; p<0.01) although age 36. The External anal sphincter (EAS) and the internal anal sphincters
78% eventually healed after a mean of 1.8 procedures. There were no dif- (IAS) length, IO position (distance from the distal edge of the EAS to the
ferences in recurrence rates according to the type of repair; the overall suc- IO), total length of the compromised sphincter (distance from the distal part
cess rate per patient was 88% after multiple procedures, at a mean follow- of each muscle to the point where it was crossed by the fistulous tract) and
up of 16.3 months. Obstetric injuries had an 89% success rate after a mean the percentage of sphincter muscle to be sectioned during surgery were meas-
of 1.3 procedures/patient, similar to traumatic fistulas. Pouch vaginal fistu- ured, compared between genders and its role on surgical plan. Student’s t
las had a 91% success rate after a mean of 1.6 procedures/patient. Age, BMI, and qui-square tests were used.
diabetes, use of steroids and immunosuppressives, size and height of the fis- Results: 2 male and 4 female patients had secondary tracts and 2 females
tula, number of vaginal deliveries, time interval between a recurrent episode had associated adjacent cavities. The EAS and the IAS length were signifi-
and the next repair and fecal diversion were not related to outcomes. cantly longer in male group. The IO position was significantly higher in male
group. The position the tract crossed the EAS was similar in both groups
154
Abstracts
but the percentage of compromised muscle was significantly higher in female
due to the shorter EAS length but concerning to the IAS, no significant dif-
P73
LONG-TERM INDWELLING SETON FOR HIGH
ference was identified between both genders (table). Based on the 3-DAUS
TRANSSPHINCTERIC FISTULAS: IS IT WORTHWHILE?
findings, it was indicated surgical techniques using seton or advanced flap in
11/18 men and 13/15 women since the tract crossed the EAS on the per- J. J. van Wijk, L. Mitalas, D. M. Oom, M. P. Gosselink, D. Zimmerman
centage higher than 50.0%. The 3-DAUS findings were concordant with and W. R. Schouten Surgery, Erasmus MC, Rotterdam, Netherlands.
the surgical findings. Purpose: Treatment of high transsphincteric perianal fistulas can be chal-
Conclusions: The 3-DAUS can provide information concerning to rela- lenging. Good results have been reported for several surgical techniques,
tion between the tract length and the percentage of compromised sphincter however failure rates of up to 60 percent have been reported for Advance-
muscles and can be useful for choosing the safer surgical technique in both ment Flaps (AFR). It is not always possible to perform a repeat AFR, fur-
genders. thermore, not all patients choose to undergo further surgery. In these patients,
a method that prevents acute perianal sepsis, while minimizing inconven-
ience to the patient would be desirable. The aim of the present retrospec-
tive cohort study was to determine if prolonged drainage with long-term
indwelling seton (LTIS) prevents acute perianal sepsis. Also, we assessed
whether treatment with simple fistulotomy at a later stage is facilitated by
LTIS insertion.
P OSTERS
Methods: LTIS was inserted in a selected group of patients with a high
transsphincteric fistula, who had undergone multiple surgical attempts at
repair of their fistula. Follow-up information in this retrospective study was
*(p<0.05)
obtained by review of charts and a detailed written questionnaire.
Results: Eighteen patients were included in this study. Patients had
P72 undergone a median of 2 (range 1-6) prior attempts at repair of their fistula.
Follow-up was median 35 (range 8-101) months. Perianal abscesses, requir-
INCIDENCE OF HORSESHOE EXTENSIONS IN POSTE-
ing surgical intervention, occurred in 3 (17%) of all patients. Furthermore,
RIOR, HIGH TRANSSPHINCTERIC FISTULAS AND THEIR
4 (22 %) of the patients needed a replacement of their seton due to disloca-
IMPACT ON FISTULA HEALING.
tion of their seton. Two patients with LTIS (11 percent) underwent fistulo-
L. Mitalas1, R. Verhaaren2, D. Zimmerman2, R. S. Dwarkasing3 and tomy as definitive treatment for their perianal fistula after 48 and 54 months
W. R. Schouten2 1Surgery / Immunology, Erasmus Medical Center, Rot- respectively. In these patients, the fistula healed completely without conti-
terdam, Netherlands, 2Surgery, Erasmus Medical Center, Rotterdam, Nether- nence impairment.
lands and 3Radiology, Erasmus Medical Center, Rotterdam, Netherlands. Conclusions: One third of patients will undergo additional surgical inter-
Purpose: Horseshoe extensions are a common finding in posterior, high vention in the first 4 years after LTIS, therfore surgical intervention does
transsphincteric fistulas. It is assumed that classical horseshoe extensions not seem to be prevented by LTIS. Furthermore, LTIS enables fistulotomy
originate when an abscess in the deep postanal space enlarges and extents at a later stage in only 11% of all patients. In these patients, fistulotomy was
into the ischioanal fossae. However, intersphincteric horseshoe extensions possible after a period of more than 4 year. Based on these data the benefits
have also been described. Until now the exact incidence of these extensions of LTIS appear to be limited. We advocate to utilise this technique with
is not clear. Furthermore, it is not known whether these extensions and asso- caution.
ciated abscesses affect fistula healing. Aim of the present study was to answer
these questions.
Methods: Between 1995 and 2007 a series of 118 patients with a poste- P74
rior, high transsphincteric fistula underwent transanal advancement flap repair THE CUTANEOUS ADVANCEMENT FLAP IS AN EXCEL-
(TAFR). Preoperatively, all patients underwent endoanal MR imaging. Asso- LENT OPTION FOR COMPLICATED ANAL FISTULAS CLO-
ciated abscesses, detected by this imaging technique, were drained. SURE.
Results: In 43 patients (36%) the fistula had a direct course towards the S. Atallah1, M. J. Snyder2 and H. R. Bailey2 1Center For Colon & Rectal
external opening in the dorsal quadrant. In 75 patients (64%) horseshoe Surgery, Florida Hospital, Winter Park, FL and 2Colon & Rectal Clinic, Uni-
extensions were found. These horseshoe extensions were classified as clas- versity of Texas - Methodist Hospital, Houston, TX.
sical and intersphincteric in 31% and 69% of the patients respectively. Com-
Purpose: Historically, cutaneous advancement flaps have been reserved
paring the three types of fistulas, the lowest healing rate was observed among
for management of anal stenosis. Unlike mucosal rectal advancement flaps,
those with a direct course (37% versus 81% and 74%, respectively). In fis-
there is sparse data about the efficacy of cutaneous advancement flaps for the
tulas with a direct course abscesses occurred significantly less often than in
management of complex anal fistulas. The purpose of this study is to evalu-
fistulas with a classical or intersphincteric horseshoe extension (35% versus
ate the efficacy of cutaneous advancement flaps for the closure of complex
54% and 55%, respectively). All the associated abscesses were drained and
anal fistulas.
did not affect the healing rate.
Methods: A retrospective review was conducted over a 5 year period
Conclusions: Horseshoe extensions occur in two out of three patients
(9/01/2002 to 9/2/2007) examining patients who underwent cutaneous
with a posterior, high transsphincteric fistula. Extension in the intersphinc-
advancement flap repair of a complex fistula in ano. Patients who under-
teric plane is the most frequent one. Concomitant abscesses are present in
went mucosal rectal advancement flap repair were used as a control group.
half of the patients with a horseshoe extension. After adequate drainage, these
Primary end-points were fistula healing and resolution. Secondary end-points
abscesses do not affect the outcome of TAFR. Despite their complexity, pos-
included complications related to the operative procedure.
terior, high transsphincteric fistulas with a horseshoe extension have a sig-
Results: 109 patients underwent surgical treatment of a complex anal
nificant better outcome than the more simple fistulas with a direct course.
fistula. Of these, 17 underwent cutaneous advancement flap closure, while
10 patients underwent rectal mucosal advancement flap closure. Patients
were followed for at least 12 months. Of the complex anal fistulas treated
with cutaneous advancement flap closure, the recurrence rate was 11.8%
(2/17) at one year follow-up. In the control group, in which patients under-
155
Abstracts
went rectal mucosal advancement flap closure, a recurrence rate of 30% prospective database. Patients with Crohn’s disease were excluded. Initial fis-
(3/10) was observed. All but one patient (16/17) had primary control of the tula tract length and location were measured intra-operatively as patients
fistula with a seton prior to cutaneous advancement flap closure. For the underwent a standardized repair procedure and followed uniform post-oper-
two patients who had a recurrence after cutaneous advancement flap closure, ative care paths. The primary outcome was complete fistula closure assessed
one spontaneously closed without further surgical intervention at three through post-operative outpatient history and examination.
months. The other case involved a patient with Crohn’s disease who had Results: Forty patients were enrolled over a 24 month period. Complete
failed six prior surgical attempts at fistula closure. There were no major com- closure was achieved in 20/40 (50%) of patients at a mean follow-up 5 months
plications in any group. Two patients who underwent cutaneous advance- (range 2-12). Closure was not associated with gender, age, tract location, date
ment flap closure had minor complications (transient pruritus; self-limited of surgery or physician on univariate analysis. Tract closure was significantly
bleeding). associated with increased tract length (p=0.034). Furthermore, fistulae longer
Conclusions: Although this study is limited by its retrospective nature, than 4 cm were more likely to be healed compared to shorter fistulae [(15/22,
it appears cutaneous advancement flaps offer the surgeon an excellent option 68%) vs. (5/18, 28%), p=0.01].
for the closure of complex anal fistulas. In this study, the results compare Conclusions: Increased fistula tract length was predictive of successful
quite favorably to outcomes seen with rectal advancement flaps. Surgisis Fistula Plug™ closure for transphincteric fistulae. Further studies
are needed to determine the underlying mechanism for this association and
develop additional criteria predictive of fistula closure. The current study
P75 suggests that fistula lengths exceeding 4 cm meet a reasonable initial thresh-
TREATMENT OF HIGH TRANSPHINCTERIC ANAL FIS- old for offering fistula plug repair.
TULA WITH ENDORECTAL ADVANCEMENT FLAP: EXPE-
RIENCE FROM THE NATIONAL UNIVERSITY HOSPITAL,
SINGAPORE. P77
J. Foo, W. K. Cheong, C. Tsang and D. C. Koh Division of Colorectal ASSESSMENT OF THE EFFICACY OF THE NEW SURGISIS®
Surgery, University Surgical Centre, National University Hospital [NUH], BIODESIGN™ RECTOVAGINAL BUTTON FISTULA PLUG
Singapore, Singapore. FOR THE TREATMENT OF ILEAL POUCH VAGINAL AND
RECTOVAGINAL FISTULAS.
Purpose: The objective of anal fistula treatment is to cure the anal fis-
tula with the lowest recurrence rate and with the least amount of functional S. J. Gonsalves1, P. M. Sagar1, J. Lengyel1, C. Morrison1 and R. Dun-
derangement in anal continence. High transphicteric anal fistula (HTSAF) ham2 1The John Goligher Colorectal Department, The General Infirmary
have been treated by a number of techniques, traditionally via a staged pro- at Leeds, Leeds, United Kingdom and 2Department of Radiology, The Gen-
cedure with seton application. But reported results indicate a high incidence eral Infirmary at Leeds, Leeds, United Kingdom.
of anal incontinence and recurrence of this type of fistula. The endorectal Purpose: The treatment of recto-vaginal and ileal pouch-vaginal fistu-
advancement flap (ERAF) fulfills the criteria for cure and preservation of las remains a challenging problem for the colorectal surgeon. The aim of
anatomy and function of the anal canal. this study was to assess the shortterm efficacy of the new Surgisis® Biode-
Methods: From 2001 to 2007, all patients with HTSAF of crytoglan- sign™ recto-vaginal button fistula plug (button fistula plug) in patients with
dular origin who were treated with ERAF were retrospectively analyzed. Pre- confirmed recto-vaginal or ileal pouch-vaginal fistulas.
operatively, these patients had endoanal ultrasound (EAUS) to confirm the Methods: Between May 2008 and September 2008, patients with con-
presence of a HTSAF. Outcomes recorded include operative time, time to firmed recto-vaginal and ileal pouch-vaginal fistulas were treated with the
complete healing of anal fistula and recurrence. button fistula plug. Patients underwent assessment of their fistulas by mag-
Results: Partial-thickness ERAF was performed on 42 patients with a netic resonance imaging (MRI) and/or examination under anaesthesia prior
HTSAF which was confirmed on EAUS. None of the patients had previous to the procedure.
ERAF surgery. There was a male predominance at 2.5:1. The mean age of Results: 12 patients with a median age of 36(IQR 29 – 42) years under-
the patients was 44.8 ± 13.4 (SD) years. The mean operative time was 61.5 went a total of 20 plug insertions. Five patients had confirmed recto-vaginal
± 20.7 (SD) minutes. The majority had completely healed at 6 weeks post- fistulas and seven patients had ileal pouch-vaginal fistulas. At a median fol-
op. 14.3% (6/42) of patients developed a recurrence. Of these, the recur- low up of 15(IQR 10 – 21) weeks, seven of 12 patients (58%) had been treated
rence of the anal fistula occurred in 4 patients within the first year after an successfully. Seven of the 20 plugs that were inserted (35%) were successful.
ERAF. 2 late recurrences were seen at 17 & 30 months following ERAF sur- This equates to the successful treatment of three out of five (60%) of the rec-
gery. tovaginal fistulas, and four of seven (57%) of the ileal pouch-vaginal fistu-
Conclusions: Our local experience shows an overall success rate of 85.7% las. A repeat procedure was carried out in each of the six patients who had
for HTSAF treated with the ERAF procedure. The use of an ERAF is an experienced an initial plug failure. Only one from this group had a success-
attractive technique for the treatment of HTSAF. ful plug insertion. Two patients underwent a third repeat procedure, which
again were unsuccessful. The success rate of these eight repeat plug inser-
tions was therefore 12.5%. All plug failures occurred due to dislodgement
P76 of the plug. There was no other morbidity in our series.
FISTULA TRACT LENGTH PREDICTS SUCCESS WITH Conclusions: The new button fistula plug successfully treated seven of
THE SURGISIS™ FISTULA PLUG. 12 (58%) rectovaginal and ileal pouch-vaginal fistulas.
M. F. McGee1, B. J. Champagne1, J. J. Stulberg2, H. L. Reynolds1,
E. Marderstein1, M. Adamina1 and C. Delaney1 1Division of Colorectal
Surgery, Department of Surgery, Case Western Reserve University, Cleve- P78
land, OH and 2Department of Epidemiology and Biostatistics, Case West- OUTCOMES AFTER FISTULOTOMY: RESULTS OF A
ern Reserve University, Cleveland, OH. PROSPECTIVE, MULTICENTER REGIONAL STUDY.
Purpose: The treatment of transphincteric fistulae with the Surgisis™ N. H. Hyman, S. O’Brien and T. Osler Surgery, University of Vermont
fistula plug has produced variable results. There is a paucity of information College of Medicine, Burlington, VT.
describing which characteristics of anorectal fistulae correlate with success. Purpose: To determine the outcomes and healing rate of anal fistula sur-
Methods: All consecutive patients undergoing transphincteric cryptog- gery across a broad spectrum of colorectal practices.
landular fistula repair with the Surgisis™ fistula plug were enrolled in a
156
Abstracts
Methods: A prospective, multicenter outcomes registry was created by fistula recurrence using MRI is needed to better ascertain the AFP success
the New England Regional Society of ASCRS. All consecutive pts. under- rate. Until such a trial has been completed, given the relatively low rate of
going surgical treatment of an anal fistula by a participating surgeon from sepsis of 6.7%, the AFP seems to be a reasonably safe and efficacious option
10/1/07-9/30-08 were entered. Demographics, fistula characteristics includ- for the treatment of anal fistulas.
ing Parks classification, smoking history, previous vaginal deliveries, diag-
nosis of Crohn’s disease, FISI, and operations performed were noted. A fol-
lowup datasheet recorded postop complications, healing at 1 and 3 months, P80
and postop FISI. Factors associated with healing and treatment success were TREATMENT OF HEMORRHAGIC RADIATION PROCTI-
compared using Fisher’s exact test. TIS WITH FORMALIN APPLICATION.
Results: 218 pts. were entered by 25 surgeons at 12 hospitals (142 M, N. E. Samalavicius, A. Kilius, K. P. Valuckas, A. Burneckis and D. Norkus
76 F). 67 pts. had recurrent fistulas and 43 had multiple tracts. 52 were smok- Clinic of Surgery, Oncology Institute of Vilnius University, Vilnius, Lithuania.
ers and 18 had Crohn’s disease. Surgical treatment and healing rate at 3
Purpose: Aim of the study was to evaluate results of treatment of hem-
months is noted in Table 1. Overall healing rate was 21% at 1 month and
orrhagic radiation proctitis with formalin application under dorsal perineal
69% at 3 months. Female gender (p=.04) and recurrent fistula (p=.03) were
block in patients, who received radiation therapy for prostate cancer.
associated with non-healing. 24% of pts. required additional surgery. The
Methods: Patients and methods. During three years, 2006-2008, 38
best healing rate was associated with fistulotomy (91%), whereas a plug had
patients underwent formalin application under dorsal perineal block for hem-
the worst (37%, p=.001).
P OSTERS
orrhagic radiation proctitis. All patients were irradiated of prostate cancer.
Conclusions: Surgical treatment of an anal fistula is associated with a
Age 56-77 years, on an average 70 years. 19 patients reported daily blood in
substantial risk of non-healing at 3 months. Fistulotomy has a high success
stools, 19 – 2 or 3 times a week. 2 patients received blood transfusions for
rate whereas the bioprosthetic plug had the lowest. Multicenter studies com-
severe anemia, one even underwent colostomy to control severe bleeding.
paring treatment options for similar fistulas are needed.
Table 1: Healing Rate at 3 Months by Procedure
According to endoscopic classification of chronic radiation-induced proc-
topathy, 8(21,1%) had grade I, 23 (60,5%) grade II and 7 (18,4%) grade III
proctitis. All patients were referred for formalin therapy after failure of non-
invasive management. Formalin application has been performed as a day case
in an operating theatre, dorsal perineal block achieved injecting a mixture
of lidocaine and bupivacaine solution. A gauze soaked with 4% formalin has
been applied to the whole diseased rectal mucosa for 4 minutes. If patient
had no improvement after 4 weeks, he was advised to repeat the procedure.
24 (63,2%) patients underwent single procedure, and 10 (26,3%) – two, 4
(10,5%) – three.
*Statistically inferior to fistulotomy Results: Results. 2 to 32 months after treatment, 34 patients were inter-
viewed (4 lost to follow-up). 20 (58,8%) reported complete cure, 8 (23,5%)
significant improvement, and 6 (17,7%) no change. One patient, who under-
P79 went colostomy for previous episodes of bleeding from radiation proctitis,
META-ANALYSIS OF ANAL FISTULA PLUG: WHAT IS THE was cured and colostomy was closed. One patient developed rectal mucosal
CURRENT RATE OF SUCCESS? damage after second application, due to which received prolonged conser-
S. Shih, Y. Edden, D. Sands, E. Weiss, J. Nogueras and S. D. Wexner vative management, though bleeding stopped completely.
Colorectal Surgery, Cleveland Clinic Florida, Weston, FL. Conclusions: Conclusion. Application of 4 % formalin for 4 minutes for
Purpose: Treatment of anal fistulas using the Surgisis® Anal Fistula Plug hemorrhagic radiation proctitis under dorsal perineal block in patients who
has yielded disparate results in the literature with success rates ranging from received radiation therapy for prostate cancer was simple, safe and effective,
12.5% to 87%. A meta-analysis of all published English language studies was and 82,3% of patients were cured or markedly improved after treatment.
performed to evaluate these widely variable results.
Methods: All twelve English language published studies were included
in the meta-analysis. The exclusion criteria in this meta-analysis were: Crohn’s P81
disease, rectovaginal, rectourethral and any pouch fistulas. The success rate IMPACT OF AGE ON THE SHORT-TERM OUTCOMES OF
was defined as successful clinical healing of each fistula as reported within LAPAROSCOPIC COLORECTAL SURGERY: IMPLICATIONS
each individual study. FOR CLINICAL PATHWAYS.
Results: There were 4 retrospective studies, which included 115 patients J. A. Alsharif, G. Martel, A. Bouchard, E. Sabri, C. R. Ramsay,
and noted a success rate of 31.3% and failure rate of 68.7%. There were 8 J. Mamazza, E. C. Poulin and R. P. Boushey General Surgery, Minimally
prospective studies, which included 196 patients and reported a success rate Invasive Surgery Research Group, The Ottawa Hospital, University of
of 67.4% and failure rate of 32.6%. Overall then, the success rate for the anal Ottawa, Ottawa, ON, Canada.
fistula plug in healing fistulas was 54% and the failure rate of 46%. Eleven Purpose: The objective of this study was to evaluate whether the out-
studies which included information on subsequent abscess formation; the comes of laparoscopic colorectal surgery are comparable among elderly and
overall rate of abscess formation was 6.7% (21/311). Nine of the 12 studies younger patients.
discussed fistula plug falling out, overall rate of plug fallout was 14.1% Methods: Consecutive patients undergoing laparoscopic colorectal pro-
(44/311). cedures from 1991-2007 were analyzed from a prospectively-collected data-
Conclusions: The Surgisis® Anal Fistula Plug has been utilized with base. Patients were separated into three age groups: group 1 (<50 years),
variable success. This meta-analysis demonstrated an approximately 54% group 2 (50-70 years), and group 3 (>70 years). Summary statistics and uni-
success rate. These results are potentially significantly affected by the vari- variate analyses were performed. Multiple logistic regression analysis was
ability in patient selection, study size, length of follow-up and methods for used to identify factors associated with an increased risk of postoperative
determining fistula healing in each of the 12 studies. None of the 12 stud- complications.
ies employed any objectives assessment of fistula healing such as fistulogra- Results: A total of 1,070 colectomies were analyzed, including 279
phy, ultrasound, MRI or examination under anesthesia. A multi center patients in group 1 (median age 37), 450 in group 2 (median age 62), and 341
prospective trial with standardized preoperative, intra operative and post- in group 3 (median age 78). The age groups were found to be significantly
operative protocols, long term follow-up of at least 1 year and evaluation of
157
Abstracts
different in terms of cardiac comorbidities (1% vs. 18% vs. 39%, p<0.0001),
pulmonary comorbidities (6% vs. 10% vs. 17%, p<0.0001), steroid use and
P83
DISPARITIES IN THE UTILIZATION OF LAPAROSCOPIC
previous abdominal surgery. Operative time and the rate of intraoperative
COLECTOMY FROM 2000 THROUGH 2005.
complications were not significantly different across age groups. In contrast,
rates of conversion to laparotomy (8% vs. 11% vs. 17%, p=0.001), postop- K. M. Hardiman, K. Lanxon-Cookson, M. Morris, B. Diggs, B. C. Shep-
erative complications (16% vs. 22% vs. 36%, p<0.0001), and 30-day mor- pard and D. Herzig General Surgery, Oregon and Health and Science Uni-
tality (0.4% vs. 1.1% vs. 5.3%, p<0.0001) were significantly more common versity, Portland, OR.
among older patients. As a consequence, the time required to resume a nor- Purpose: Laparoscopic approaches are increasingly used in the surgical
mal diet and to discharge from hospital were both significantly prolonged management of colon diseases. Previous reports suggest that laparoscopic
among older patients. On multivariate analysis, age >70 was the single most colectomy may be associated with shorter length of stay, decreased morbid-
important factor associated with the occurrence of a postoperative compli- ity, and perhaps lower overall costs. Data regarding the utilization of laparo-
cation (group 3 vs. group 1, OR 2.3, 95% CI [1.4, 3.7], p=0.0005). Cardiac scopic colectomy are limited.
and pulmonary comorbidities, as well as the type of colorectal resection were Methods: We performed a retrospective review of data from the Nation-
also significantly associated with postoperative complications. wide Inpatient Sample including 141,562 elective colectomies from 2000
Conclusions: Compared to younger patients undergoing laparoscopic through 2005 performed for benign or neoplastic colon disease. Informa-
colectomy, those aged >70 had a greater risk of morbidity and mortality, as tion regarding demographics, diagnosis, hospital stay and charges were
well as an increased length of stay in hospital. Patients enrolled in clinical assessed. Differences in the approach to treatment of benign and malignant
pathways and fast-track protocols may have to be stratified on the basis of disease were examined by year to examine the effect of guidelines limiting
age to account for these findings. laparoscopy for cancer prior to 2004.
Results: A laparoscopic approach was used in 3.8% of colectomies, with
an increased utilization over time from 2.5% in 2000 to 5.7% in 2005. Patients
P82 having laparoscopic colectomy had a significantly shorter median hospital
LENGTH OF STAY (LOS) AND OTHER OUTCOMES AFTER stay (4 vs. 6 days, p<0.001), but their median hospital charges were not dif-
OPEN (OC) VS LAPAROSCOPIC COLECTOMY (LAC): ARE ferent ($22,739 vs. $22,580, p=0.52). Multivariate analysis revealed that pre-
THEY NOW THE SAME? dictors of having a laparoscopic colectomy were benign disease, living in a
A. Kwok, L. Pernar, M. Kelly, X. Gu, J. Goldberg, E. Breen and R. Ble- zip code with the highest quartile of income, being privately insured, hav-
day Department of Surgery, Brigham and Women’s Hospital, Boston, MA, ing the operation in later years, being in an urban or teaching hospital, and
MA. being male. Benign disease was less predictive of having a laparoscopic colec-
Purpose: In the 2005 Cochrane Review, LOS of patients undergoing tomy in 2004-2005 as compared to earlier years (odds ratio 1.4 (2004-2005)
LAC was reduced by 1.4 days. Since then, peri-op “fast-track” regimens for compared to 2.5 (2000-2003)).
patients following both OC and LAC has shortened LOS by focusing on Conclusions: The percentage of elective colectomies done laparoscop-
pain relief, early oral feeding, and mobilization. The purpose of this study ically is low but increasing. Despite similar costs and shorter hospital stays,
was to investigate whether the difference in LOS and other variables still determinants of having a laparoscopic colectomy remain highly dependent
exists between elective LAC and OC. on socioeconomic factors including health insurance, income, and hospital
Methods: Inclusion criteria were elective colectomies, age >18 years, and type. Malignancy is increasingly being treated laparoscopically.
procedures performed between 1/1/2007 and 6/30/2008. The choice of pro-
cedure (OC vs LAC) was determined by the surgeon. Exclusion criteria
included rectal procedures or concurrent small bowel resections. A total of
P84
DIFFERENCES IN INFECTIOUS COMPLICATIONS
376 (OC 235, LAC 141) charts were reviewed. Primary endpoint was LOS.
BETWEEN OPEN AND LAPAROSCOPIC APPENDECTOMY
Secondary end-point was readmission < 30 days. Variables analyzed were
BMI, use of epidural, history of coronary artery disease, COPD, diabetes, FOR PERFORATED APPENDICITIS.
and prior abdominal surgery. An intention-to-treat analysis was used. Fisher T. L. Hedrick, B. R. Swenson and C. M. Friel Surgery, University of Vir-
exact test and chi-square analysis were performed using SAS software. The ginia Health System, Charlottesville, VA.
study was approved by the IRB. Purpose: Few studies have evaluated the differences in infectious com-
Results: OC had a 0.75 day greater Mean LOS (OC 6.35, LAC 5.60; plications following open and laparoscopic appendectomy for perforated
p<.001). Median LOS however was equal in both groups (5 days). With no appendicitis. We sought to compare the outcomes for each procedure using
history of prior surgery, there was no significant difference in LOS between a large national database. We hypothesized that infectious complications
the two groups (Mean LOS OC 6.52, LAC 5.83; Median LOS OC 5.5, LAC would be lower for patients undergoing laparoscopic appendectomy in the
5.0; p<.08). 60% of OC patients had had prior surgery vs. 43% of the LAC setting of perforated appendicitis.
patients. Readmission rates were significantly higher in the OC group (OC Methods: National Surgical Quality Improvement Program data were
14.89%, LAC 5.67%; p<.007) including patients without a history of prior gathered for all patients undergoing emergent open and laparoscopic appen-
surgery. BMI was not a factor in LOS in either group. Of the comorbidities dectomy during 2005 - 2007 (CPT codes: 44970, 44950 and 44960). Only
analyzed only COPD had a significant impact on LOS. patients with an infected wound classification were included in analysis.
Conclusions: At our institution, LAC has a statistically significant reduc- Patients undergoing laparoscopic appendectomy were 1:1 propensity score
tion in the Mean LOS but this may be largely influenced by a history of matched to patients undergoing open appendectomy on 39 demographic and
prior surgery. Median LOS appears equal in both groups. Readmission rates peri-operative variables using greedy methodology. Outcomes for the two
are higher with OC, including patients without a history of prior surgery. matched groups were then compared using Student’s t-test or chi-squared
When analyzing outcomes for patients undergoing OC vs LAC, surgeon analysis, where appropriate.
selection can distort comparisons between groups. As “fast-track” protocols Results: 3,640 patients were matched (1,820 in each group). The groups
become more widely used, OC and LAC outcomes especially LOS may soon were well matched in terms of age, gender, pre-morbid functional status,
be the same. comorbidities, steroid use, preoperative weight loss, ASA classification, and
operative time. Noninfectious outcomes were similar between groups. How-
158
Abstracts
ever, the incidence of superficial and deep surgical site infections was higher
in the open group while the incidence of intra-abdominal abscess was higher
P86
HAND-ASSISTED LAPAROSCOPIC COLECTOMY (HALC):
in the laparoscopic group (Table 1).
THE BENEFITS OF LAPAROSCOPIC COLECTOMY (LAC)
Conclusions: Although non-infectious outcomes are similar, there are
differences in infectious complications between open and laparoscopic appen- AT NO EXTRA COST.
dectomy for perforated appendicitis. While overall infectious outcomes, J. D. Vogel, E. Ozturk, R. P. Kiran, D. Geisler and T. Hull Cleveland
superficial and deep surgical site infections are lower in the laparoscopic Clinic, Cleveland, OH.
group, likely owing to a smaller incision, the incidence of intra-abdominal Purpose: The short-term outcomes of HALC and LAC have been shown
abscess is increased. This should be acknowledged in the setting of perfo- to be quite similar. However, a comprehensive, case-matched comparison
rated appendicitis and vigorous irrigation, particularly of interloop abscesses, of the costs of HAL and LAC, performed at a United States (USA) medical
should be of the upmost importance with the laparoscopic technique. center, has not been reported. A detailed and meaningful cost analysis of
HALC is needed for surgeons and payers to understand the financial impli-
cations of this technique. The purpose of our study was to determine the
short-term outcomes and the direct costs associated with HALC and LAC
performed at a single USA medical center.
Methods: HALC and LAC performed in a 36 month period (8/2005 to
8/2008) were identified from a prospectively maintained comprehensive
P OSTERS
SSI - surgical site infection
laparoscopic colectomy database. 100 HALC were matched to 100 LAC for
the following: colectomy type(right, left, total), diagnosis, age (±10 years),
gender, American Society of Anesthesiologists (ASA) score (<3 or 3-5), prior
P85 abdominal surgery, and conversion. For all patients, body mass index (BMI),
POST-OPERATIVE MRSA WOUND INFECTIONS IN
operating time, postoperative morbidity, length of stay (LOS), readmission,
LAPAROSCOPIC VERSUS OPEN COLORECTAL RESEC-
and reoperation were assessed. Direct costs for operating room (OR), nurs-
TIONS. ing care, intensive care unit, anesthesia, laboratory, pharmacy, radiology,
K. Cranfield, R. Raman, G. N. O’Dair, G. Sen, P. F. Dobson, J. W. May medicine, professional, and ancillary services related to the initial HALC or
and A. F. Horgan Colorectal Surgery, Freeman Hospital, Newcastle upon LAC hospitalization and readmissions were compared.
Tyne, United Kingdom. Results: The HALC and LAC groups were similar, without significant
Purpose: The global burden of MRSA infections is increasing. Post- differences in any of the matching variables. There were no differences in
operative MRSA infections are a significant cause of morbidity and mortal- mean BMI (29 and 28) or operating time (168 and 163 minutes), median
ity in surgical patients. No study has been identified comparing post-oper- LOS (4 days), readmission (6 and 11%), or reoperation rates (5 and 9%) for
ative MRSA infections in laparoscopic versus open surgery. This study has the HALC and LAC groups. Overall morbidity in the HAL and LAC groups
compared rates of post-operative meticillin resistant Staphylococcus aureus was 16 and 32% (p=0.009). Major morbidity, including abscess, hemorrhage,
(MRSA) infection in elective laparoscopic and open colorectal resections. and anastomotic leak, were similar for HALC and LAC (6 and 10%). Oper-
Methods: A database of a consecutive series of 187 patients undergoing ating room costs were increased for the HALC group, medicine costs were
elective colorectal resections at a single institution between 2005 and 2008 increased for the LAC group. Total costs were similar for HAL and LAC
was analysed. All patients were swabbed for MRSA colonization of nose, (Table). The costs for HAL and LAC remained similar when readmission
throat and perineum on admission and on discharge. Additional swabs were and reoperation were included in the analysis
taken from all patients with suspected post-operative surgical site infections Conclusions: The short-term outcomes and total costs of HALC and
(SSI). Post-operative MRSA SSI rates were compared between laparoscopic LAC are similar. Cost should not be a deterrent to the use of HALC.
The Costs of HALC and LAC (median, IQR)
and open groups. Potential confounding factors such as patient age, sex, BMI,
ASA grade, pelvic v abdominal surgery, and length of stay were investigated
in multiple univarate analyses. Fisher’s exact test was used for categorical
data, and Mann-Whitney U test for continuous data.
Results: 3 patients were MRSA positive on admission, and so were
excluded. Rates of MRSA infections in open and laparoscopic surgery were
5/73 (6.8%) and 0/114 (0%) respectively (p= 0.008) Patients undergoing
laparoscopic surgery had a significantly shorter length of stay than open
patients (median stay 6 days versus 9 days; p = 0.012). MRSA infection was
associated with a longer hospital stay (median stay 16 days for those devel-
oping MRSA SSI, 7 days for those not developing MRSA SSI; p = 0.012)
Post operative MRSA SSI was not related to patient age (p=0.47), sex (p=0.37),
BMI (p=0.99), ASA grade (p=0.35), or pelvic versus abdominal surgery
(p=0.07). ER: Emergency Room
Conclusions: There was an apparent reduction in MRSA surgical site
infection in the patients undergoing laparoscopic colorectal surgery. The
reasons for this observation could relate to minimal access techniques or
reduced length of stay for laparoscopic patients. It is proposed that laparo-
scopic surgery may contribute to reducing the incidence of an important hos-
pital acquired infection.
159
Abstracts
both groups (82%), followed by sub-total colectomy. Conversion rates were
P87 32% and 18.7%, respectively (p= 0.09). The mean operative time (201 vs.
PERFORMING HAND-ASSISTED OR STRAIGHT LAPARO-
182 minutes) and mean blood loss (202 vs. 161 ml) were not significantly dif-
SCOPIC COLECTOMY AFTER COLORECTAL FELLOW-
ferent (p>0.05). However, the overall length of incision was significantly
SHIP: DOES PRIVATE VS. UNIVERSITY SETTING MAKE A larger in group I (11.4 vs. 6.7 cm p=0.045). A stoma was created in 16% and
DIFFERENCE? 17% of patients, respectively. Overall early postoperative complications were
J. J. Stulberg1, S. L. Stein3 and B. J. Champagne2 1Colorectal Surgery, not statistically different among both groups (p>0.05); anastomotic leak
University Hospital Case Medical Center, Cleveland, OH, 2Epidemiology occurred in 1 (2%) and 4 (5%) patients, p=0.6484, and abdominal abscess in
and Biostatistics, Case Western Reserve University, Cleveland, OH and 4 (8%) and 3 (3.75%) patients, p=0.5584, respectively. Reoperative rates were
3
Colon & Rectal Surgery, Weill Cornell Medical Center, New York, NY. 6% and 10% (p=0.5292), and mean hospital stay was similar in both groups,
Purpose: Laparoscopic practice patterns of young colon and rectal sur- 7.5 vs. 6.7 days respectively; p=0.3266; there was no mortality.
geons are generally thought to differ between private practice (PP) and uni- Conclusions: The results of reoperative laparoscopic-assisted resection
versity hospital (UH) settings, but little evidence exists in the literature. It for recurrent Crohn’s disease are similar to those results noted for primary
is thought that surgeons utilize laparoscopic and hand assist surgery with dif- Crohn’s disease.
ferent frequency and indications based on practice specific impediments such
as assistance, emergency surgery and time restraints. To determine whether
this assertion was true, we investigated practice patterns of new colorectal
P89
surgeons. TECHNICAL RESULTS AFTER LAPAROSCOPIC REC-
Methods: Graduates of ASCRS approved colorectal residencies between TOPEXY TO THE PROMONTORY FOR ENTEROCELE AND
2003-2008 were sent an electronic survey, which was first reviewed by a panel TOTAL RECTAL PROLAPSE: PROSPECTIVE STUDY IN 170
of surgeons from ASCRS Young Surgeon’s Committee. Number of laparo- CONSECUTIVE PATIENTS.
scopic cases performed, use of hand assisted (HALS) versus straight laparo- J. Faucheron, D. Voirin and G. Poncet University Hospital, Grenoble,
scopic (SL) left colectomy and impediments to performing laparoscopic sur- France.
gery were assessed. Practice parameters were evaluated as occurring more Purpose: Laparoscopic rectopexy for enterocele or complete rectal pro-
or less than 50% of the time. lapse offers short term advantages compared with operations performed by
Results: Surveys were emailed to 342 graduates, 51% (176) responded open surgery. The aim of this prospective study was to report the technical
with 59% in PP and 43% in a UH setting. Of young colorectal surgeons in outcome after laparoscopic rectopexy to the promontory in consecutive
PP, 38% have performed >30 SL and 30% have performed >30 HALS com- patients.
pared to 39% of young colorectal surgeons in UH which have performed Methods: From May 1996 to April 2008, 170 consecutive patients (160
>30 SL and HALS. More surgeons in PP performed laparoscopic surgery women) of median age 54 years (range 16-84) underwent an operation for
on patients with rectal cancer (36.2% vs. 17.5%) and diverticular disease either a symptomatic enterocele or a total rectal prolapse. Of these, 9 were
(57.5% vs. 70%). Surgeons in PP listed hospital equipment and support as operated on for recurrence. Operative data and postoperative morbidity were
greater impediments to performing LC, while UH surgeons listed patient prospectively collected.
availability (44.9% vs. 33.7%) and length of surgery (27.5 % vs. 20.2%) more Results: Three patients had a conversion through laparotomy during
frequently. the learning curve. The median duration of surgery was 115 minutes (range
Conclusions: Young colorectal surgeons in private practice perform more 45-370) and diminishes with time. There was no mortality. The thirty days
straight laparocopic colectomies than HALS procedures while those in Uni- morbidity consisted in temporary brachial plexus palsy in 2 cases, urinary
versity settings perform both equally. This finding is contradictory to pop- infection in 3, ureteral lesion in one case having had a previous bone graft
ular belief and further studies should investigate possible drivers. on the promontory for spondylolisthesis and lastly perforation of small bowel
that was sutured laparoscopically during the operation in one. The median
hospital stay was 2.2 days (range 1-12). Four patients were operated on as
P88 outpatients.
LAPAROSCOPY FOR RECURRENT CROHN’S DISEASE: Conclusions: Laparoscopic rectopexy is a safe procedure to treat ente-
HOW DO THE RESULTS COMPARE TO THE RESULTS FOR rocele and total rectal prolapse, with a low morbidity rate and a hospital stay
PRIMARY CROHN’S DISEASE? of less than 3 days.
R. Pinto, S. Shawki, K. Narita, E. Weiss, J. Nogueras and S. D. Wexner
Colorectal Surgery, Cleveland Clinic Florida, Weston, FL.
Purpose: 80% of patients with Crohn’s disease will eventually require
P90
surgical resection and up to 50% of those patients will need reoperation LONG-TERM OUTCOMES AFTER LAPAROSCOPIC
within 10 years. The aim of this study was to assess the feasibility and out- COLECTOMY IN THE TREATMENT OF SIGMOID DIVER-
comes of reoperative laparoscopic-assisted surgery for recurrent Crohn’s dis- TICULITIS.
ease compared to the outcome after index laparoscopic resection. T. Lipof1, A. E. Zanno1, J. M. Spilka1, C. M. Bartus2, K. H. Johnson2,
Methods: A retrospective analysis of a prospectively maintained data- W. V. Sardella2, P. V. Vignati2 and J. L. Cohen2 1Integrated Residency in
base was performed on patients who had re-operative laparoscopy (Group General Surgery, University of Connecticut School of Medicine, Farming-
I) and first time laparoscopy (Group II) for Crohn’s disease from 2001 - 2008. ton, CT and 2Department of Surgery: Colorectal Division, Hartford Hospi-
Data collection included patient’s characteristics, surgical procedures, and tal, Hartford, CT.
postoperative course. Student’s t and Fisher tests were used when appropri- Purpose: The goal of prophylactic resection of sigmoid diverticulitis is
ate. to minimize the risk of recurrent diverticulitis. At many institutions laparo-
Results: 130 patients were included in this study distributed as follows: scopic resection has replaced open resection as the standard of care. Little
Group I: 50 patients with a mean age of 42 years; Group II: 80 patients with data exists as to the long-term efficacy of laparoscopic colectomy in achiev-
a mean age of 35. Preoperative ASA and BMI were similar for both groups. ing that goal. We present our outcome data following laparoscopic resection
Group I patients had a longer period of disease, 15.5 vs. 8.9 years (p=0.0002). for diverticulitis.
Immunosuppressive therapy was being utilized in 42 & 66 patients respec- Methods: All patients who underwent laparoscopic colectomy in the
tively. Ileocolic resection was the most commonly performed procedure in treatment of sigmoid diverticulitis from October 1998 to September 2007
160
Abstracts
were identified at a single institution. Patients all underwent colorectal anas-
tomoses. A retrospective review was performed to identify patient demo-
P92
LAPAROSCOPIC COLECTOMY IN THE OBESE PATIENT :
graphics, type of surgery, complications and hospital length of stay. Patients
RESULT OF A RANDOMIZED TRIAL.
were followed specifically for recurrent diverticulitis as defined by their clin-
ical presentation and confirmed by CT imaging. A. Vignali, S. Di Palo, E. Orsenigo, L. Ghirardelli and C. Staudacher
Results: 340 (45% female, 55% male) patients underwent hand-assisted Department of Gastrointestinal Surgery, IRCCS San Raffaele, Milan, Italy.
laparoscopic colectomy for diverticulitis during the study period. Mean age Purpose: To assess the impact of laparoscopy on postoperative pulmonary
was 55. Mean hospital length of stay was 5.5 days (median 4 days). 22% function and early postoperative outcome in obese ( Body Mass Index > 30
were defined as complicated diverticulitis by the presence of abscess (N=30, kg/m2) colon cancer patients who were randomly assigned to elective laparo-
39%), fistula (N=40, 53%), or stricture (N=6, 8%). The conversion rate was scopic (LPS) or open colectomy.
7%. There was no perioperative mortality. Major complications include anas- Methods: one hundred and thirty-three obese patients were randomly
tomotic leak (N=4, 1%) and reoperation for bleeding (N=3, 1%). Our mean assigned to laparoscopic (n= 66) or open colectomy (n = 67). Age, American
follow-up period was 42 months. Seven patients (2%) were confirmed to Society of Anesthesiologist Score (ASA), operative variables, conversion,
have recurrent diverticulitis during this follow-up period. length of stay, patient’s outcome and 30-days morbidity were analyzed. Before
Conclusions: Although little controversy remains regarding the uti- (POD -1) and after operation (POD 1,2,3,4 and 5), respiratory function [peak
lization of laparoscopic colectomy in the treatment of diverticular disease, expiratory flow, forced vital capacity (FVC) and forced expiratory volume
there is scarce data elucidating the long-term outcomes. This large series (FEV) ] was determined by spirography and blood gas. Postoperative pain
P OSTERS
demonstrates a low rate (2%) of recurrent diverticulitis when a laparoscopic (VAS) and analgesic consumption were also monitored
approach is used in the surgical management of diverticulitis. Our recur- Results: The two groups were well balanced for demographics, ASA
rence rate compares favorably to the established recurrence rate after open score as were as for type of surgery as were as for BMI. Conversion rate was
resection. Given the low morbidity of this procedure, this outcome data 10.6 % (6/66 patients). In LPS group, operative time was 29 minutes longer
further establishes laparoscopic colectomy as a safe and effective approach ( P = 0.001). Similar respiratory baseline values were observed in the two
in the surgical treatment of sigmoid diverticulitis. groups. FEV and FVC recovered faster in LPS when compared to open (P=
0.03,P= 0.046, respectively). On POD 2 a trend to reduction of postopera-
tive pain was observed in LPS patients (P = 0.11 ). Morphine consumption
P91 was significantly less in the LPS group both on POD1 and 2 (P = 0.01). No
A COMPARISON OF OPEN AND LAPAROSCOPIC RESEC- differences were observed with respect to overall morbidity rate (29.3% vs
TIONS FOR RECTAL CANCER BASED ON THE PROPOSED 24.9% in LPS ; P = 0.67), anastomotic leak or readmission rate. In particu-
COST II OUTCOME MEASURES. lar a similar incidence of cardiac ( 0 vs. 2 in LPS ; P =0.41 ) and pulmonary
D. Trottier, H. P. Huynh, E. Sabri, C. Soto, A. Scheer, H. Moloo, complications (3 vs.1 in LPS ; P = 0.39 ) was observed in the two groups. In
S. Zolfaghari, E. Poulin, J. Mamazza and R. P. Boushey General Surgery, the LPS group the median length of stay (days) was significantly shorter when
University of Ottawa, Ottawa, ON, Canada. compared to open (8 vs 10 ; P = 0.03).
Conclusions: laparoscopic colectomy can be performed safely in obese
Purpose: To compare laparoscopic (L) and open (O) surgery in patients
patients with faster recovery of pulmonary function and reduced length of stay.
with rectal carcinomas situated below 15cm from the anal verge (AV), using
similar outcomes established by the Clinical Outcomes of Surgical Therapy
(COST) II group study.
Methods: We analyzed prospectively-collected data by 13 surgeons from
P93
PROSPECTIVE COMPARATIVE STUDY OF VOIDING AND
1991-2008. Demographics, tumor characteristics, adequacy of oncologic
SEXUAL FUNCTION BETWEEN OPEN AND LAPARO-
resection, short-term outcomes and survival data were analyzed.
SCOPIC TOTAL MESORECTAL EXCISION WITH PELVIC
Results: 433 patients had resection of a rectal carcinoma (228L vs. 205O).
AUTONOMIC NERVE PRESERVATION IN RECTAL CAN-
Age, BMI, ASA scores and pathologic TNM-staging were comparable. A
similar number of patients received neoadjuvant therapy (NA) in both arms CER.
(33%L vs. 34%O). Operative times were longer for the laparoscopic approach H. Hur, N. K. Kim, B. S. Min, J. S. Kim, S. K. Sohn and C. H. Cho
(236minsL vs. 166minsO, p=0.0001) and the conversion rate was 16%. Rates Surgery, Yonsei University College of Medicine, Seoul, Korea, South.
of abdominoperineal resections were higher in the laparoscopic group (27%L Purpose: The aim of this study was to evaluate and compare voiding and
vs. 7%O), however, there was a greater proportion of distal rectal tumors in sexual dysfunction between open and laparoscopic rectal cancer surgery
the laparoscopic group (22%L vs. 13%O). The use of ileostomies was com- Methods: 40patients(26male and 14female)who underwent open(N=18)
parable (12.5%L vs. 19.0%O). There were no differences in post-operative or laparoscopic(lapa)(N=22)surgery for rectal cancer were prospectively
complications and leak rates were also similar (6.6%L vs. 6.8%O). There enrolled. Urine flowmetry and standard questionnaires using International
was a significant decrease in the incidence of ileus and length of stay in the Prostate Symptom Score(IPSS), International Index of Erectile Func-
laparoscopic group (2.3%L vs. 17.9%O, p=0.03; 6dL vs. 8dO p=0.002, respec- tion(IIEF), and Female Sexual Function Index (FSFI)were perfomed before
tively). No significant differences were seen with regards to surrogates of and 1 month, 3months after surgery.
adequate oncologic resection. Specifically, the total number of harvested Results: IPSS was increased 1month after surgery(open: 8.9±6.2 to
lymph nodes was similar (11.4L [9.8NA, 12.9noNA] vs. 11.7O [12.7NA 13.3±5.5, lapa: 10.2±5.4 to 15.1±6.8; P<0.001, P<0.001, respectively),but
and 12noNA]), and an equal proportion of patients in both groups had dis- 3months after, similar score was resulted(open:9.8±6.8, lapa:11.9±5.0;
tal margins > 2cm (66.7%L vs. 51.1%O) as well as radial margins > 0.1cm P=0.472, P=0.524). Significant differences in mean voiding volume were seen
(98%L vs. 93%O). 3 patients in the open group (2.1%) had positive radial before and 3months after surgery(open: 171.7±130.7 vs.141.0±59.7, lapa:
margins while none were observed in the laparoscopic group. Average fol- 274.1±14.2 vs. 176.6±117.7; P=0.04, P=0.03, respectively). But, there is no
low-up was 21 months and there was no difference in overall survival. differences in peak flow rate and residual volume both in open and lapa group.
Conclusions: Laparoscopic resection for rectal cancer is equivalent to Total IIEF scores were significantly decreased both 1month and 3months
open resection based on oncologic endpoints proposed by the COST II trial. after surgery(open:48.0±22.4 vs. 23.3±21.7 and vs. 26.8±2.5, lapa:33.9±22.7
Laparoscopy leads to a lower incidence of ileus and a shorter length of stay. vs.13.9±8.8 and vs. 15.5±13.3; P<0.001, P<0.001, respectively). Erectile func-
Overall survival rates are similar between both groups. tion were also sifnificantly decreased. Of 17patients(open:10, lapa:7)who have
normal ejaculation ability before surgery, only 5patients(open:4, lapa:1) have
normal function 1month after surgery(P=0.004, P=0.001, respectively), and
161
Abstracts
7patients(open:4, lapa:3)3months after(P=0.004, P=0.003, respectively). Total mortality during the postoperative period and pathological results were
FSFI scores were significantly decreased 1month after surgery(open: 8.1±5.2 reviewed.
vs. 3.4.±1.9, lapa: 14.5±11.1 vs. 5.3±7.6; P=0.043, P=0.035, respectively)but, Results: A total of 80 pts (46 men; 36 women) were treated. Average age
similar scores resulted 3months after surgery in lapa group(16.0±13.2; was 60.1 years (range from 26-84). Seventy-one pts were stage II or III and
P=0.779). had received neoadjuvant chemo-radiotherapy. The location of the tumor in
Conclusions: Voiding function, male and female sexual function signif- the rectum was: low in 43 pts, mid in 27 and upper in 9 pts. We performed
icantly decreased 1month after both open and lapa surgery. Voiding func- sphincter-preserving surgery in 67 pts (50 low anterior resections and 17
tion and female sexual function was recovered 3months, but male sexual func- intersphincteric resections) and abdomino-perineal resections in 14 pts.
tion was still decreased. Laparoscopic surgery showed similar outcome of Median operative time was 270 minutes (range 150-540). Median robotic
voiding and sexual function with open surgery in rectal cancer time was 50 minutes (range 20-126). Conversion rate was 6.4%. A complete
TME with negative radial and distal margins was achieved in 79 pts with a
median of 14 (range 3 to 28) lymph nodes removed. Clinical anastomotic
P94 leak occurred in 9 of 67 pts (13.4%). Other complications included prolonged
THE LEARNING CURVE FOR TEM: NOT SO STEEP. ileus (10 pts), urological disorders (4 pts) and wound infection (2 pts). Stoma
A. Vorenberg, M. R. Oviedo, R. Pinto, S. D. Wexner and D. Sands Col- related complications occurred in 9 pts. The median hospital stay was 6
orectal, Cleveland Clinic Florida, Weston, FL. days (range 3 to 30). There was no 30-day postoperative mortality.
Purpose: Transanal endoscopic microsurgery (TEM) was first described Conclusions: RTME can be carried out safely and according to onco-
in 1983. The technique has been slow to gain acceptance in mainstream logical principles. Ultimately, a large randomized trial is needed to assess the
colorectal surgical practice. One of the reasons for this has been the per- potential benefits of robotic systems in rectal surgery.
ceived steep learning curve. As more attention is focused on minimally inva-
sive techniques, interest in TEM has exponentially increased. The aim on
this study was to evaluate the learning curve for TEM and the feasibility of
P96
WOUND INFECTION FOLLOWING STOMA CLOSURE BY
incorporation of this technique into a colorectal surgical practice.
TWO TECHNIQUES: A COMPARATIVE STUDY.
Methods: Data was entered into a prospectively collected database and
a retrospective chart review was performed 26 patients underwent TEM from T. T. Marquez, D. Christoforidis, A. Abraham, R. D. Madoff and
Nov 2005-Oct 2008. All cases were performed by a single surgeon. Several D. A. Rothenberger Surgery; Division of Colon & Rectal Surgery, Uni-
variables were analyzed including age, sex, operative time, size of tumor, type versity of Minnesota, Minneapolis, MN.
of tumor, specimen fragmentation, speed of excision, distance from the den- Purpose: Stoma closure has been associated with a high rate of surgical
tate line, and complications. The learning curve was assessed by both obser- site infection (SSI) and the ideal stoma site skin closure technique is still
vational differences in the early and later cases as well as with a cumulative debated. The aim of this study was to compare the rate of SSI following pri-
sum control chart (CUSUM). mary skin closure (PC) versus a skin approximating, subcuticular purse-string
Results: 23 patients results were analyzed. Average operating time was closure (APS).
130.5 min (range 49-254 min). Average specimen size was 16.6 cm2 with a Methods: We reviewed the charts of all patients undergoing stoma clo-
96% nonfragmented specimen rate. The average rate of excision expressed sure between 2002-2007 by two surgeons at a single tertiary care institu-
in min/cm2 declined significantly after 4 cases with an average rate of exci- tion. Patients who had a new stoma created at the same site or those with-
sion of 13.85min/cm2 for the first 4 cases and an average rate of excision of out wound closure were excluded. The endpoint was SSI, determined
7.86 min/cm2 (p=0.0014) for the last 19 cases.With more experience, we according to current CDC guidelines, at the stoma closure site and/or the
began approaching more proximal tumors. We plotted our learning curve midline laparotomy incision.
and noted that the steepest portion of the curve correlated with the first 4 Results: There were 61 patients in the PC group and 17 in the APS
cases. After an additional 4 cases, the learning curve was stable utilizing the group. The two groups were similar in baseline and intra-operative charac-
CUSUM method. We noted an additional rise and leveling off of the curve teristics, except that patients in the PC group were more often diagnosed
in the later experience correlated with the approach of more proximal lesions. with benign disease (p=0.0156), had more often a stapled anastomosis
There were no significant complications noted in the series (p=0.002) and were more often operated by Surgeon A (p<0.001). The over-
Conclusions: TEM is a valuable tool for the colorectal surgeon’s arma- all surgical site infection rate was 14 of 78 (18%). All SSI occurred in the pri-
mentarium and provides safe transanal access to mid and upper rectal lesions mary closure group (14 of 61 vs. 0 of 17, p=0.03).
with superior specimen retrieval. The learning curve for TEM is sur- Conclusions: Our study suggests that a skin approximating closure with
mountable appearing to be associated with a significant decrease in opera- a subcuticular purse-string of the stoma site leads to less SSI than a primary
tive time after 4 cases. closure. Randomized studies are needed to confirm our findings and assess
additional endpoints such as healing time, cost, and patient satisfaction.
Intra- and Postoperative characteristics
P95
ROBOTIC-ASSISTED TOTAL MESORECTAL EXCISION:
OUR FOUR-YEAR INSTITUTIONAL EXPERIENCE WITH
80 UNSELECTED CASES.
S. McKenzie, C. Pastor, J. H. Baek, J. Garcia-Aguilar and A. Pigazzi
General Oncologic Surgery, City of Hope National Medical Center, Duarte,
CA.
Purpose: During the last few years robotic surgery has been shown to
be feasible in the treatment of rectal cancer. However, experience with this
technique is still limited. The goal of our study was to evaluate short-term
outcomes after a four-year experience with robotic assisted total mesorectal 1
sustained Systolic blood pressure <90mmHg with intervention
excision (RTME). 2
minimal intraoperative T°<36°C
Methods: From a prospectively maintained database, we selected patients 3
2 patients in the PC group and 1 in the APS did not have an anastomosis but resitement
who had RTME between November 2004 and October 2008. Morbidity and of their stoma.
162
Abstracts
defined as failure to implement the ERP. Data reported was age, gender
P97 (number male),technique (open or laparoscopic, hospital stay (LOS), dura-
THE SAFETY AND EFFICACY OF A NOVEL, TECHNO-
tion of IV narcotics (hrs) and the average visual analog pain score (VAS) dur-
LOGICAL OSTOMY SYSTEM FOR PATIENTS WITH
ing the initial 48 hours.
COLOSTOMIES. Results: We reviewed 197 eligible patients and there was no difference
T. Maxwell1, A. Padmanabhan2, D. Taylor2, D. Pedersen3, A. Durnal3, in age, gender, or technique use between the ERP and non-ERP groups. Full
R. Wills4, D. Kommala5 and S. Wade1 1Image Specialties, St. Joseph, MO, implementation of the ERP was achieved in 44.6% of the patients. The LOS
2
Colon and Rectal Surgery Inc., Columbus, OH, 3Clinical Investigator, of was significantly shorter for the ERP patients (3.1±1.0 vs 6.0±4.6;
Phoenix, AZ, 4Restored Images, Kansas City, MO and 5ConvaTec, Skill- p<.00001). The VAS pain scores were also significantly lower for the ERP
man, NJ. patients (3.3±2.8 vs 4.8±3.0; p<.05). There were more anastomotic leaks (8
Purpose: To assess the safety, efficacy, and performance of a novel (5.7%)vs 0) and readmissions (8.5% v 16.8%; p<.05))in the non-ERP group.
colostomy device compared to a traditional pouching system in patients with Prolonged administration of parenteral narcotics was the most frequent
colostomy. reason for failed implementation of ERP.
Methods: This Phase II, 142-day, 4-stage, open-label, non-randomized, Conclusions: Implementation of a colectomy ERP is challenging even
multicenter study enrolled patients with end colostomies for ≥3 months, cur- with a structured implementation process (44% adoption rate). Interestingly,
rently wearing a traditional pouching system. During novel device-wear, implementation correlated with a lower complication rate, a reduced LOS,
patients recorded safety outcomes (condition of surrounding skin if skin bar- and improved analgesia. These benefits accrued even though implementa-
P OSTERS
rier wafer was changed; color, moisture, physical condition of the stoma; and tion preceded clinical recognition of complications by several days.
gastrointestinal symptoms) in daily diaries.
Results: Twenty-six patients entered the study (mean age 55.77 years;
15 female, 11 male). Twenty-one patients completed the study; 2 withdrew P100
due to leakage, 2 withdrew consent, 1 discontinued before novel device wear. SELF-EXPANDING METALLIC STENTS FOR ACUTE LEFT-
During the 21-day usual product wear period, one patient reported 2 adverse SIDED LARGE BOWEL OBSTRUCTION: A REVIEW OF 130
events (AEs), (AE rate 0.003/patient day;0.09/patient month); during the 14- PATIENTS.
day period before novel device-wear, 5 patients reported AEs (AE rate W. Law, C. C. Foo, J. T. Poon and J. K. Fan Department of Surgery, The
0.018/patient day;0.54/patient month), one serious; during the 107-day novel University of Hong Kong Medical Centre, Hong Kong, China.
device wear period 15 patients reported AEs (AE rate 0.013/patient Purpose: To evaluate the results of endoscopic placement of self-expand-
day;0.39/patient month), three serious and considered not related to treating metallic stents (SEMS) for acute left-sided large bowel obstruction.
ment. The novel device was worn for 97% of study days; mean daily wear Methods: From 1997 to June 2008, 130 patients underwent insertion of
time was 6.21 hours. Main reason for device removal was “time to SEMSs for acute left-sided large bowel obstruction. One hundred and one
change”/”study visit” (64%). Investigator ratings of stoma color and mois- procedures were definitively palliative and 29 patients underwent stent inser-
ture remained within normal range throughout the study. During novel tion as a bridge for surgery. The records were reviewed and the success rate
device-wearing stage, patients had no unusual gastrointestinal symptoms on of the procedures and the outcomes of patients were analyzed.
99.7% of days, and no odor was noted for 80% of days. Eighty percent of Results: The mean age of the patients was 67 years old (range: 27-98).
patients reported stoma noise was less than usual. Mean number of leaks per The leading causes of obstruction were primary colorectal cancer (67%),
patient month were 1.2 (traditional) and 4.2 (novel). Microbiology and vas- recurrent colorectal cancer (16%) and extrinsic compression by other malig-
cularity profiles did not reveal concerns. Approximately 2/3 of patients pre- nancies (14%), the most common being carcinoma of stomach. The success
ferred the novel device. rate was 80.8% after insertion of the first stent. In 12 patients, a second
Conclusions: This study demonstrated safety and efficacy of the novel stent insertion was required. After second stent insertion, overall success rate
device when used for 8 hours per day in colostomy patients. increase to 89.2%. Complications occurred in 20% of patients with migra-
tion or dislodgement of the stents being the most common (12.3%). Perfo-
ration occurred in two patients and one patient developed colovesical fistula
P99 after SEMS insertion. In the 101 patients who received palliative stenting,
IMPLEMENTATION OF AN ENHANCED RECOVERY PRO- 12 (11.9%) required subsequent surgery with stoma required in all except
GRAM FOR COLECTOMY: IS IT BETTER? one patient. The median survival was 2 (1.2-2.7) months for those who under-
B. J. Rogoway1, I. Risvi1, M. Luchtefeld2, D. Kim2, N. Dujovny2 and went SEMS insertion as a palliative procedure. Among the 29 patients who
A. J. Senagore3 1General Surgery, Grand Rapids Medical Education and underwent SEMS insertion as a bridge to surgery, subsequent surgery was
Research Center, Grand Rapids, MI, 2Colon and Rectal Surgery, The Fer- performed at a mean interval of 12 days (4-69). Laparoscopic resection was
guson Clinic/Michigan Medical PC, Grand Rapids, MI and 3Research, Spec- performed in nine patients and primary anastomosis was possible in 26
trum Health, Grand Rapids, MI. patients. The median survival for those who underwent SEMS insertion as
Purpose: The essential components and benefits of a mature enhanced a bridge to surgery was 27 (95% CI: 13-40) months.
recovery program (ERP) for patients undergoing colorectal surgery have Conclusions: SEMS serves as an effective means to relieve acute left-
been substantiated, however there is little evidence documenting the chal- sided coloinc obstruction. It allows for subsequent definitive surgery on an
lenges and benefits during implementation of such a program. The purpose elective setting. It decreases the need of stoma and laparoscopic surgery
of this study was to define the process and outcomes of implementation of becomes feasible. It also serves as a good palliative measure for advanced and
a colorectal surgery ERP. disseminated disease.
Methods: The ERP was defined by consensus of the department and
codified on a standard order sheet and a one hour educational program was
provided for the dedicated nursing units. All elective surgical patients under-
going a laparoscopic or open segmental colectomy during the 12 month
implementation were enrolled. Successful use of the ERP was defined as: ad
lib diet within 24 hours; ambulation within 24 hours; scheduled oral NSAID
and gabapentin use within 24 hours; and termination of parenteral narcotics
within 48 hours. Failure to implement one or more of the components was
163
Abstracts
Results: We analyzed the care provided to 21,264 patients who under-
P101 went one of these three types of procedures (hemorrhoids: 9,996; other
OPTIMAL TIME OF SURGERY AFTER PREOPERATIVE
anorectal: 5,684; colectomies: 5,584). The proportion of these procedures
SELF-EXPANDABLE METALIC STENT INSERTION FOR
that was performed by an ABCRS-certified surgeon increased from 22.9%
OBSTRUCTIVE COLORECTAL CANCER. in 1992 to 33.6% in 2002. This shift was more rapid for anorectal proce-
S. Kim, Y. Park, K. Lee, S. Sohn and J. Kim Colorectal Surgery, Yonsei dures (hemorrhoids: 28.4% to 45.0%, other anorectal: 23.9% to 34.5%) than
University College of Medicine, Seoul, Korea, South. for colectomies (11.0% to 12.0%). Patients residing in major metropolitan
Purpose: Self-expandable metallic stent (SEMS) has been used for pre- areas (MMAs) were more likely than patients residing in non-MMAs to be
operative decompression of obstructive primary colorectal cancer (CRC). treated by a colorectal surgeon (35.6% vs. 13.2%). Increases in the propor-
This study was aimed to determine the optimal time for elective radical sur- tion of procedures performed by an ABCRS-certified surgeon were 29.2%
gery following colonic stent insertion for CRC with obstruction. to 43.44% in MMAs and 9.8% to 15.6% in non-MMAs.
Methods: From April 2000 to September 2008, 62 patients received Conclusions: Over the 11-year period of our study there was a signifi-
placement of colonic SEMS for the purpose of temporary decompression cant increase in the proportion of colorectal procedures for benign indica-
prior to performing colorectal resection. Obstructive sites were distal trans- tions performed by subspecialty-trained colorectal surgeons. These trends
verse colon (n=1), descending colon (n=13), sigmoid colon (n=36), rectum were seen in areas of higher and lower population density.
(n=6). Technical success was achieved in all the patients and clinical success
in 56 patients (90.3%). The 56 patients were categorized into the two groups
according to the duration between placement of SEMS and operation: Group P103
A, patients operated within 7 days of colonic stent insertion (n=26); Group COLON AND RECTAL SURGERY: NOT JUST ANOTHER
B, patients operated over 7 days of colonic stent insertion (n=30). Operation GENERAL SURGERY PROCEDURE.
time, postoperative morbidity and mortality, and factors related to postop- B. R. Swenson, T. L. Hedrick, R. G. Sawyer and C. M. Friel Depart-
erative recovery, such as time to the first bowel movement, time to the inges- ment of Surgery, University of Virginia Health System, Charlottesville, VA.
tion of normal diet and length of hospital stay were compared. Purpose: In an era of increased outcomes reporting it is important to
Results: The patients of group B (56.7%) had more comorbid diseases build proper risk-adjustment models. Emergency vascular surgery proce-
than those of group A (19.2%)(p=0.004). Postoperative morbidity occurred dures are traditionally associated with higher mortality risks than emergency
in 2 patients (7.7%) of group A (rectovaginal fistula 1, chylous ascites 1), general surgery procedures. Colorectal surgery is traditionally grouped with
whereas 5 patients (16.7%) of group B (postoperative ileus 2, pneumonia 2, general surgery in these analyses. We hypothesize that emergency colorec-
pleural effusion 1). However, no significant difference was observed. Only tal surgery conveys a greater mortality risk to patients than emergency non-
one postoperative mortality occurred in group B. The two study groups colorectal general surgery.
showed no difference in terms of operation time and postoperative recov- Methods: The National Surgical Quality Improvement (NSQIP) data-
ery. In addition, when adjusted with comorbid diseases, there was no signif- base for general and vascular surgery from 2005-2007 was utilized. Univariate
icant difference for all the variables between the two groups. analysis comparing the 30-day mortality of colorectal surgery to non-col-
Conclusions: We found out that the time of operation following colonic orectal general surgery and vascular surgery for all cases and for emergency
stenting did not affect the postoperative short term outcomes of patients with cases were performed. Logistic regression was used to further assess the influ-
obstructive colorectal cancer. This study suggests that once colonic obstruc- ence of emergency while controlling for surgery type.
tion is successfully decompressed by preoperative placement of SEMS, early Results: 363,897 cases were identified (31,150 [8.56%] colorectal sur-
surgical intervention after stenting is feasible with acceptable postoperative gery, 287,082 [78.89%] non-colorectal general surgery, 45,665 [12.55%] vas-
morbidity and no delayed recovery. cular surgery). 30-day mortality outcomes are listed in the table. Mortality
was higher in the colorectal surgery group followed closely by the vascular
surgery group. Colorectal and vascular procedures were associated with a
P102 higher risk when performed under emergency conditions compared to non-
COLORECTAL PROCEDURES FOR BENIGN INDICA-
colorectal general procedures. The risk ratio of emergency surgery in the
TIONS: WHAT PROPORTION ARE PERFORMED BY colorectal group was greater than that of the non-colorectal surgery group.
ABCRS-CERTIFIED SURGEONS? Logistic regression confirmed this finding showing a 30% greater impact of
R. R. Cannom1, G. T. Ault1, A. M. Kaiser1, R. W. Beart1, P. Vukasin1, emergency surgery in colorectal surgery compared to the other two groups.
A. Garza1, R. D. Madoff2 and D. A. Etzioni1 1Colorectal Surgery, Uni- Conclusions: Emergency surgery greatly increases mortality after col-
versity of Southern California, Los Angeles, CA and 2Division of Colorec- orectal, general and vascular surgery. Colorectal surgery is at least as risky
tal Surgery, University of Minnesota, Minneapolis, MN. as vascular surgery and more than general surgery when all cases are con-
Purpose: The surgical workforce within the United States (US) is mov- sidered and may be even more so when done emergently. When reporting
ing rapidly towards increasing subspecialization. This trend is of particular physician specific outcomes colon and rectal surgery should be separated
importance to the definition of the field of colorectal surgery, which has sig- from other general surgery to ensure equitable comparisons.
nificant overlap in scope of practice with the field of general surgery. We 30-day mortality
hypothesized that over time, an increasing proportion of colorectal proce-
dures for benign indications is performed by subspecialty-trained colorec-
tal surgeons.
Methods: We used data from a nationally-representative sample of
Medicare patients who underwent a colorectal procedure for a benign con-
dition between 1992 and 2002. We established whether the surgeon respon- Categorical variables reported as % (N). Risk ratios reported as RR (95% confidence
sible for the patient’s initial care was a board-certified colorectal surgeon interval)
based on a linkage with two overlapping data sources: 1) historical data from *,, p <0.05 on pairwise comparison
the American Board of Colon and Rectal Surgeons (ABCRS), and 2) the
American Medical Association Physician Masterfile. Procedures were cate-
gorized based on Current Procedural Terminology (CPT) codes as hemor-
rhoidal (excision/band/inject/destroy), colectomy, and other anorectal.
164
Abstracts
the post-operative period. Although internally validated, PQL as yet lacks
P104 external validation with a universally accepted QoL metric such as the Short
KNOWLEDGE AND ATTITUDES REGARDING COLOREC-
Form-36 (SF-36).
TAL CANCER SCREENING AMONG MEDICAL STUDENTS:
Methods: PQL was designed by developing a 14 question dataset with
A TALE OF TWO SCHOOLS. surgeon and patient input, each ranked on a Likert scale from 1-10. A prior
D. Wietfeldt1, M. Boehler1, C. Schwind1, Y. Becker2, B. Lewis2, study showed internal consistency by Cronbachs alpha, and by factor analy-
J. Rakinic1 and I. Hassan1 1General Surgery, Southern Illinois University, sis the 14 domains break down into a Recovery Score and Symptom Score.
Springfield, IL and 2Surgery, University of Wisconsin, Madison, WI. Baseline pre-operative PQL and SF-36 scores were determined for 100 con-
Purpose: Colorectal Cancer (CRC) is the second most common cause secutive patients undergoing a variety of major colorectal abdominal proce-
of cancer-related deaths in the United States. Studies show that the most dures. Factor analysis was performed to confirm the validity of the study
important predictor of patient compliance with CRC screening is physician group SF-36 scores. Spearman’s rank test determined correlations between
recommendation. We assessed the knowledge and attitudes of medical stu- each of the 8 SF-36 scales and the 14 PQL questions and summary scores.
dents regarding CRC screening. Results: Eighty-eight patients had complete data. SF-36 factor analysis
Methods: A study specific survey was distributed to first, second, third confirmed comparability between the study group and the general popula-
and fourth year medical students (MS) at two medical schools. School A tion. All PQL questions correlated significantly with all SF-36 scales. For
administered a written survey while School B surveys were completed on- individual pairings between the eight SF-26 scales and 14 PQL questions,
line. Surveys included questions pertaining to recommended screening prac- maximum Spearman correlation coefficients ranged from 0.53 to 0.78 (p <
P OSTERS
tices for CRC, starting age and frequency of CRC screening. Risk factors 0.0001 for all comparisons).
associated with and personal attitudes toward CRC screening were also Conclusions: PQL is strongly correlative with SF-36 for patients under-
assessed. going a variety of colorectal procedures and is constructually valid in the pre-
Results: The response rate was 95% for A and 25% for B. The com- operative period. PQL represents a simple, point-of-care alternative to SF-
bined scores for all years regarding screening recommendations were 28% 36 for rapid QoL assessment.
(SD 22) for A and 29% (SD 24) for B. There was a significant difference in
the percentage of correctly answered questions regarding screening between
first year MS and all other years for School A & B. However, there was no P106
difference in the percentage of correct answers between years 2, 3, & 4 for THE INTRAOPERATIVE SURGICAL APGAR SCORE PRE-
both schools (Table 1). The majority of students in both schools knew that DICTS POST-DISCHARGE COMPLICATIONS AFTER COL-
an increased risk of CRC was associated with a positive family history (100%), ORECTAL RESECTION.
IBD (90%)and increasing age (90%). Medical students’ attitudes towards S. E. Regenbogen1, L. Bordeianou1, M. M. Hutter1 and A. A. Gawande2
CRC screening were consistent between classes and schools. All students 1
Surgery, Massachusetts General Hospital, Boston, MA and 2Surgery,
agreed that they would want to know as early as possible if they had cancer Brigham and Women’s Hospital, Boston, MA.
and 93% believed that there is strong evidence supporting the benefits of Purpose: We previously derived and validated an intraoperative 10-point
CRC screening. Surgical Apgar Score—based on blood loss, lowest heart rate, and lowest
Conclusions: Although most MS had positive attitudes regarding can- mean arterial pressure—that effectively predicts major complications within
cer screening, our survey identified several important deficits in knowledge. 30 days of colorectal resection. However, many post-colectomy complica-
Surveyed MS had a poor baseline understanding of the screening recom- tions arise only after uncomplicated hospital stays, and surgeons have little
mendations for colorectal cancer. Although the level of knowledge increased means to estimate patients’ risk of these late complications. We sought to
between the first and second year, no further improvement was seen in sub- evaluate whether this intraoperative metric would predict the likelihood of
sequent years. The deficits found can be remedied by a more rigorous cur- post-discharge complications after colectomy.
riculum that specifically increases student involvement and awareness regard- Methods: We linked data from our institution’s National Surgical Qual-
ing colorectal cancer screening. ity Improvement Program database with our Anesthesia Intraoperative Man-
Mean Percentage Correct Responses for Recommended Screening Practices
agement System for all 795 colorectal resections enrolled over four years.
Using Cochrane-Armitage chi-square trend tests and logistic regression,
we evaluated the Surgical Apgar Score’s prediction for major postoperative
complications before and after discharge.
Results: Surgical Apgar Scores were independently predictive of both
inpatient complications and late complications after uncomplicated discharges
*Statistically significant difference between year 1 and all other years p<.001 (both p<0.0001, see Table). Late complications occurred from 0-27 (median
11) days after discharge; the most common were surgical site infections (42%),
sepsis (24%) and venous thromboembolism (16%). In pairwise comparisons
P105 against average-scoring patients (Surgical Apgar Scores 7-8), the relative risk
CONSTRUCT VALIDATION OF A NOVEL POSTOPERA- of post-discharge complications trended lower, to 0.6 (95%CI 0.2-1.7) for
TIVE QUALITY OF LIFE (PQL) METRIC. those with the best Scores (9-10); and were significantly higher, at 2.6 (1.4-
M. F. McGee1, V. K. Cheruvu2, S. M. Debanne2, B. O’Brien-Ermlich1, 4.9) for Scores 5-6, and 4.5 (1.8-11.0) for Scores 0-4. Discrimination for
M. Laughinghouse1, B. J. Champagne1, H. L. Reynolds1, E. Marder- late complications was good (c=0.68).
stein1 and C. Delaney1 1Division of Colorectal Surgery, Department of Sur- Conclusions: The intraoperative Surgical Apgar Score remained a use-
ful measure of risk, well beyond the immediate postoperative hospitaliza-
gery, Case Western Reserve University, Cleveland, OH and 2Department of
tion, even though 20% of post-colectomy complications arose only after
Epidemiology and Biostatistics, Case Western Reserve University, Cleve-
uncomplicated discharges. This finding suggests that even late complications
land, OH.
may be related to intraoperative condition and events. Surgeons could use
Purpose: Existing quality of life (QoL) assessment tools are often com- this intraoperative metric to target low-scoring patients for intensive post-
plex, or lack specificity, and are not generally focused on assessment of peri- discharge surveillance after colectomy, and also to track, audit and evaluate
operative care. The postoperative quality of life (PQL) assessment is designed safety improvement interventions.
to capture subtle, but significant QoL factors in an easy tool validated for
165
Abstracts
P108
MESENTERIC EMBOLIZATION FOR LOWER GASTROIN-
TESTINAL BLEEDING.
A. Heriot1, C. J. Gillespie1, A. Sutherland1, P. Mossop2, R. Woods1,
J. Keck1, M. Johnston1 and R. Brouwer1 1Department of Colorectal Sur-
gery, St. Vincent’s Hospital, Melbourne, VIC, Australia and 2Department of
Radiology, St. Vincent’s Hospital, Melbourne, VIC, Australia.
Purpose: Mesenteric embolization is an established treatment for lower
gastrointestinal bleeding (LGIB). The aim was to determine the outcome
of angiography and embolization for LGIB and its influencing factors.
Methods: A prospective database of all mesenteric angiograms and
embolizations peformed for LGIB at a tertiary centre between 1998 and 2008
was analysed in combination with chart review. Factors assessed included
outcome, complications, demographics, mortality, morbidity, site and aeti-
Overall, inpatient, and post-discharge outcomes according to Surgical Apgar Score
ology of bleed, and comorbidities.
Results: There were 106 angiograms performed during 82 episodes of
P107 LGIB in 76 patients. Active bleeding was identified in 38 episodes (46%),
with embolizations performed in 36 (44%). Causes of bleeding included vas-
MANAGEMENT OF ANASTOMOTIC LEAK IN COLON AND
cular (31%), diverticular (28%), anastomotic (14%), inflammatory (8%), and
RECTAL SURGERY.
neoplastic (3%). Overall mortality was 8% with 3 deaths from rebleeding
J. Blumetti1, V. Chaudhry1, J. Cintron1, A. Bastawrous1, J. Harrison1, after negative angiograms and 3 due to medical comorbidity. Short-term
S. Marecik2, J. Park2, H. Abcarian3 and L. M. Prasad2 1Surgery, Division complications of angiography were false aneurysm (1) and Enterobacter sep-
of Colon and Rectal Surgery, Stroger Hospital of Cook County, Chicago, IL, sis (1). Long-term complications were groin lymphocele (1) and late rebleed
2
Surgery, Division of Colon and Rectal Surgery, Lutheran General Hospi- from collateralisation (1). In 44 episodes angiography did not demonstrate
tal, Park Ridge, IL and 3Surgery, Division of Colon and Rectal Surgery, Uni- active bleeding. 11 (25%) of these continued to bleed, 7 of which had suc-
versity of Illinois at Chicago, Chicago, IL. cessful surgery without re-attempting angiography. Of the 36 patients who
Purpose: Anastomotic leaks cause significant morbidity & mortality. had embolizations, 27 (75%) were successful after one embolization. 9 patients
Reoperation has been the preferred treatment; however there is a trend (25%) rebled, 6 (17%) of whom required surgery and 2 had re-emboliza-
towards nonoperative management. This study evaluates the management tions. Embolizations were performed in the small bowel (44%), left colon
and outcome of anastomotic leak. (25%), right colon (19%), and at an anastomosis (11%). Of the 3 re-emboliza-
Methods: A retrospective chart review of patients with bowel anasto- tions, 2 developed ischaemic bowel and 1 stopped bleeding, with surgery
moses from 1997 to 2008 was performed. Anastomotic leak was defined as required in one patient.
radiographic finding of leak, abscess near anastomosis, fistula, clinical diag- Conclusions: Mesenteric angiography for LGIB effectively identifies
nosis of anastomotic defect, or confirmation of leak at reoperation. Out- the site of bleeding in 46% and allows embolization in 44%. Embolization
comes of survival and healing (radiographic healing or restoration of GI con- stops bleeding in 75% but repeat embolization is associated with a high rate
tinuity, “GIC”) were evaluated. of complications. A significant percentage of patients with negative
Results: 103 leaks were seen in 1708 anastomoses (6%). Survival was angiograms require surgical intervention.
96% (4 deaths). 28/103 (27%) leaks were managed operatively. 75/103 (73%)
were managed nonoperatively. Survival was significantly greater in the non-
operative vs. operative group (99% vs 89%, p<0.05) Operative management P109
of 17 extraperitoneal (EP) leaks included drainage & diversion (13), Hart- THE DIGITAL RECTAL EXAMINATION SCORING SYSTEM
mann’s procedure (3), or transanal drainage (1). 11 intraperitoneal (IP) leaks (DRESS).
were managed operatively by resection & anastomosis +/- diversion (6), resec- B. A. Orkin, S. B. Sinykin and P. C. Lloyd Division of Colon and Rectal
tion & diversion (4), and diversion & drainage (1). Resection of anastomo- Surgery, George Washington University, Washington, DC.
sis was more common in IP vs. EP leaks (91% vs 17%, p <0.001). Nonop- Purpose: Assessment of anal sphincter tone is a critical part of routine
erative management of 51 EP leaks included antibiotics alone (17), anorectal examinations. Yet, no standardized, quantifiable method for describ-
percutaneous drainage (32), & other (2). 24 IP leaks were managed nonop- ing anal sphincter tone on digital exam (DRE) exists. We developed a novel
eratively with antibiotics (15), drainage (8), & other (1). There was no sig- clinical scoring system for anal sphincter tone using an analog scale of 0 to
nificant difference in restoration of GI continuity between EP and IP leaks. 5 for both resting pressure (RP) and squeeze pressure (SQ). The score ranges
In the EP group, patients with drainage & diversion had 54% GIC vs 0% from 0=no discernable pressure to 5=extremely tight with 3=normal. We
of Hartmann’s. In the nonoperative group, GIC was seen in 48% of EP leaks hypothesized that the DRESS score would correlate with anorectal manom-
with stoma vs. 70% without stoma (p>0.1). etry pressures.
Conclusions: Survival after anastomotic leak is higher than previously Methods: 303 patients (mn age 51; range 28-86)seen between 1998 and
reported. Nonoperative treatment is safe, and was performed in most patients. 2008 who had an exam with a DRESS score and a concurrent manometry
Restoration of GI continuity in nonoperative treatment of EP leaks was inde- test were identified from a prospective database. The means of 4 quadrant
pendent of diversion. Resection was the most common operative treatment manometry values at rest and with maximal squeeze were compared with the
for IP leaks; drainage & diversion without resection was safe for EP leaks RP and SQ DRESS scores at each point from 0 to 5. Boxplots for the manom-
and resulted in more GI continuity than Hartmann’s resection. etry results by DRE score were graphed for visual representation. We per-
formed an ANOVA using a significance level of α=0.05 to test whether each
of the DRESS scores were different from one another. Spearman rank cor-
relation coefficients were calculated to assess the strength of association
between the manometry results and the DRESS score.
166
Abstracts
Results: Manometric pressures (mmHg; Mn+SEM) for DRESS RP val-
ues 0–5 were 20.6±2.1, 38.5±2.0, 47.8±1.6, 72.3±1.5, 94.4±2.9, and 128.0±6.7,
P111
PROSPECTIVE STUDY ON THE TREATMENT OF
respectively. Pressures for DRESS SQ values 0–5 were 45.9±5.6, 66.5±3.2,
INTRACTABLE PRURITUS ANI WITH TRIAMCINOLONE
108.2±4.9, 156.3±4.5, 238.6±9.8, and 368.2±49.1, respectively. The boxplots
demonstrated clear differences between each DRESS score and positive pro- LOCAL INJECTION.
gression from 0 to 5 for both RP and SQ. ANOVA analysis showed a sig- G. S. Kang1, B. S. Kim2, J. H. Kim2 and D. W. Kang2 1Womens Anorec-
nificant difference in mean manometry measurements at all levels of DRE, tal Clinic, Daehanwellness Hospital, Pusan, Korea, South and 2General Sur-
both for RP (P<0.001) and SQ (P<0.001). Spearman rank correlations showed gery, Daehanwellness Hospital, Pusan, Korea, South.
a strong positive correlation between the DRESS values and manometry Purpose: Pruritus Ani is a common presenting problem in colorectal
pressures with coefficients of 0.82 for RP and 0.81 for SQ. practice, which distress patients with embarrassing symptom. Although there
Conclusions: The DRESS score correlated very well with the average are numerous causes and numerous treatments for Pruritus Ani, unfortu-
manometry pressures for RP and SQ. We feel that the DRESS system is a nately the many cases may be refractory to treatment and fall into an idio-
useful quantitative description of anal sphincter RP and SQ in the clinical pathic classification for which no specific treatment exists. We have used
setting. Further validation is planned. We propose the DRESS system become perianal intracutaneous injection of Triamcinolone to treat chronic intractable
a standard part of anorectal examination and documentation. Pruritus Ani and observed full relief of itching sensations. The initial obser-
vations made by Minvielle et al in 1969, but there is no long-term studies.
The following prospective studies were employed to evaluate the long-term
P OSTERS
usefulness of perianl intracutaneous triamcinolone injection for the treat-
ment of intractable Pruritus Ani.
Methods: 100 patients with idiopathic pruritus ani were enrolled over 3
years periode. Patients were treated with perianl intracutaneous triamci-
nolone injection and observed for two years long for the relief of pruritus.
Results: By 95 percents of enrolled patients with idiopathic Pruritus Ani,
has been observed long-term (over two years) relief of pruritus symptoms
with single treatment.
Conclusions: Local injection of Triamcinolone is simple but very effec-
tive methode to treat chronic intractable Pruritus Ani.
P112
P110 LIMBERG FLAP RECONSTRUCTION FOR TREATMENT
SURGICAL DILEMMA OF INTUSSUSCEPTION DIAG- OF RECURRENT PILONIDAL SINUS DISEASE: IS IT TIME
NOSED BY CT SCAN. TO DECLARE VICTORY?
D. M. Hayden, K. Liu, J. A. Myers, C. H. Smith and T. J. Saclarides K. Madbouly and A. Hussein Department of Surgery- Section of Colorectal
General Surgery, Rush University Medical Center, Chicago, IL. Surgery, University of Alexandria, Alex, Egypt.
Purpose: Determine the significance of intussusceptions found by CT. Purpose: Treatment of recurrent pilonidal sinus (RPS) remains a diffi-
Methods: Retrospective review of adult abdominal CT scans with “intus- cult problem in terms of minimizing disease recurrence and patient dis-
susception” in the report. comfort. Secondary wound healing after large excision results in a chronic
Results: Eighty-nine patients had radiographic evidence of intussus- wound that requires cleansing and dressing changes for a long time. The
ception, 27 had surgery, 17 with a preoperative diagnosis of intussusception present study analyses the results of rhomboid excision with Limberg flap
confirmed by operative findings in 7. Three had a cancerous lead point reconstruction (LFR) in the surgical treatment of recurrent sacrococcygeal
(cecum, appendix, ileum). Three had reduced intussusception (edema, necro- pilonidal disease.
sis). One had an intussuscepted enteral tube. For the other 10, there was no Methods: 34 patients (28 Males: 6 Females) with RPS were treated by
evidence of intussusception, however, 3 had cancer, 2 appendicitis, 1 a Peter- rhomboid excision and LFR without drains. Data collected included age, sex,
son’s hernia and 4 had negative explorations. Sixty-two had no surgery, 36 operative (OR) time, operative blood loss (EBL), flap ischemia and/or necro-
(58%) had a follow-up CT, 5 (14%) had persistent intussusception. Three sis, wound infection and/or dehiscence, time to mobilization, length of hos-
had surgery, 2 were treated conservatively with symptom resolution. Of the pital stay (LOS), time of return to work, time till complete healing and recur-
non-operative group, 20 (32%) had persistent symptoms (no significant dif- rence. Patients were assessed at weekly intervals after surgery till complete
ference vs. operative group (r= -0.12, p=0.28)). CT-diagnosed intussuscep- healing and every 6 months thereafter.
tion was clinically significant if: 1) there were obstructive symptoms (r= +0.24, Results: The patients’ mean age was 33.4 ± 3.6 years (range 23-47 years)
p= 0.02); 2) it was present on delayed images (r= +0.524, p=0.001); 3) had and the mean number of previous operations was (3.4± 1.1). OR time ranged
ileocolic location (r= +0.32, p=0.002); 4) had size greater than 3 cm (r=+0.45, from (70 – 110 minutes) with a mean of 85.3 ± 10.4 minutes. Mean EBL was
p=0.001). Large bowel and ileocolic intussusceptions significantly correlated 60 cc. Pain after surgery was minimal. One patient developed sterile seroma
with cancer (p=0.03). CT intussusceptions were likely incidental when found (2.9%) and another patient (2.9%) had purulent discharge. All patients had
for non-abdominal complaints (r=+0.29, p=0.01) and with small bowel loca- satisfactory wound healing and were mobilized immediately after surgery.
tion (r=+0.26, p=0.02). Fifty-eight CT reports described intussusception as Mean LOS was 18.2 ± 1.5 hours (range 8-24 hours). No wound dehiscence,
transient or absent on delayed images. These patients were less likely to pres- flap ischemia, or necrosis was reported. They all returned to normal activ-
ent with abdominal symptoms (r= -0.29, p=0.013) or have recurrent symp- ity within 2 to 7 days (mean 4.9 days). Complete wound healing was achieved
toms (r= -0.26, p=0.03), less likely to undergo surgery (r= -0.50, p=0.001) after 14- 28 days (mean 16.1± 4.3 days). No delayed wound complications
and, if taken to the operating room, they were less likely to have intussus- or recurrences were reported after a mean follow up period of 28.1 months
ception (r= -0.53, p=0.001) or cancer (r= -0.47, p=0.001). (range 3-36 months).
Conclusions: The decision to operate must include consideration of Conclusions: Rhomboid excision and LF is safe, well tolerated and effi-
clinical presentation as well as radiographic findings of intussusception size, cient method for treatment of RPS. This procedure guarantees low mor-
location, and presence on delayed images. bidity, short hospital stay, short time off work, and carries low risk of recur-
rence. However, it is technically demanding and needs long OR time.
167
Abstracts
P113 P115
PERINEAL HIDRADENITIS SUPPURATIVA: IS WIDE EXCI- HISTORY OF HYSTERECTOMY: A SIGNIFICANT PROB-
SION NECESSARY? LEM FOR COLONOSCOPISTS SOLVED BY SIGMOID
R. Hsiung, M. Snyder and H. R. Bailey Division of Colon and Rectal COLECTOMY.
Surgery, University of Texas Health Science Center, Houston, TX. K. A. Garrett and J. M. Church Colorectal Surgery, Cleveland Clinic Foun-
Purpose: This study was conducted to review our results for the treat- dation, Cleveland, OH.
ment of perineal Hidradenitis Suppurativa (HS). Although the literature Purpose: During colonoscopy, it is hard to traverse the sigmoid colon
favors wide excision of all affected tissue, we have managed patients with in patients who have had hysterectomy, presumably due to post-surgical pelvic
minimal to very extensive disease by un-roofing the sinus tracts. adhesions. We performed this study to see if this difficulty is clinically obvi-
Methods: The charts of 32 patients with chronic perineal HS treated ous and whether sigmoid colectomy prevents it.
between August 2000 and May 2008 were reviewed for demographic, treat- Methods: Data was acquired from a single endoscopist’s prospectively
ment, and outcome data. Other evaluated parameters include duration of maintained database. Data examined included history of hysterectomy, sig-
symptoms, associated conditions, post-operative wound care, time to com- moid colectomy, completion rate, medication used during exam and time of
plete healing, and recurrences. examination. Patients with a history of APR were excluded.
Results: The mean age at the time of presentation was 47 (range, 18- Results: From 1989 to 2006, a total of 4116 colonoscopies were per-
74) years and the average duration of symptoms was 7 (range, 0.5-25) years. formed on women. 993 examinations were performed in women who had
Thirty (94%) patients had extensive disease (wound size of greater than 5 undergone hysterectomy (24.1%); 108 of these 993 (10.9%) had undergone
cm). Seventeen (53%) patients had undergone 1 or more incision and drainage sigmoid colectomy. 3123 exams were in woman who had their uterus; 320
procedures and 18 (56%) had received prior antibiotic therapy. Inguinal, axil- (10.2%) of these had undergone sigmoid colectomy. Results of the interac-
lary, and inner thigh involvements were present in 11 (33%), 8 (25%), and tion of sigmoid colectomy and hysterectomy are shown in the table.
5 (11%) patients, respectively. All patients were treated with un-roofing of Conclusions: Post hysterectomy adhesions to the sigmoid colon make
identified sinus tracts. Overhanging skin edges were excised with the elec- colonoscopy more difficult and more painful. These adverse effects are
trocautery to saucerize the wound. No patients required post-operative admis- reversed by sigmoid colectomy.
sion. All wounds were allowed to heal by secondary intention. The average Interaction of sigmoid colectomy and hysterectomy with performance of colonoscopy
healing time was 4 (range, 2-16) weeks. Mean time of follow-up was 6 (range,
0.5-25) months. Incomplete follow-up was found in 8 (25%) patients. Recur-
rence, including new disease in the near vicinity of the treated site, was
observed in 5 (16%) patients. The average time to recurrence was 3 (range,
1-6) months.
Conclusions: Perineal HS is a chronic relapsing disease. While the lit-
erature supports the concept of wide excision, our results support a less aggres-
sive surgical approach. While multiple wounds are created, they are quite
superficial, result in minimal pain, can be managed in an out-patient set-
ting, and heal rapidly without the need for grafting.
P114 P116
BASCOM’S CLEFT CLOSURE IN THE TREATMENT OF INCOMPLETE COLONOSCOPY: RATES, RECOMMENDA-
SACROCOCCYGEAL PILONIDAL DISEASE. TIONS, AND FOLLOW-UP.
J. Evans and N. Cripps St Richards Hospital, Chichester, United Kingdom. M. R. Villalba1, H. J. Wasvary2 and D. C. Barkel2 1General Surgery, William
Purpose: The aim of this study was to determine the recurrence rate Beaumont Hospital, Royal Oak, MI and 2Colon and Rectal Surgery, William
after Bascom’s Cleft Closure for mild to severe pilonidal disease. Pilonidal Beaumont Hospital, Royal Oak, MI.
disease predominantly affects young adults in whom recurrent episodes trans- Purpose: Management of incomplete examinations is evolving as new
late into loss of productive hours and quality of life. There remains no clear technology becomes part of the endoscopist’s armamentarium. While the
consensus in the optimal surgical management of this condition goal of colonic screening is the same for all practioners, variations in prac-
Methods: All patients underwent Cleft Closure by a single surgeon for tice after an incomplete colonoscopy remain individualized. We seek to exam-
pilonidal disease. They were followed up in clinic until healed and con- ine if differences in reason for incomplete exams, suggested follow-up, and
tacted via a telephone and their notes reviewed for evidence of recurrence actual patient follow-up exist between surgeons and gastroenterologists (GI).
or complications. Methods: A retrospective chart review was performed of all adult patients
Results: 67 (57 male) consecutive pilonidal patients age range 14-63 undergoing an incomplete colonoscopy for the year 2006. Endoscopy reports
years. 26 had undergone previous procedures and 50 were day cases. Of 55 and hospital records were reviewed. Data included demographics, endo-
patients followed up for a median of 40 months (range 1-80) only 1 needed scopist, anatomic distance reached, reason for incomplete exam, recom-
a formal revisional procedure (<1%) although 3 wound complications needed mended follow-up, actual patient follow-up, and pathology revealed on fol-
further surgical treatment with eventual healing. low-up.
Conclusions: Bascom’s Cleft Closure is a definitive and effective treat- Results: A total of 12,974 colonoscopies were performed during the study
ment for pilonidal disease of all severities. It can be undertaken in the day period with 350(2.7%) incomplete exams. GI performed 6,205 exams with
surgery unit in the vast majority of cases. Compared with other techniques 227(3.7%) incomplete vs. 6,769 exams by surgeons with 123(1.8%) incom-
it has extremely low recurrence rates (<1%) and few complications. plete; p <0.001. Reported reasons for incomplete exams, quality of prep for
GI and pathologic findings for surgeons, did differ between groups; p= 0.012.
Anatomic distance reached and recommendations for follow-up did not show
significant differences between the groups, however, actual patient follow-
up did differ; p= 0.036. Of the 350 patients, 155(44%) did not have any iden-
tifiable follow-up for their incomplete exam. Eighty patients(23%) under-
168
Abstracts
went repeat colonoscopy, 79 patients(23%) underwent either barium MRI of the anorectum and pelvis (unless contraindicated), colonoscopy and
enema(BE) or virtual colography(VC), and 34 patients(10%) went to sur- 20 MHz HFUS (Olympus Keymed UM-3R, Japan). Depth of invasion (T
gery. Significant pathology was found in 39/159(25%) patients undergoing stage) of the lesion by MRI and 20 MHz ultrasound were compared with
follow-up investigations. Repeat colonoscopy revealed pathology in final histology. Statistical differences were analysed using chi squared and
29/80(36%) patients, with VC being positive in 6/23(26%) while only Fisher’s exact t test using Graphpad Prism 5.
4/56(7%) BE revealed a new finding. Results: 19 patients were studied, mean age 69.5 years (range 27-89).
Conclusions: This series shows that surgeons are more likely to com- Mean distance of the tumour from the anal verge was 10 cm +/- 3 (SE 0.7,
plete a colonoscopy than GI. Incomplete exams are more likely prep related range 5-15cm). The tumours occupied 10-50% of the rectal circumference
for GI and pathologic for surgery. While recommendations following incom- with a mean of 30.1% +/- 15 (SE 3.4). Histological assessment revealed 11
plete exams do not differ, variation seen in actual follow-up is attributable benign lesions with dysplasia (5 high grade, 6 low grade) and 8 adenocarci-
to each group’s bias. Importance must be placed on follow-up studies, where nomas (7 T1 with 3 mucosal and 4 submucosal cancers, 1 T3). 16/19 (84%)
as many as 25% will reveal missed pathology. patients had clear histological resection margins MRI did not discriminate
between mucosal and submucosal lesions and these were grouped together
for analysis. Therefore 18 patients had lesions superficial to muscularis pro-
P117 pria (MP) (11 benign and 7 malignant). 4 patients did not have pre-opera-
SAVING THE COLON: ALWAYS LOOK BEFORE YOU LAP. tive MRI including the patient with histological T3 stage. For lesions super-
K. A. Garrett and J. M. Church Colorectal Surgery, Cleveland Clinic Foun- ficial to MP (T0/T1), MRI correctly staged 5/15 lesions (33%), overstaging
P OSTERS
dation, Cleveland, OH. 10 patients (67%): 6 as T2 lesions and 4 as T3. 20 MHz US was superior to
Purpose: Despite the popularization of minimally invasive surgery, colon MRI for lesions superficial to MP (p=0.002). The accuracy of 20 MHz US
resection is a major procedure with mortality, morbidity and functional seque- for assessing depth of lesion was 95% (18/19 correctly identified). In addi-
lae. Because of easier access to laparoscopic techniques more benign polyps tion, 20 MHz US differentiated between mucosal and submucosal lesions
are being referred for resection. This study was done to draw attention to with a sensitivity of 93%, specificity of 75% giving a positive predictive value
the role of expert colonoscopic polypectomy in minimizing surgery for these 93% and a likelihood ratio of 3.7.
patients Conclusions: 20 MHz mini probe ultrasonography is superior to the
Methods: A prospectively maintained polyp database recorded the details conventionally used MRI for the assessment of T1 lesions with high sensi-
of all patients referred for surgery for an apparently benign polyp. The pri- tivity in differentiation between mucosal and submucosal lesions. This may
mary end point was the type of treatment received. Secondary endpoints become an essential adjunct for assessment of patients undergoing TEMS.
were the properties of the polyps and the outcome of the polypectomy.
Results: From 1989 to 2008, 94 patients (56 male, 38 female) were
referred to one colorectal surgeon for formal resection of a colorectal polyp.
P119
TO CLOSE OR NOT TO CLOSE THE SURGICAL DEFECT
Each patient underwent repeat colonoscopy and 78 (83%) of the polyps were
AFTER TRANSANAL ENDOSCOPIC MICROSURGERY?
able to be removed endoscopically. Four patients in this group underwent
resection for unfavorable cancer in the polyp, consequently 74 (78.7%) J. S. Chun, M. Mutch, A. Lin and S. Hunt Section of Colon-Rectal Sur-
patients had their polyps treated purely endoscopically. Reasons for failure gery, Washington University School of Medicine, St. Louis, MO.
of endoscopic treatment included polyp shape (4), position (6), size (2) and Purpose: Traditional dogma dictates that the surgical defect should be
difficulty with intubation (4). 7 patients had complications after polypectomy closed following transanal endoscopic microsurgery (TEM). However, this
(6 hemorrhage and one post polypectomy syndrome). No patients needed can be difficult and time-consuming. The purpose of this study was to deter-
surgery for a complication. There were 4 polyps 10mm in diameter or less, mine any difference in short-term outcomes between patients whose defects
12 less than 20 mm in diameter and 15 less than 30mm. Median size was were closed primarily, and those whose defects were left to heal by second-
35mm (range 6 to 80). 63 polyps were proximal to the splenic flexure. 30 ary intention when the peritoneal cavity was not violated.
(32%) polypectomies were done in the operating room and 44 in the office. Methods: A retrospective review of all TEM cases from 2005 to 2008
There were 19 tubular adenomas, 55 tubulovillous adenomas, 5 villous ade- was performed. Factors reviewed include closure of the surgical defect, oper-
nomas, 2 serrated polyps and 8 cancers (1 lymphoma). At first follow up ating time, complications, length of stay, and re-admissions. Patients who
(median 7 months), 19/53 (36%) polyps persisted. At second follow up only underwent submucosal excision or whose peritoneal cavities were violated
13% of polyps persisted and at third follow-up this was 4%. were excluded. Fisher’s Exact Test and the Wilcoxon Two-Sample Test were
Conclusions: Colonoscopic polypectomy provides safe, effective treat- used for analysis.
ment of the majority of colorectal polyps sent for resection. Surgeons should Results: 62 TEM cases were included in the analysis. 44 of the surgical
always rescope such patients before making an incision. defects were closed while 18 were left open. All patients whose defects were
left open received at least 24 hours of intravenous antibiotics and 5-7 days
of oral antibiotics. Patients whose defects were closed received at least 24
P118 hours of antibiotics, but were frequently discharged without oral antibi-
20 MHZ HIGH FREQUENCY MINI PROBE ULTRASOUND otics. 73% of the patients were male and 27% female (mean age 63.9 years,
(HFUS) AS AN AIDE TO TRANSANAL ENDOSCOPIC range 50-83 years). 82% of females’ defects were closed while 67% of males’
MICROSURGERY (TEMS) – COMPARISON WITH MAG- defects were closed (P=0.32). The mean OR time was 107 minutes when the
NETIC RESONANCE IMAGING (MRI). defect was closed and 82 minutes when left open (P=0.03). The overall com-
A. Haji1, S. M. Ryan3, I. Bjarnason2 and S. Papagrigoriadis1 1Colorectal plication rate was 11% when the defect was left open and 23% when closed
Surgery, Kings College Hospital, London, United Kingdom, 2Gastroen- (P=0.48). The re-admission rate when defects were left open was 11% and
terology, Kings College Hospital, London, United Kingdom and 3Radiol- 13.6% when defects were closed (P=1.0). Average length of stay was 1.8
ogy, Kings College Hospital, London, United Kingdom. days when left open and 1.9 days when closed (P=0.10).
Conclusions: After a full-thickness excision by TEM in which the peri-
Purpose: This study compares the local staging of MRI and 20 MHz
toneal cavity was not violated, leaving the defect open results in a signifi-
HFUS of consecutive patients deemed suitable for the TEMS procedure.
cantly shorter operating time than closing the defect, without increasing
Methods: Inclusion criteria included all rectal tumours below the peri-
complications, re-admissions, or length of stay. These results suggest that
toneal reflection with benign disease on endoscopic biopsy. All patients had
169
Abstracts
leaving the defect open may allow for improved efficiency in the OR with- movement of the arms was synchronized with that of the camera. Collisions
out compromising the patient’s outcomes. occurred when the arms deviated laterally in opposite directions, and when
the arms were moved together to one side without moving the camera to fol-
low. Although the movements were restricted compared to other procedures,
P120 there was still enough room to perform the excision and close the defect,
TRANSANAL ENDOSCOPIC ROBOTIC MICROSURGERY: including defects located on either lateral wall or the superior most wall.
FEASIBILITY IN A MODEL. Conclusions: Successful use of the Da Vinci robot in transanal excision
J. Blumetti1, S. Marecik2, M. Singer1, H. Abcarian1 and L. M. Prasad2 has been demonstrated on this simplified inanimate model. A flexible
1
Surgery, Division of Colon and Rectal Surgery, University of Illinois at anoscope which can hold insufflation is crucial if this technique is to be suc-
Chicago, Chicago, IL and 2Surgery, Division of Colon and Rectal Surgery, cessful in vivo. Further studies on an animal model will be performed prior
Lutheran General Hospital, Park Ridge, IL. to adapting this technique to a clinical setting.
Purpose: Transanal endoscopic microsurgery (TEM) is an established
tool for the removal of rectal tumors and polyps. It is limited by a steep learn-
ing curve and limited mobility of the instruments within the anal canal and
rectum. The Da Vinci robot has the potential to decrease the learning curve
and allow for technical improvements in transanal surgical techniques. The
use of the robot in transanal surgery has not yet been studied, and prior to
the use of this new technique, the feasibility of such a procedure needs to be
established.
Methods: A model was created to simulate the anus and rectum. A self
retaining flexible retractor was then used to dilate the anus to 3.5 cm. The
Da Vinci S system was then utilized with a camera arm and two working
arms. A 30 degree camera was placed at the “anal verge” superiorly. Two
working arms, one equipped with a grasper, and the other with a snap-fit
instrument with knife blade were placed at a level inferior and lateral to the
camera. See photo. A point 10 cm from the “anal verge” was chosen for dis-
section. A 3 cm full thickness excision was performed in the “rectum”. The
working instruments were then replaced with two needle drivers, and the
defect was closed with interrupted absorbable suture.
Results: The excision and closure was performed successfully by two
Da Vinci robot setup for transanal endoscopic robotic microsurgery
separate surgeons on the inferior, superior, and lateral walls of the rectal
model. In order to prevent collisions within the small working space, the
170
Featured Lecturers and Faculty
Maher A. Abbas, MD, FACS, Robin Boushey, BSc, MD, PhD, James Church, MBChB, FRACS Paula Erwin-Toth, MSN, RN,
FASCRS CIP, FRCSC Director, Sanford R. Weiss Center for ET, CWOCN, CNS
Asst. Professor of Surgery, UCLA, Asst. Professor of Surgery, Clinical Hereditary Colorectal Neoplasia, Victor Director, WOC/ET Nursing
Chief, Colon & Rectal Surgery, Chair, Investigator at the, Ottawa Health Fazio Chair in Colorectal Surgery, Education, Cleveland Clinic, Cleveland,
Center for Minimally Invasive Surgery, Research Institute in the Cancer Centre Digestive Diseases Institute, Cleveland OH
Kaiser Permanente Los Angeles Program, Director of Research in the Clinic Foundation, Cleveland, OH
Medical Center, Los Angeles, CA Division of General Surgery, University Chris Feudtner, MD, PhD, MPH
of Ottawa, The Ottawa Hospital – Philip A. Cole, MD, FACS, Director, Dept. of Medical Ethics,
Herand Abcarian, MD General Campus, Ottawa, ON, Canada FASCRS Steven D. Handler Endowed Chair in
Professor of Surgery, University of Whitney Boggs, MD, Professor of Medical Ethics, Director of Research &
Illinois-Chicago, Chicago, IL Marc I. Brand, MD, FACS Surgery, Chief, Div. of Colon & Rectal Attending Physician PACT (Palliative
Asst. Professor of Surgery, Rush Medical Surgery, Louisiana State University Care Team) & Integrated Care Service
Karim Alavi, MD, FACS, College, Section of Colon & Rectal Health Science Center, Shreveport, LA (ICS), General Pediatrics, Children’s
FASCRS Surgery, Rush University Medical Hospital of Philadelphia, Philadelphia,
Asst. Professor of Surgery, Assoc. Center, Chicago, IL Donald Colvin, MD PA
Program Director in General Surgery, Chief of Colorectal Surgery Section,
Dept. of Surgery, University of Gina Brown, MBBS, MD, MRCP, INOVA Fairfax Hospital, Partner, Alessandro Fichera, MD, FACS,
Massachusetts Memorial Medical FRCR Fairfax Colon and Rectal Surgeons, FASCRS
Center, Worcester, MA Consultant Radiologist, Dept. of Fairfax, VA Asst. Professor, Program Director
Radiology, Royal Marsden Hospital, Colon and Rectal Surgery Training
Farshid Araghizadeh, MD, FACS, Sutton, Surrey, UK Gregory S. Cooper, MD Program, Dept. of Surgery - University
FASCRS Professor of Medicine & Oncology, of Chicago Medical Center, Chicago, IL
Assoc. Professor of Surgery, Chief, W. Donald Buie, MD, MSc, Case Western Reserve University
Section of Colorectal Surgery, FRCSC School of Medicine, University Charles Finne, MD
University of Texas Southwestern Assoc. Professor of Surgery & Hospitals, Case Medical Center, Adjunct Professor, Div. of Colon &
Medical Center, Dallas, TX Oncology, Dept. of Surgery, University Cleveland, OH Rectal Surgery, University of
of Calgary, Calgary, AB, Canada Minnesota, Minneapolis, MN
H. Randolph Bailey, MD Bradley R. Davis, MD, FACS
Clinical Professor, Dept. of Surgery, Kelli Bullard Dunn, MD, FACS, Asst. Professor of Surgery, University of James Fleshman, MD
Chief, Div. of Colon & Rectal Surgery, FASCRS Cincinnati, Div. of Colon & Rectal Professor of Surgery, Chief, Section of
University of Texas Health Science Assoc. Professor of Surgery, Roswell Surgery, Cincinnati, OH Colon & Rectal Surgery, Washington
F A C U LT Y
Center Houston, Houston, TX Park Cancer Institute and The University School of Medicine, St.
University at Buffalo/SUNY, Conor P. Delaney, MD, MCh, Louis, MO
Tim Baker Buffalo, NY PhD, FRCSI, FACS
Senior Vice President, Speaker Professor of Surgery, Case Western Eugene Foley, MD
Training Expert, Fleishman-Hillard, Peter Cataldo, MD Reserve University, Chief, Div. of Professor of Surgery, University of
Cleveland, OH Assoc. Professor of Surgery, University Colorectal Surgery, Vice-Chairman, Wisconsin, Madison, WI
of Vermont, College of Medicine, Dept. of Surgery, Director, Institute for
Christine Bartus, MD, FASCRS Burlington, VT Surgery and Innovation, University Lachlan Forrow, MD
Asst. Professor of Surgery, University of Hospitals, Case Medical Center, Beth Israel Deaconess Medical Center,
Connecticut, New Britain, CT Megan M. Cavanaugh, MD, Cleveland, OH Assoc. Professor, Medicine, Harvard
FACS, FASCRS Medical School, Boston, MA
Nancy Baxter, MD, PhD, Asst. Clinical Professor, Oregon Health Joshua Dorsey, MHA
FRCSC, FASCRS and Science University, Colon & Rectal Administrator, Digestive Disease Morris Franklin, MD
Assoc. Professor of Surgery, St. Clinic, Surgical Specialty Group, PC, Institute, Dept. of Colon & Rectal Director, Texas Endosurgery Institute,
Michael’s Hospital, Toronto, ON, Portland, OR Surgery, Cleveland Clinic, San Antonio. TX
Canada Cleveland, OH
Bradley J. Champagne, MD Gerald M. Fried, MD
David Beck, MD Asst. Professor of Surgery, Case Nadav Dujovny, MD Professor of Surgery & Adair Chair of
Chairman, Dept. of Colon & Rectal Western Reserve University, Div. of Ferguson Clinic, Dept. of Colorectal Surgical Education, McGill University,
Surgery, Ochsner Clinic Foundation, Colorectal Surgery, Program Director Surgery, Grand Rapids, MI Steinberg-Bernstein Chair of Minimally
New Orleans, LA Laparoscopic Colorectal Fellowship, Invasive Surgery & Innovation, McGill
University Hospitals, Case Medical Brian Dunkin, MD University Health Centre, Montreal,
Mariana Berho, MD Center, Cleveland, OH Head, Section of Endoscopic Surgery, QC, Canada
Division Chairman, Laboratory The Methodist Hospital, Houston, TX
Medicine, Cleveland Clinic Florida, George J. Chang, MD, MS, Robert Fry, MD
Weston, FL FACS, FASCRS Gary Dunn, MD Emilie & Roland deHellebranth
Asst. Professor of Surgery, Dept. of Clinical Assoc. Professor of Surgery, Professor of Surgery, Chairman, Dept.
Richard Billingham, MD Surgical Oncology, Colon & Rectal Louisiana State University Health of Surgery, Pennsylvania Hospital,
Clinical Professor, Dept. of Surgery, Surgery, U.T. M.D. Anderson Cancer Sciences Center-Shreveport, Chief, Div. of Colon & Rectal Surgery,
University of Washington, Seattle, WA Center, Houston, TX Shreveport, LA UPHS, Philadelphia, PA
Heidi Chua, MD Jonathan Efron, MD

Asst. Professor of Surgery, Mayo Clinic Assoc. Professor of Surgery, Mayo
College of Medicine, Rochester, MN Medical School, Phoenix, AZ
171
Sharon Gregorcyk, MD, FACS, Daniel Herzig, MD Matthew Kalady, MD Edward Lee, MD
FASCRS Asst. Professor of Surgery, Assoc. Cleveland Clinic Foundation, Dept. of Assoc. Professor of Surgery, Chief,
Colon & Rectal Surgeon, Medical City Residency Program Director, Oregon Colorectal Surgery, Cleveland, OH Section of GI/Surgical Oncology, Vice
Dallas, Dallas, TX Health & Science University, Chairman, Dept. of Surgery, Albany
Portland, OR Jennifer L. Kemp, MD Medical College, Albany, NY
José Guillem, MD Vice Chair, Rose Radiology, Diversified
Director, Familial Colorectal Cancer Steve Heymen, PhD Radiology of Colorado, PC, Chief of Sang W. Lee, MD
Registry, Dept. of Surgery, Memorial Asst. Professor in Medicine, Director of Ultrasound & Pelvic Imaging Divs., Asst. Professor of Surgery, Div. of Colon
Sloan Kettering Cancer Center, Biofeedback Services, Center for Denver, CO & Rectal Surgery, NY Presbyterian
Professor of Surgery, Cornell University Functional GI Motility Disorders, Hospital, Weill-Cornell Medical
Medical College, New York, NY University of North Carolina, Chapel Seon-Hahn Kim, MD College, New York, NY
Hill, NC Head of Colorectal Div. & Professor of
Brooke H. Gurland, MD Dept. of Surgery, Director of Robotic & Erin Reilly Lewis, Counsel
Dept. of Colorectal Surgery, Cleveland Terry Hicks, MD MIS Center, Korea University Anam Baker & Daniels, Indianapolis, IN
Clinic, Cleveland, OH Assoc. Chairman, Dept. of Colon & Hospital, Seoul, South Korea
Rectal Surgery, Oschner Clinic, New Charles Littlejohn, MD
Angelita Habr-Gama, MD Orleans, LA Clifford Y. Ko, MD, MS, MSHS Colon & Rectal Surgeons of Southern
Professor of Surgery, University of Sao FACS, FASCRS Connecticut, LLC, Stamford, CT
Paulo School of Medicine, Sao Paulo, Rebecca Hoedema, MD Robert and Kelly Day Chair of Surgery,
Brazil Clinical Asst. Professor, MSU College Professor of Surgery & Health Services, Ann Lowry, MD
of Human Medicine, Ferguson Clinic, UCLA School of Medicine, Los Clinical Professor of Surgery, University
Sara Hallam, RN, BSN, CWOCN Dept. of Colorectal Surgery, Grand Angeles, CA, Director, Div. of Research of Minnesota, Div. of Colorectal
Dept. of Colon & Rectal Surgery, Rapids, MI & Optimal Patient Care, American Surgery, Minneapolis, MN
Cleveland Clinic, Cleveland, OH College of Surgeons
Kyle Holen, MD Armand R. Lucas, MD
Kerry L. Hammond, MD Assoc. Professor, Director, Medical Ira J. Kodner, MD Staff, Dept. of Plastic Surgery,
Asst. Professor, Div. of GI & Oncology Fellowship, University of Solon and Bettie Gershman Professor, Cleveland Clinic, Cleveland, OH
Laparoscopic Surgery, Medical Wisconsin School of Medicine & Public Section of Colon & Rectal Surgery,
University of South Carolina, Health, Madison, WI Director Center for Study of Ethics & Martin Luchtefeld, MD
Charleston, SC Human Values, Washington University Clinical Asst. Professor, MSU College
Torbjörn Holm, MD, PhD in St. Louis, St. Louis, MO of Human Medicine, Ferguson Clinic-
Professor R. J. Heald, OBE, Assoc. Professor of Surgery, Section of Michigan Medical PC, Spectrum
MChir, FRCS Coloproctology, Karolinska University Smitha S. Krishnamurthi, MD Health, Grand Rapids, MI
Pelican Cancer Foundation, The Ark, Hospital, Stockholm, Sweden Asst. Professor, Div. of Hematology/
Basingstoke & North Hampshire NHS Oncology, Dept. of Medicine, Case Kirk Ludwig, MD, FACS,
Foundation Trust, Basingstoke, Jon S. Hourigan, MD Western Reserve University/University FASCRS
Hampshire, UK Asst. Professor of Surgery, Section of Hospitals Case Medical Center, Assoc. Professor of Surgery, Medical
Colon & Rectal Surgery, Div. of General Director, Clinical Trials Unit, Case College of Wisconsin, Dept. of Surgery,
Charles Heise, MD, FACS, Surgery, University of Kentucky Comprehensive Cancer Center, Milwaukee, WI
FASCRS Medical Center, Lexington, KY Cleveland, OH
Assoc. Professor of Surgery, University Helen MacRae, MD
of Wisconsin School of Medicine & Emina Huang, MD Alex Jenny Ky, MD, FACS, Assoc. Professor of Surgery, University
Public Health, Dept. of Surgery, Section University of Florida, Gainesville, FL FASCRS of Toronto, DH Gales Director of
of Colon & Rectal Surgery, Asst. Professor, Dept. of Surgery, Mount Surgical Skills Center, Toronto, ON,
Madison, WI Steven R. Hunt, MD Sinai Hospital, New York, NY Canada
Asst. Professor, Surgery, Div. of General
Michael Hellinger, MD, FACS, Surgery, Section of Colorectal Surgery, Antonio M. Lacy, MD, PhD Najjia N. Mahmoud, MD
FASCRS Washington University School of Professor of Surgery, University of Asst. Professor of Surgery, University of
Colon & Rectal Surgery, Dept. of Medicine, St. Louis, MO Barcelona, Faculty of Medicine, Chief of Pennsylvania Health System,
Surgery, Mount Sinai Medical Center, Gastrointestinal Surgery, Hospital Philadelphia, PA
Miami Beach, FL Neil Hyman, MD Clinic of Barcelona, Barcelona, Spain
Professor of Surgery, Chief, Div. of Floriano Marchetti, MD
Alan J. Herline, MD General Surgery, University of Vermont David W. Larson, MD Asst. Professor of Clinical Surgery,
Vanderbilt University Medical Center, College of Medicine, Burlington, VT Asst. Professor of Surgery, Mayo Clinic, Program Director, Colon & Rectal
Assoc. Professor of Surgery/Biomedical Dept. of Surgery, Div. Colon & Rectal Surgery, Miller School of Medicine,
Engineering, Colon & Rectal Surgery, David Jayne, MB BCh MD FRCS Surgery, Rochester, MN University of Miami/Jackson Memorial
Nashville, TN Senior Lecturer in Surgery, University Hospital, Miami, FL
of Leeds & Leeds Teaching Hospitals Soren Laurberg, MD
Alexander Heriot, MD NHS Trust, Leeds, UK Professor of Colorectal Surgery, Aarhus Slawomir J. Marecik, MD
Peter MacCallum Cancer Center, Dept. University Hospital, Aarhus, Denmark Asst. Clinical Professor of Surgery,
of Surgical Oncology, Melbourne, VIC, Andreas M. Kaiser, MD, FACS University of Illinois at Chicago,
Australia Assoc. Professor of Clinical Colorectal Brandie Leach, MS, CGC Attending Physician, Advocate
Surgery, Interim Chairman, USC Dept. Genetic Counselor, Center for Lutheran General Hospital, Park
of Colorectal Surgery, Keck School of Personalized Genetic Healthcare, Ridge, IL
Medicine, University of Southern Cleveland Clinic, Cleveland, OH
California, Los Angeles, CA
172
David A. Margolin, MD, FACS, Thomas J. Nasca, MD, MACP Leela M. Prasad, MD, FRCS(C), Patricia Roberts, MD
FASCRS Chief Executive Officer, Accreditation FRCS(E), FACS, FASCRS Chair, Dept. of Colon & Rectal Surgery,
Director, Colon & Rectal Surgical Council for Graduate Medical Vice Chairman, Dept. of Surgery, Lahey Clinic, Burlington, MA,
Research, The Ochsner Clinic Education, Chicago, IL, Professor of Clinical Professor of Surgery, University Professor of Surgery, Tufts University
Foundation, New Orleans, LA Medicine, Jefferson Medical College, of Illinois School of Medicine at School of Medicine, Boston, MA
Philadelphia, PA Chicago, Chicago, IL
Jeffrey M. Marks, MD, FACS Howard Ross, MD, FACS,
Assoc. Professor, Dept. of Surgery, Paul Neary, MD, FRCSI Janice F. Rafferty, MD FASCRS
Director of Surgical Endoscopy, Consultant Colorectal Surgeon, Div. of Professor of Surgery, Chief, Div. of Director, Crohn’s & Colitis
University Hospitals, Case Medical Colorectal Surgery, Adelaide and Meath Colon & Rectal Surgery, University of Management Center, Director,
Center, Cleveland, OH Hospital, Incorporating the National Cincinnati College of Medicine, Minimally Invasive Surgery, Riverview
Children’s Hospital, Dublin, Ireland Cincinnati, OH Medical Center, Red Bank, NJ
John H. Marks, MD, FACS,
FASCRS Heidi Nelson, MD Sonia Ramamoorthy, MD Vicki Rumpler, RN, BSN
Chief, Section Colorectal Surgery, Fred C. Andersen Professor, Professor Asst. Professor of Surgery, Div. of Digestive Disease Institute, Dept. of
Director, Minimally Invasive Colorectal of Surgery, Mayo Clinic College of Surgical Oncology, UC San Diego Colon & Rectal Surgery, Cleveland
Surgery & Advanced Rectal Cancer Medicine, Rochester, MN Medical Center, San Diego, CA, Asst. Clinic, Cleveland, OH
Management Fellowship, Professor, Professor of Surgery, Colon & Rectal
Lankenau Institute for Medical Vincent J. Obias, MD Surgery, UCSD Medical Center/ Theodore Saclarides, MD, FACS,
Research, Lankenau Hospital, Asst. Professor of Surgery, Div. of Moores Cancer Center, La Jolla, CA FASCRS
Wynnewood, PA Colorectal Surgery, The George Professor of Surgery, Rush Medical
Washington University, Satish S. Rao, MD College, Head, Section of Colon &
David Maron, MD Washington, DC Professor, Director, Rectal Surgery, Rush University
Asst. Professor of Surgery, Div. of Colon Neurogastroenterology & GI Motility, Medical Center, Chicago, IL
& Rectal Surgery, University of Kevin W. Olden, MD University of Iowa Health Care, Iowa
Pennsylvania, Philadelphia, PA Division Director, Jerome S. Levy City, IA Dana R. Sands, MD, FACS,
Professor of Medicine, University of FASCRS
M. Shane McNevin, MD Arkansas for Medical Sciences, Little Thomas E. Read, MD Staff Surgeon, Dept. of Colorectal
Surgical Specialists of Spokane, Rock, AR Dept. of Colon & Rectal Surgery, Lahey Surgery, Cleveland Clinic Florida,
Director, Providence Continence Clinic Medical Center, Burlington, MA Weston, FL
Center, Spokane, WA Guy R. Orangio, MD
F A C U LT Y
Georgia Colon & Rectal Surgical Feza H. Remzi, MD, FASCRS David J. Schoetz, Jr., MD
Anders Mellgren, MD, PhD Associates, Atlanta, GA Chairman, Dept. of Colorectal Tufts School of Medicine Academic
Director, Pelvic Floor Center, Colon & Surgery, Ed & Joey Story Chair in Dean at Lahey Clinic, Chairman
Rectal Surgery Associates, University of Bruce A. Orkin, MD Colorectal Surgery, Cleveland Clinic, Emeritus, Department of Colon &
Minnesota, Minneapolis, MN Professor of Surgery, Director, Div. of Cleveland, OH Rectal Surgery, Professor of Surgery,
Colorectal Surgery, The George Tufts University School of Medicine,
James I. Merlino, MD, FACS, Washington University, Andrew Renehan, PhD, FRCS, Lahey Clinic, Burlington, MA
FASCRS Washington, DC FDS
Dept. of Colorectal Surgery, Cleveland HEFCE Senior Lecturer in Cancer Anthony J. Senagore, MD, MS,
Clinic, Cleveland, OH Benjamin Perakath, MS FRCS(G) Studies & Surgery, Honorary MBA, FACS, FASCRS
Dept. of Surgery Unit 5 (General & Consultant, University of Manchester, Vice President, Research & Medical
Dan Metcalf, MD Colorectal Surgery), Christian Medical Christie Hospital NHS Foundation Education, Spectrum Health, Professor
Duluth Clinic, Duluth, MN College, Vellore, Tamil Nadu, India Trust, Manchester, UK of Surgery, Michigan State University/
CHM, Grand Rapids, MI
Bruce Minsky, MD Perry J. Pickhardt, MD Harry Reynolds, Jr., MD, FACS,
Assoc. Dean and Professor of Radiation Assoc. Professor of Radiology, FASCRS Elin R. Sigurdson, MD, PhD
& Cellular Oncology, Chief Quality Abdominal Imaging Section, University Div of Colorectal Surgery, Asst. Program Director, Fox Chase Cancer
Officer, University of Chicago Medical of Wisconsin School of Medicine & Professor of Surgery, University Center, Philadelphia, PA
Center, Chicago, IL Public Health, Madison, WI Hospitals, Case Medical Center,
Cleveland, OH Mika N. Sinanan, MD, PhD
Arden Morris, MD James J. Pomposelli, MD, PhD, Professor of Surgery, Dept. of Surgery,
Asst. Professor, Colon & Rectal Surgery, FACS Rocco Ricciardi, MD, MPH University of Washington, Seattle, WA
University of Michigan Medical School, Assoc. Professor of Surgery, Tufts Dept. of Colon & Rectal Surgery,
Ann Arbor, MI Medical School, Director, Renal Lahey Clinic, Burlington, MA, Asst. Bradford Sklow, MD
Transplantation, Div. of Hepatobiliary Professor of Surgery, Tufts University, Colon & Rectal Surgery, University of
Matthew Mutch, MD Surgery & Transplantation, Lahey Boston, MA Utah, Huntsman Cancer Center, Salt
Assoc. Professor of Surgery, Section of Clinic Medical Center, Burlington, MA Lake City, UT
Colon & Rectal Surgery, Washington David E. Rivadeneira, MD,
University School of Medicine, St. Lisa Poritz, MD FACS, FASCRS Toyooki Sonoda, MD
Louis, MO Assoc. Professor of Surgery, Section of St. Catherine of Siena Medical Center, Asst. Professor of Surgery, Weill Cornell
Colorectal Surgery, Penn State Smithtown, NY Medical College, New York, NY
Deborah Nagle, MD University, Milton S. Hershey Medical
Chief, Section of Colon & Rectal Center, Hershey, PA
Surgery, Beth Israel-Deaconess Medical
Center, Boston, MA
173
Michael P. Spencer, MD Shawn Tsuda, MD Martin R. Weiser, MD Charles B. Whitlow, MD
Colon & Rectal Surgery Assocs., Ltd., Asst. Professor, Dept. of Surgery, Assoc. Attending Surgeon, Memorial Program Director, Colon & Rectal
Adjunct Assoc. Professor of Surgery, University of Nevada School of Sloan Kettering Cancer Center, Surgery Dept., Ochsner Clinic
University of Minnesota, Minneapolis, Medicine, Las Vegas, NV Associate Professor of Surgery, Weill Foundation, New Orleans, LA
MN Cornell Medical Center, New York, NY
Kelly Tyler, MD Kirsten Bass Wilkins, MD
Michael J. Stamos, MD Asst. Professor of Surgery, Tufts Eric Weiss, MD Clinical Asst. Professor of Surgery,
Professor of Surgery, Chief, Div. of University School of Medicine, Residency Program Director, Director, UMDNJ-Robert Wood Johnson
Colon & Rectal Surgery, Vice Chair, Springfield, MA Surgical Endoscopy, Vice Chairman, Medical School, New Brunswick, NJ
Dept. of Surgery, University of Dept. of Colorectal Surgery, Cleveland
California, Irvine School of Medicine, H. David Vargas, MD, FACS, Clinic Florida, Weston, FL Paul E. Wise, MD
Orange, CA FASCRS Asst. Professor of Surgery, Colon &
Assoc. Professor of Surgery, Head, Kevin B. Weiss, MD, MPH Rectal Surgery, Vanderbilt University
Scott R. Steele, MD Section of Colon & Rectal Surgery, President and CEO, American Board of Medical Center, Nashville, TN
Asst. Professor of Surgery, Uniformed University of Kentucky Chandler Medical Specialties, Evanston, IL
Services University, Madigan Army Medical Center, Lexington, KY W. Douglas Wong, MD, FACS
Medical Center, Tacoma, WA Mark L. Welton, MD, FACS, Chief, Colorectal Service, Memorial
Madhulika G. Varma, MD FASCRS Sloan-Kettering Cancer Center,
Sharon L. Stein, MD Chief, Section of Colorectal Surgery, Interim Medical Director, Clinical Professor of Surgery, Cornell University
Asst. Professor of Surgery, Section of Dept. of Surgery, University of Cancer Center, Professor and Chief, Medical College, New York, NY
Colon & Rectal Surgery, Weill Cornell California, San Francisco, San Colon & Rectal Surgery, Dept. of
Medical Center, New York, NY Francisco, CA Surgery, Stanford University, School of James Wu, MD, PhD
Medicine, Stanford, CA Cleveland Clinic Foundation, Dept.
Jonah Stulberg, MPH Paul Vignati, MD, FACS, of Colon & Rectal Surgery,
MD/PhD Candidate in Health Services FASCRS Steven D. Wexner, MD, FACS, Beachwood, OH
Research, Case Western Reserve Asst. Clinical Professor of Surgery, FRCS, FRCS(Ed)
University School of Medicine, University of Connecticut Surgical Chief Academic Officer, Emeritus Chief Tonia Young-Fadok, MD, MS
Research Fellow, Div. of Colorectal Residency, Hartford, CT of Staff (1997-2007), Chairman, Chair, Div. of Colon & Rectal Surgery,
Surgery, University Hospitals, Case Department of Colorectal Surgery, Mayo Clinic, Professor of Surgery,
Medical Center, Cleveland, OH Jon Vogel, MD Cleveland Clinic Florida, Professor of Mayo Clinic College of Medicine,
Staff Surgeon, Cleveland Clinic Surgery, Ohio State University, Affiliate Phoenix, AZ
Larissa Temple, MD, FACS Foundation, Dept. of Colorectal Professor, Dept. of Surgery, Div. of
Assoc. Attending Colon & Rectal Surgery, Cleveland, OH General Surgery, University of South Massarat Zutshi, MD
Surgeon, Memorial Sloan Kettering Florida College of Medicine, Weston, Staff Surgeon, Cleveland Clinic, Dept.
Cancer Center, New York, NY Shao Wanjin, MD Florida of Colorectal Surgery, Joint
Nanjing TCM University Hospital, Appointment Dept. of Biomedical
William Timmerman, MD Dept. of Coloproctology, Nanjing, Mark H. Whiteford, MD Engineering, Lerner Research Institute,
Assoc. Professor, Dept. of Surgery, People’s Republic of China Clinical Asst. Professor, Oregon Health Cleveland, OH
Virginia Commonwealth University, & Science University, Gastrointestinal
Medical College of Virginia, Michael Weston Warner, FRACS, & Minimally Invasive Surgery Div.,
Richmond, VA MRCS(Eng), MB, ChB Legacy Portland Hospitals, Portland,
Colorectal Surgeon, Royal Perth OR
Gino T. Trevisani, MD Hospital, Perth, Western Australia
Asst. Professor, University of Vermont
College of Medicine, Burlington, VT
174
Poster Disclosures
P1: J. Church, Presenting & Senior Author: Myriad Genetics – P25: B. Paun, Presenting Author: No Affiliation
Honorarium (Speaker/Consultant); Salix Pharmaceuticals – Honorarium W. Buie, Senior Author: No Affiliation
(Speaker/Consultant); Cleveland Clinic/Cologene Software – Salary
P26: A. Vignali, Presenting Author: No Affiliation
(Employee); Pfizer – Research Support (Research Participant)
C. Staudacher, Senior Author: No Affiliation
P3: B. Teng, Presenting Author: No Affiliation
P27: A. Pena, Presenting Author: No Affiliation
K. Bullard Dunn, Senior Author: No Affiliation
P. Vukasin, Senior Author: No Affiliation
Funded by the ASCRS Research Foundation
P28: P. Georgiou, Presenting Author: No Affiliation
P4: Y. Xu, Presenting Author: No Affiliation
P. Tekkis, Senior Author: No Affiliation
S. Cai, Senior Author: No Affiliation
P29: S. Glasgow, Presenting Author: No Affiliation
P5: H. Kunitake, Presenting Author: No Affiliation
A. Lowry, Senior Author: No Affiliation
C. Ko, Senior Author: No Affiliation
P30: D. Stewart, Presenting Author: No Affiliation
P6: P. Wise, Presenting & Senior Author: No Affiliation
W. Koltun, Senior Author: No Affiliation
P7: J. Adams, Presenting Author: No Affiliation
P31: B. Loh, Presenting Author: No Affiliation
D. Margolin, Senior Author: No Affiliation
A. Ferrara, Senior Author: Ethicon Endosurgical – Honorarium
P8: P. Wise, Presenting Author: No Affiliation (Proctor); Covidien – Honorarium (Proctor)
P. Wise, Senior Author: No Affiliation
P32: I. Park, Presenting Author: No Affiliation
P9: E. Mignanelli, Presenting Author: No Affiliation G. Choi, Senior Author: No Affiliation
J. Church, Senior Author: Myriad Genetics – Honorarium
P33: D. Row, Presenting Author: No Affiliation
(Speaker/Consultant); Salix Pharmaceuticals – Honorarium
G. Nash, Senior Author: No Affiliation
(Employee); Pfizer – Research Support (Research Participant) P34: H. Wang, Presenting Author: No Affiliation
M. Berho, Senior Author: No Affiliation
P10: F. Ferenschild, Presenting Author: No Affiliation
J. de Wilt, Senior Author: No Affiliation P35: S. Dharmarajan, Presenting Author: No Affiliation
A. Lin, Senior Author: No Affiliation
P11: P. Prathanvanich, Presenting Author: No Affiliation
A. Rojanasakul, Senior Author: No Affiliation P36: H. Uchida, Presenting Author: No Affiliation
H. Hasegawa, Senior Author: No Affiliation
P12: U. Shin, Presenting Author: No Affiliation
C. Yu, Senior Author: No Affiliation P37: Y. Hashiguchi, Presenting Author: No Affiliation
K. Hase, Senior Author: No Affiliation
P13: J. Nordenstam, Presenting Author: No Affiliation
R. Madoff, Senior Author: No Affiliation P38: H. Chern, Presenting Author: No Affiliation
B. Chinn, Senior Author: No Affiliation
P14: D. Jin Choi, Presenting Author: No Affiliation
S. Kim, Senior Author: No Affiliation P39: M. Torres, Presenting Author: No Affiliation
E. Haas, Senior Author: No Affiliation
P OSTER D ISCLOSURES
P16: S. Lee-Kong, Presenting Author: No Affiliation
J. Guillem, Senior Author: No Affiliation P40: M. Rottoli, Presenting Author: No Affiliation
R. Kiran, Senior Author: No Affiliation
P17: S. Iida, Presenting Author: No Affiliation
H. Hasegawa, Senior Author: No Affiliation P41: J. Karas, Presenting Author: No Affiliation
D. Chessin, Senior Author: No Affiliation
P18: H. Kobayashi, Presenting Author: No Affiliation
K. Sugihara, Senior Author: No Affiliation P42: R. Pinto, Presenting Author: No Affiliation
S. Wexner, Senior Author: Medtronics – No Remuneration (Institutional
P19: J. Leite, Presenting & Senior Author: No Affiliation
Support for IRB Study – Investigator); Simendo – Consulting Fee
P20: B. Mizrahi, Presenting Author: No Affiliation (Consultant)
J. Marks, Senior Author: Covidien: Honorarium (Consultant/Speakers
P43: M. Rottoli, Presenting Author: No Affiliation
Bureau); Wolf – Honorarium (Consultant/Speakers Bureau); Stryker –
Honorarium (Consultant/Speakers Bureau); Glaxo Smith Kline –
Honorarium (Consultant); Zassi – Honorarium (Consultant); Covidien – P44: E. Steinhagen, Presenting Author: No Affiliation
Grant/Research Support; SurgiQuest – Honorarium (Scientific Advisory D. Chessin, Senior Author: No Affiliation
Board); SurgiQuest (Stockholder)
P45: E. Ozturk, Presenting Author: No Affiliation
P21: A. da Luz Moreira, Presenting Author: No Affiliation R. Kiran, Senior Author: No Affiliation
M. Kalady, Senior Author: No Affiliation
P23: W. Khoury, Presenting Author: No Affiliation

P24: R. Nenshi, Presenting Author: No Affiliation

D. Urbach, Senior Author: No Affiliation
175
Poster Disclosures
P46: J. Fleshman, Presenting Author: Ethicon – Research Grant P64: J. Frenkel, Presenting & Senior Author: No Affiliation
(Researcher); Lifecell – Research Grant (Researcher); Applied Medical –
P65: B. Paris, Presenting Author: No Affiliation
Honoraria, Research Grant (Lecturer, Researcher); Sapphire Therapeutics
H. Abcarian, Senior Author: No Affiliation
– Honoraria, Research Grant (Consultant, Researcher); Innocoll –
Research Grant, Honoraria (Researcher, Consultant); SurgRX – P66: L. Norcross, Presenting Author: No Affiliation
Owns Stock A. Ferrara, Senior Author: Covidien – Honorarium (Proctor); Ethicon –
R. McLeod, Senior Author: Ethicon Endosurgery – Research Grant Honorarium (Proctor)
(Research)
P67: K. Emmett, Presenting Author: No Affiliation
P47: A. M'Koma, Presenting Author: No Affiliation J. Cromwell, Senior Author: No Affiliation
R. Caprioli, Senior Author: No Affiliation
P68: H. Miller, Presenting Author: Pacira Pharmaceuticals, Inc – Clinical
P48: D. Chessin, Presenting Author: No Affiliation Trial Investigator Payment (Clinical Trial Investigator)
J. Bauer, Senior Author: No Affiliation H. Miller, Senior Author: Pacira Pharmaceuticals, Inc – Clinical Trial
Investigator Payment (Clinical Trial Investigator)
P49: S. Khaitov, Presenting Author: No Affiliation
Off-Label: DepoBupivacaine: investigational: Pacira Pharmaceuticals, Inc.
D. Chessin, Senior Author: No Affiliation
P69: R. Pinto, Presenting Author: No Affiliation
P50: J. Canedo, Presenting Author: No Affiliation
(Consultant)
(Consultant)
P70: E. Leung, Presenting & Senior Author: No Affiliation
P51: K. Mathis, Presenting Author: No Affiliation
D. Larson, Senior Author: No Affiliation P71: S. Murad-Regadas, Presenting & Senior Author: No Affiliation
P52: E. O'Connor, Presenting Author: No Affiliation P72: L. Mitalas, Presenting Author: No Affiliation
C. Heise, Senior Author: No Affiliation W. Schouten, Senior Author: No Affiliation
P53: J. Touzios, Presenting Author: No Affiliation P73: J. Wijk, Presenting Author: No Affiliation
D. Larson, Senior Author: No Affiliation W. Schouten, Senior Author: No Affiliation
P54: V. De Franco, Presenting Author: No Affiliation P74: S. Atallah, Presenting Author: No Affiliation
G. Meurette, Senior Author: No Affiliation M. Snyder, Senior Author: No Affiliation
P55: M. Levack, Presenting Author: No Affiliation P75: J. Foo, Presenting Author: No Affiliation
L. Bordeianou, Senior Author: No Affiliation W. Cheong, Senior Author: No Affiliation
P56: B. Govaert, Presenting Author: No Affiliation P76: M. McGee, Presenting Author: No Affiliation
C. Baeten, Senior Author: No Affiliation C. Delaney, Senior Author: No Affiliation
Off Label: Interstim Therapy: Interstim:Medtronic
P77: S. Gonsalves, Presenting Author: No Affiliation
P57: M. Capon, Presenting Author: No Affiliation P. Sagar, Senior Author: No Affiliation
S. Plusa, Senior Author: No Affiliation
P78: N. Hyman, Presenting Author: No Affiliation
P58: D. Oom, Presenting Author: No Affiliation N. Hyman, Senior Author: No Affiliation
W. Schouten, Senior Author: No Affiliation
P79: S. Shih, Presenting Author: No Affiliation
P59: S. Wexner, Presenting Author: Medtronics – No Remuneration S. Wexner, Senior Author: Medtronics – No Remuneration (Institutional
(Institutional Support for IRB Study – Investigator); Simendo – Support for IRB Study – Investigator); Simendo – Consulting Fee
Consulting Fee (Consultant) (Consultant)
A. Mellgren, Senior Author: Ethicon Endosurgery – Research Support
(Consultant); American Medical Systems – Research Support P80: N. Samalavicius, Presenting & Senior Author: No Affiliation
(Consultant); Q-Med Scandinavia – Research Support (Consultant); P81: J. Alsharif, Presenting Author: No Affiliation
Medtronic – Research Support (Consultant); Carbon Medical – Research R. Boushey, Senior Author: Covidien Canada – Research Funding and
Support (Consultant) Honorarium (Speaker/Teacher of Laparoscopic Course); Storz Canada -
The IRB approved study was supported and funded by Medtronics. Research Funding and Honorarium (Speaker/Teacher of Laparoscopic
P60: N. Gandhi, Presenting Author: No Affiliation Course); Applied Medical – Honorarium (Speaker/Teacher of
L. Gottesman, Senior Author: No Affiliation Laparoscopic Course)
P61: K. Song, Presenting Author: No Affiliation P82: A. Kwok, Presenting Author: No Affiliation
D. Lee, Senior Author: No Affiliation R. Bleday, Senior Author: No Affiliation
P62: L. Sta.Ana, Presenting Author: No Affiliation P83: K. Hardiman, Presenting Author: No Affiliation
A. Ferrara, Senior Author: Ethicon Endosurgical – Honorarium D. Herzig, Senior Author: No Affiliation
(Proctor); Covidien – Honorarium (Proctor) P84: T. Hedrick, Presenting Author: No Affiliation
P63: D. Chatoor, Presenting Author: No Affiliation C. Friel, Senior Author: No Affiliation
U. Baumgartner, Senior Author: Agency for Medical Innovations – P85: K. Cranfield, Presenting Author: No Affiliation
Honorarium (Teaching) A. Horgan, Senior Author: No Affiliation
176
Poster Disclosures
P86: J. Vogel, Presenting & Senior Author: Applied Medical, Inc. – P104: D. Wietfeldt, Presenting Author: No Affiliation
Honorarium (Speaker/Course Instructor) I. Hassan, Senior Author: No Affiliation
P87: J. Stulberg, Presenting Author: Ethicon Endo-Surgery – Salary P105: M. McGee, Presenting Author: No Affiliation
(Employee/Research Fellow) C. Delaney, Senior Author: No Affiliation
B. Champagne, Senior Author: GSK – Honorarium (Speaker); Covidien
P106: S. Regenbogen, Presenting Author: No Affiliation
– Honorarium (Speaker)
A. Gawande, Senior Author: No Affiliation
P88: R. Pinto, Presenting Author: No Affiliation
P107: J. Blumetti, Presenting Author: No Affiliation
L. Prasad, Senior Author: No Affiliation
(Consultant) P108: A. Heriot, Presenting & Senior Author: No Affiliation
P89: J. Faucheron, Presenting & Senior Author: No Affiliation P109: B. Orkin, Presenting & Senior Author: No Affiliation
P90: T. Lipof, Presenting Author: No Affiliation P110: D. Hayden, Presenting Author: No Affiliation
P. Vignati, Senior Author: No Affiliation T. Saclarides, Senior Author: Richard Wolf Medical – Honorarium
(Instructor); Ethicon Endosurgery – Honorarium (Instructor)
P91: D. Trottier, Presenting Author: No Affiliation
R. Boushey, Senior Author: Covidien Canada – Research Funding and P111: G. Kang, Presenting & Senior Author: No Affiliation
Honorarium (Speaker/Teacher of Laparoscopic Course); Storz Canada -
Research Funding and Honorarium (Speaker/Teacher of Laparoscopic P112: K. Madbouly, Presenting Author: No Affiliation
Course); Applied Medical – Honorarium (Speaker/Teacher of A. Hussein, Senior Author: No Affiliation
Laparoscopic Course) P113: R. Hsiung, Presenting Author: No Affiliation
P92: A. Vignali, Presenting Author: No Affiliation H. Bailey, Senior Author: Merck Inc. – Honorarium (Speaker);
C. Staudacher, Senior Author: No Affiliation Adolor/GSK – Honorarium (Speaker)
P93: H. Hur, Presenting Author: No Affiliation P114: J. Evans, Presenting Author: No Affiliation
N. Kim, Senior Author: No Affiliation N. Cripps, Senior Author: No Affiliation
P94: A. Vorenberg, Presenting Author: No Affiliation P115: K. Garrett, Presenting Author: No Affiliation
D. Sands, Senior Author: No Affiliation J. Church, Senior Author: Myriad Genetics – Honorarium
(Speaker/Consultant); Salix Pharmaceuticals – Honorarium
P95: S. McKenzie, Presenting Author: No Affiliation (Speaker/Consultant); Cleveland Clinic/Cologene Software – Salary
A. Pigazzi, Senior Author: Intuitive Surgical – Honorarium (Speaker, (Employee); Pfizer – Research Support (Research Participant)
Proctor)
P116: M. Villalba, Presenting Author: No Affiliation
P96: T. Marquez, Presenting Author: No Affiliation D. Barkel, Senior Author: No Affiliation
D. Rothenberger, Senior Author: No Affiliation
P117: K. Garrett, Presenting Author: No Affiliation
P97: T. Maxwell, Presenting Author: No Affiliation J. Church, Senior Author: Myriad Genetics – Honorarium
S. Wade, Senior Author: ConvaTec Inc.: Consulting Fee: Independent (Speaker/Consultant); Salix Pharmaceuticals – Honorarium
Contractor
P OSTER D ISCLOSURES
Off-Label: Vitala: Ostomy: ConvaTec Inc. (Employee); Pfizer – Research Support (Research Participant)
P99: B. Rogoway, Presenting Author: No Affiliation P118: A. Haji, Presenting Author: No Affiliation
A. Senagore, Senior Author: Deltex Medical - Unrestricted Educational S. Papagrigoriadis, Senior Author: No Affiliation
Grant; Tranzyme Pharma -Consulting Fee (Consultant/Advisor)
P119: J. Chun, Presenting Author: No Affiliation
P100: C. Foo, Presenting Author: No Affiliation S. Hunt, Karl Storz Endoscopy – Honorarium (Instructor); Ethicon
W. Lun Law, Senior Author: No Affiliation Endosurgery – Honorarium (Instructor); Applied Medical – Honorarium
(Instructor); Adolor/GSK – Honorarium (Instructor); Covidien –
P101: S. Kim, Presenting Author: No Affiliation
Honorarium (Instructor); Richard Wolf – Honorarium (Speaker)
Y. Park, Senior Author: No Affiliation
P120: J. Blumetti, Presenting Author: No Affiliation
P102: R. Cannom, Presenting Author: No Affiliation
L. Prasad, Senior Author: No Affiliation
D. Etzioni, Senior Author: No Affiliation
P103: B. Swenson, Presenting Author: No Affiliation

C. Friel, Senior Author: No Affiliation
177
Program Participants
Abbas M . . . . . . . . . . . . . . .59, 70, 88 Dujovny N . . . . . . . . . . . . . . . . .30, 37 Hellinger M . . . . . . . . . . . . . . . . . . .59
Abcarian H . . . . . . . . . . . . . . . . . . .60 Dunk in B . . . . . . . . . . . . . . . . . . . . .70 Heriot A . . . . . . . . . . . . . . . . . . . . .78
Alavi K . . . . . . . . . . . . . . . . . . . .38, 41 Dunn G . . . . . . . . . . . . . . . . . . .50, 79 Herline A . . . . . . . . . . . . . . .30, 36, 73
Alonso S . . . . . . . . . . . . . . . . . . . . . .74 Edlund J . . . . . . . . . . . . . . . . . . . . . .77 Herzig D . . . . . . . . . . . . . . . . . .31, 74
Araghizadeh F . . . . . . . . . . . . . . . . .39 Efron J . . . . . . . . . . . . . .32, 37, 38, 47 Heymen S . . . . . . . . . . . . . . . . . . . .75
Asgeirsson T . . . . . . . . . . . . . . . . . .90 Eggenberger J . . . . . . . . . . . . . . . . .58 Hick sT . . . . . . . . . . . . . . . . . . .59, 77
Awad Z . . . . . . . . . . . . . . . . . . . . . . .88 Eisenstat T . . . . . . . . . . . . . . . . . . .77 Ho V . . . . . . . . . . . . . . . . . . . . . . . .29
Bailey H . . . . . . . . . . . . . . . . . . .67, 77 El-Badawi K . . . . . . . . . . . . . . . . . .61 Hoedema R . . . . . . . . . . . . .24, 35, 50
Bak er T . . . . . . . . . . . . . . . . . . . . . .40 El-Gazzaz G . . . . . . . . . . . . . . . . . .62 Hofmann L . . . . . . . . . . . . . . . . . . .82
Bartus C . . . . . . . . . . . . . . . . . . .24, 26 Ellis N . . . . . . . . . . . . . . . . . . . . . . .58 Holen K . . . . . . . . . . . . . . . . . . . . . .84
Bastawrous A . . . . . . . . . . . . . . . . . .73 Erwin-Toth P . . . . . . . . . . . . . . . . .34 Holm T . . . . . . . . . . . . . . . . . . . . . .49
Baxter N . . . . . . . . . . . . . . . . . .45, 77 Essani R . . . . . . . . . . . . . . . . . . . . . .89 Holubar S . . . . . . . . . . . . . . . . . . . .65
Beck D . . . . . . . . . . . . . . . . . . . . . . .50 Etzioni D . . . . . . . . . . . . . . . . . . . . .85 Hourigan J . . . . . . . . . . . . . . . . . . . .41
Beets G . . . . . . . . . . . . . . . . . . . . . .51 Fajardo A . . . . . . . . . . . . . . . . . . . . .88 Huang E . . . . . . . . . . . . . . . . . .43, 58
Berdah S . . . . . . . . . . . . . . . . . . . . .29 Fancher T . . . . . . . . . . . . . . . . . . . .71 Huang R . . . . . . . . . . . . . . . . . . . . .71
Berho M . . . . . . . . . . . . . . . . . .46, 48 Ferenschild F . . . . . . . . . . . . . . . . . .52 Hubner M . . . . . . . . . . . . . . . . . . . .89
Bertelson N . . . . . . . . . . . . . . . . . . .72 Feudtner C . . . . . . . . . . . . . . . . . . .66 Hull T . . . . . . . . . . . . . . . . . . . . . . .58
Bhoot N . . . . . . . . . . . . . . . . . . . . . .56 Fichera A . . . . . . . . . . . . . . .47, 57, 73 Hunt S . . . . . . . . . . . . . . . . . . . . . . .30
Billingham R . . . . . . . . . . . . . . .67, 87 Finan K . . . . . . . . . . . . . . . . . . . . . .68 Hur H . . . . . . . . . . . . . . . . . . . . . . .73
Bleier J . . . . . . . . . . . . . . . . . . . . . . .55 Finne C . . . . . . . . . . . . . . . . . . . . . .23 Hyman N . . . . . . . . . . . . . . . . .46, 58
Boushey R . . . . . . . . . . . . . . . . . . . .36 Fleshman J . . . . . . . . . . . . . . . . . . . .57 Jarrar A . . . . . . . . . . . . . . . . . . . . . .83
Brand M . . . . . . . . . . . . . . . . . .29, 38 Foley E . . . . . . . . . . . . . . . . . . . . . .84 Jayne D . . . . . . . . . . . . . . . . . . .37, 60
Brown G . . . . . . . . . . . . . . . . . . . . .48 Forbes S . . . . . . . . . . . . . . . . . . . . . .64 Kaiser A . . . . . . . . . . . . . . . . . . .39, 55
Buie W . . . . . . . . . . . . . . . .39, 54, 63 Forrow L . . . . . . . . . . . . . . . . . . . . .67 Kalady M . . . . . . . . . . . . . . .68, 73, 76
Bullard Dunn K . . . . . . . . . . . . .43, 67 Frank lin M . . . . . . . . . . . . . . . . . . .35 Kasparek M . . . . . . . . . . . . . . . . . . .89
Cannom R . . . . . . . . . . . . . . . . . . . .71 Fried G . . . . . . . . . . . . . . . . . . . . . .70 Kemp JA . . . . . . . . . . . . . . . . . . . . .89
Cataldo P . . . . . . . . . . . . . . . . . . . . .23 Friel C . . . . . . . . . . . . . . . . . . . . . . .71 Kemp J . . . . . . . . . . . . . . . . . . . .44, 89
Cavanaugh M . . . . . . . . . . . . . . . . .33 Fry R . . . . . . . . . . . . . . . . . . . . . . . .28 Kennedy G . . . . . . . . . . . . . . . . . . .29
Celinsk iS . . . . . . . . . . . . . . . . . . . .88 Gallagher J . . . . . . . . . . . . . . . . . . .58 Kerwel T . . . . . . . . . . . . . . . . . . . . .69
Cellini C . . . . . . . . . . . . . . . . . . . . .82 Garcia-Aguilar J . . . . . . . . . . . . . . .47 Kessler H . . . . . . . . . . . . . . . . . . . . .51
Champagne B . . . . .37, 38, 39, 40, 50 Garrett K . . . . . . . . . . . . . . . . . .64, 88 Khaitov S . . . . . . . . . . . . . . . . . . . . .55
Chang G . . . . . . . . . . . . . . .37, 45, 57 Georgiou P . . . . . . . . . . . . . . . . . . .74 Khoo R . . . . . . . . . . . . . . . . . . . . . .88
Chen G . . . . . . . . . . . . . . . . . . . . . .68 Govaert B . . . . . . . . . . . . . . . . .55, 79 Kim S . . . . . . . . . . . . . . . . . . . . . . . .60
Chinn B . . . . . . . . . . . . . . . . . . . . . .29 Gregorcyk S . . . . . . . . . . . . . . . . . .33 Ko C . . . . . . . . . . . . . . . . . .43, 45, 58
Cho D . . . . . . . . . . . . . . . . . . . . . . .85 Grucela A . . . . . . . . . . . . . . . . .55, 64 Kodner I . . . . . . . . . . . . . . . . . . . . .87
Chua H . . . . . . . . . . . . . . . . . . . . . .34 Gu J . . . . . . . . . . . . . . . . . . . . . . . . .69 Koh P . . . . . . . . . . . . . . . . . . . . . . .73
Church J . . . . . . . . . . . . . . . . . . . . .76 Guillem J . . . . . . . . . . . . . . . . . .42, 43 Koltun W . . . . . . . . . . . . . . . . . . . .47
Cole P . . . . . . . . . . . . . . . . . . . .50, 77 Gurland B . . . . . . . . . . . . . . . . .29, 44 Krishnamurthi S . . . . . . . . . . . . . . .78
Colvin D . . . . . . . . . . . . . . . . . . . . .31 Habr-Gama A . . . . . . . . . . . . . . . . .66 Kunitak eH . . . . . . . . . . . . . . . . . . .90
Cooper G . . . . . . . . . . . . . . . . . . . .78 Haji A . . . . . . . . . . . . . . . . . . . . . . .29 Ky A . . . . . . . . . . . . . . . . . . . . . .33, 41
Cosman B . . . . . . . . . . . . . . . . . . . .77 Hall J . . . . . . . . . . . . . . . . . . . . . . . .85 Lacy A . . . . . . . . . . . . . . . . . . . .52, 81
Davis B . . . . . . . . . . . . . . . . . . .36, 37 Hallam S . . . . . . . . . . . . . . . . . . . . .34 Larson D . . . . . . . . . . . . . . .24, 47, 81
Delaney C . . . . .24, 26, 27, 32, 35, 48 Hammond K . . . . . . . . . . . . . . .28, 30 Laurberg S . . . . . . . . . . . . . . . . .44, 75
DeNardi P . . . . . . . . . . . . . . . . . . . .83 Heald R . . . . . . . . . . . . . . . . . . . . . .48 Leach B . . . . . . . . . . . . . . . . . . . . . .76
Dorsey J . . . . . . . . . . . . . . . . . . . . . .34 Hedrick T . . . . . . . . . . . . . . . . . . . .71 Lee E . . . . . . . . . . . . . . . . . . . . . . . .27
Dozois E . . . . . . . . . . . . . . . . . . . . .77 Heise C . . . . . . . . . . . . . . . . . . . . . .35 Lee S . . . . . . . . . . . . . . .37, 38, 79, 81
178
Program Participants
Lesperance K . . . . . . . . . . . . . . . . . .62 Pastor C . . . . . . . . . . . . . . . . . . . . . .61 Steele S . . . . . . . . . . . . . . . . . . .58, 67
Lewis E . . . . . . . . . . . . . . . . . . . . . .53 Pastor D . . . . . . . . . . . . . . . . . . . . .68 Stein S . . . . . . . . . . . . . . . . .36, 40, 89
Li M . . . . . . . . . . . . . . . . . . . . . . . . .52 Perak ath B . . . . . . . . . . . . . . . . . . . .54 Strong S . . . . . . . . . . . . . . . . . . . . . .47
Liberman A . . . . . . . . . . . . . . . . . . .51 Perez R . . . . . . . . . . . . . . . . . . . . . .51 Stulberg J . . . . . . . . . . . . . . . . . . . . .40
Littlejohn C . . . . . . . . . . . . . . . . . . .31 Pick hardt P . . . . . . . . . . . . . . . . . . .30 Subhas G . . . . . . . . . . . . . . . . . . . . .71
Lobato L . . . . . . . . . . . . . . . . . . . . .51 Pittet O . . . . . . . . . . . . . . . . . . . . . .85 Sun M . . . . . . . . . . . . . . . . . . . . . . .72
Lowry A . . . . . . . . . . . . . . . . . . .28, 75 Podolsky E . . . . . . . . . . . . . . . . . . .71 Swenson B . . . . . . . . . . . . . . . . . . . .85
Lucas A . . . . . . . . . . . . . . . . . . . . . .34 Pomposelli J . . . . . . . . . . . . . . . . . .84 Temple L . . . . . . . . . . . . . . . . . . . . .43
Luchtefeld M . . . . . . . . . . . . . . .41, 63 Poritz L . . . . . . . . . . . . . . . . . . .43, 58 Ternent C . . . . . . . . . . . . . . . . . . . .88
Ludwig K . . . . . . . . . . . . . . . . . .24, 36 Poylin V . . . . . . . . . . . . . . . . . . . . . .71 Timmerman W . . . . . . . . . . . . . . . .26
MacRae H . . . . . . . . . . . . . . . . .24, 32 Prasad L . . . . . . . . . . . . . . . .29, 60, 88 Touzios J . . . . . . . . . . . . . . . . . . . . .85
Maeda Y . . . . . . . . . . . . . . . . . . . . .79 Rafferty J . . . . . . . . . . . . . . . . . . . . .33 Trevisani G . . . . . . . . . . . . . . . . . . .27
Mahmoud A . . . . . . . . . . . . . . . . . .61 Rak inic J . . . . . . . . . . . . . . . . . . . . .58 Tsai B . . . . . . . . . . . . . . . . . . . . . . . .51
Mahmoud N . . . . . . . . . . . . . . . . . .48 Ramamoorthy S . . . . . . . . . . . .37, 60 Tsoraides S . . . . . . . . . . . . . . . . . . .88
Mantyh C . . . . . . . . . . . . . . . . . . . .74 Rao S . . . . . . . . . . . . . . . . . . . . . . . .75 Tsuda S . . . . . . . . . . . . . . . . . . . . . .70
Marchetti F . . . . . . . . . . . . .24, 27, 35 Ratto C . . . . . . . . . . . . . . . . . . .55, 79 Tyler K . . . . . . . . . . . . . . . . . . . . . .31
Marecik S . . . . . . . . . . . . . . . . .29, 60 Read T . . . . . . . . . . . . . . . . . . . . . . .41 Umoh N . . . . . . . . . . . . . . . . . . . . .71
Margolin D . . . . . . . . . . . . .47, 57, 78 Reissman P . . . . . . . . . . . . . . . . . . .29 Vargas D . . . . . . . . . . . . . . .25, 26, 35
Marks JH . . . . . . . . . . . .24, 27, 37, 77 Remzi F . . . . . . . . . . . . . . . . . . .34, 81 Varma M . . . . . . . . . . . . . . .37, 44, 64
Marks JM . . . . . . . . . . . . . . . . . . . . .70 Renehan A . . . . . . . . . . . . . . . . . . . .54 Vignati P . . . . . . . . . . . . . . . . . .24, 26
Maron D . . . . . . . . . . . . . . . . . .35, 57 Reynolds H . . . . . . . . . .24, 26, 35, 78 Vik is E . . . . . . . . . . . . . . . . . . . . . . .88
McNevin S . . . . . . . . . . . . . . . . . . .39 Ricciardi R . . . . . . . . . . . . . . . . .73, 84 Vogel J . . . . . . . . . . . . . . . . . . . . . . .36
Mellgren A . . . . . . . . . . . . . . . .44, 47 Rider P . . . . . . . . . . . . . . . . . . . . . .80 Vuk asin P . . . . . . . . . . . . . . . . . . . . .29
Merlino J . . . . . . . . . . . . . . . . . . . . .78 Ridolfi T . . . . . . . . . . . . . . . . . .71, 73 Wanjin S . . . . . . . . . . . . . . . . . . . . .54
Messick C . . . . . . . . . . . . . . . . . . . .68 Rivadeneira D . . . . . . . . . . . . . . . . .36 Warner M . . . . . . . . . . . . . . . . . . . .54
Metcalf D . . . . . . . . . . . . . . . . . . . .50 Roberts P . . . . . . . . . . . . . . . . . .31, 40 Watanabe T . . . . . . . . . . . . . . . . . . .68
Mignanelli E . . . . . . . . . . . . . . . . . .82 Ross H . . . . . . . . . . . . . . . . . . . . . . .39 Weiser M . . . . . . . . . . . . . . . . . .38, 40
Minsk yB . . . . . . . . . . . . . . . . . . . . .48 Rumpler V . . . . . . . . . . . . . . . . . . . .34 Weiss E . . . . . . . . . . . . .25, 37, 58, 70
Moore H . . . . . . . . . . . . . . . . . . . . .73 Saclarides T . . . . . . . . . . . . . . . . . . .33 Weiss K . . . . . . . . . . . . . . . . . . . . . .63
Morris A . . . . . . . . . . . . . . . . . .67, 77 Salcedo L . . . . . . . . . . . . . . . . . . . . .73 Welton M . . . . . . . . . . . . . . . . .59, 77
Murphy J . . . . . . . . . . . . . . . . . . . . .79 Sanchez J . . . . . . . . . . . . . . . . . .71, 88 Wexner S . . . . . . . . . . . . . . . . . .38, 70
Mutch M . . . . . . . . . . . . . . . . . .50, 58 Sands D . . . . . . . . . . . . . . . . . . .23, 57 White E . . . . . . . . . . . . . . . . . . . . . .64
Nagle D . . . . . . . . . . . . . . . .25, 35, 67 Sardella W . . . . . . . . . . . . . . . . . . . .77 Whiteford M . . . . . .23, 36, 37, 40, 81
Nasca T . . . . . . . . . . . . . . . . . . . . . .53 Schoetz D . . . . . . . . . . . . . . . . . . . .63 Whitlow C . . . . . . . . . . . . . . . . . . . .30
Nasseri Y . . . . . . . . . . . . . . . . . . . . .71 Senagore A . . . . . . .42, 48, 60, 89, 90 Wilk ins K . . . . . . . . . . . . . . . . . . . .31
Neary P . . . . . . . . . . . . . . . . . . .27, 35 Shanwani A . . . . . . . . . . . . . . . . . . .55 Wise P . . . . . . . . . . . . . . . . . . . . . . .76
Nelson H . . . . . . . . . . . . . . . . . . . . .49 Shellnut J . . . . . . . . . . . . . . . . . . . . .82 Wong W . . . . . . . . . . . . . . . . . . . . .47
P ROGRAM PARTICIPANTS
Newstead G . . . . . . . . . . . . . . . . . . .54 Shibata D . . . . . . . . . . . . . . . . . . . . .73 Wong N . . . . . . . . . . . . . . . . . . . . . .82
Obias V . . . . . . . . . . . . . . . . . . .24, 27 Sigurdson E . . . . . . . . . . . . . . . . . . .45 Wu J . . . . . . . . . . . . . . . . . . . . . . . . .34
Olden K . . . . . . . . . . . . . . . . . . . . . .44 Simmang C . . . . . . . . . . . . . . . . . . .47 Young-Fadok T . . . . . . . . . . . . . . . .36
Orangio G . . . . . . . . . . .28, 31, 40, 47 Sinanan M . . . . . . . . . . . . . . . . . . . .32 Zutshi M . . . . . . . . . . . . . . . . . . . . .75
Ork in B . . . . . . . . . . . . . . . .23, 33, 47 Sk low B . . . . . . . . . . . . . . . . . . . . . .36
Page M . . . . . . . . . . . . . . . . . . . . . .29 Smith M . . . . . . . . . . . . . . . . . . . . .68
Paquette I . . . . . . . . . . . . . . . . . . . .89 Sonoda T . . . . . . . . . . . . . . . . . .26, 81
Park J . . . . . . . . . . . . . . . . . . . . . . . .56 Spencer M . . . . . . . . . . . . . . . . . . . .41
Park K . . . . . . . . . . . . . . . . . . . . . . .73 Stamos M . . . . . . . . . . . . . .47, 48, 59
179
Convention Center Maps
C
Convention Center, 2nd Floor
THE WESTIN CONVENTION

DIPLOMAT CENTER
SERVICE
ELEVATORS
ATLANTIC REGENCY
BALLROOM BALLROOM 5 4
3 3
GRAND GRAND
ATLANTIC
BALLROOM BALLROOM
BALLROOM REGENCY DIPLOMAT
EAST WEST
2 BALLROOM BALLROOM
2 3
ATLANTIC
General BALLROOM
1 REGENCY 1 2
Session BALLROOM
M W 1
ESCALATOR ELEVATORS
REGISTRATION
180
Convention Center Maps
Convention Center, 3rd Floor
M APS
DIPLOMAT CENTER
M W
GREAT HALL GREAT HALL

M 6 Exhibits 2
GREAT HALL GREAT HALL Posters

4 3
GREAT HALL GREAT HALL

W 5 1
ELEVATORS
181
Hotel Maps
The Westin Diplomat Resort, 2nd Floor

DIPLOMAT CENTER
Speaker Ready Room
NORTH SOUTH
TER
TOWER ACE RAC TOWER
TERR E
203 218
202 201 220 219
204 217
ESCALATORS
205 216
Walkway
ELEVATORS ELEVATORS to
SKYWALK Convention
Center
M W 209 W M
206 208 215
207 212 213 214
BUSINESS
CENTER
182
Hotel Maps
The Westin Diplomat Resort, 3rd Floor
M APS
DIPLOMAT CENTER
NORTH SOUTH
E TER
TOWER AC RAC TOWER
TERR E
318
303 302 301 320 319
317
32 2 32 1
305 316
ESCALATOR ESCA LA TOR
ELEVATORS SKYWALK ELEVATORS
M W 309 310 W M
306 308 311 315
312 313 314

307
183
Great Hall
RF-1 RF-2 RF-3 RF-4 RF-5 RF-6
RF-7
T Aloka
EN ACOSOG Ultrasound
M
H K
Simbionix REFRESHMENT
BREAK GS-1 GS-2 GS-3 GS-4 GS-5 GS-6
ES EA 327 426 526 927
FR BR
RE D2 Market
Research P-120 P-119 P-118 P-117 P-116 P-115
921 P-109 P-110 P-111 P-112 P-113 P-114
Exhibit Map
Smart HRA Lexion The TEI Sigma Tau EZ Canica

Alpine Prometheus Biosciences Pharmaceuticals AmericanExpress
Pill Research Medical Group Inc Surgical Design
Salix Biomed Medtronic P-108 P-107 P-106 P-105 P-104 P-103
Pharmaceuticals 223 Inc 423 522 523 622 723 822 823 THD 923
USA P-97 P-98 P-99 P-100 P-101 P-102
Mediwatch My Studio MAST
Space I-Flow Pentax American Gore & Market Biosurgery Inc
Corp Medical Medical Assoc Access
121 221 320 321 421 Co Systems Partners 821 P-96 P-95 P-94 P-93 P-92 P-91
CS MicrolinePENTAX Elsevier Karl Storz DiagnoCure P-85 P-86 P-87 P-88 P-89 P-90
Endoscopy Oncology
Surgical Labs
419 518 519 618 619 718 719 818 819 918 919
P-84 P-83 P-82 P-81 P-80 P-79
Exiqon Cardinal Ellman
Diagnostics Health Int'l P-73 P-74 P-75 P-76 P-77 P-78
Intuitive
184
Alaven
Pharmaceuticals
117 LLC Surgical 317 416
Sierra Sci P-72 P-71 P-70 P-69 P-68 P-67
Calmoseptine
Inst BK Myriad
Medical
Richard Adolor/ Applied Olympus- BREAK P-61 P-62 P-63 P-64 P-65 P-66
115 214 215 Systems 414 Wolf 515 Genetic
Labs GSK Medical Gyrus ACMI
Lumitex Electro Konsyl
Medical Merck Caris
MD Surgical Pharmaceuticals
Inst & Co Diagnostics P-60 P-59 P-58 P-57 P-56 P-55
113 212 313 412 413 513 612 613 713 813 913 P-49 P-50 P-51 P-52 P-53 P-54
P-48 P-47 P-46 P-45 P-44 P-43
Wiley- ResiCal P-37 P-38 P-39 P-40 P-41 P-42
Blackwell Life Cell Inc IFFGD
109 209
Collaborative
308
Wolters
Ethicon Endo Genzyme
Biosurgery
NiTi
Surgical
P-36 P-35 P-34 P-33 P-32 P-31
MFB Int'l Grp
BREAK
107 206
of
Americas
207
Kluwer Health-
LWW
306
Covidien Surgery Solutions
P-25 P-26 P-27 P-28 P-29 P-30
RG Medical Sontec Boston MD P-24 P-23 P-22 P-21 P-20 P-19
Mederi USA/MAHE
Int'l Inc Inst Scientific Logic
305 505
Therapeutics P-13 P-14 P-15 P-16 P-17 P-18
104 105 204 205 304 705 805
George
Percy P-12 P-11 P-10 P-9 P-8 P-7
McGown P-1 P-2 P-3 P-4 P-5 P-6
102 Sandhill Advanced Ferndale Agency for Axcan General SAPI Med Surgin/
Scientific Infusion Medical
Labs Innovations Pharma Surgery S.P.A OrigynRx
Cook Medical News
200 300 301 400 501 601 700 800 901
Entrance
Future ASCRS Meetings
2010
May 15-19
Hilton Minneapolis Hotel
& Convention Center
Minneapolis, MN
2011
May 14-18
Vancouver Convention
& Exhibition Centre
Vancouver, Canada
2012
June 2-6
Henry B. Gonzalez
Convention Center
and Grand Hyatt Hotel
San Antonio, TX
2013
April 27 - May 1
Phoenix Convention Center &
Sheraton Phoenix Hotel
Phoenix, AZ
ASCRS
American Society of Colon and Rectal Surgeons
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005-4460

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ASCRS Premier Partners

May 2-6, 2009

The Westin Diplomat Resort & Spa

Susan Galandiuk, MD Neil H. Hyman, MD Janice F. Rafferty, MD Mark L. Welton, MD

Administrative Office Diseases of the Colon & Rectum

C. Neal Ellis, MD James Merlino, MD

James Fleshman, MD Alessandro Fichera, MD Christopher Mantyh, MD Robert Sinnott, DO

Future ASCRS Annual Meetings

May 15-19 May 14-18 June 2-6 April 27-May 1

• Dress casually and for comfort. • Recognize ways to improve physician-patient

Accreditation • Review current recommendations and strategies for

Target Audience Internet Café

Poster Displays AV Requirements for Speakers

Call for Abstracts

Monday 5:00 – 6:30 pm On-Line Submission Site Opens

Norman D. Nigro Research Lectureship Ernestine Hambrick Lectureship

Harry E. Bacon Lectureship

1 Patient Care – Provide care that is compassionate, 4 Professionalism – Demonstrate a commitment to

Part I – Professional Standing Part IV – Practice Performance Assessment

Part III – Cognitive Expertise

Adolor Corporation and Covidien

Ferndale Laboratories, Inc. Merck & Co., Inc.

Genzyme Biosurgery Myriad Genetic Laboratories, Inc.

Intuitive Surgical, Inc.

Konsyl Pharmaceuticals, Inc.

Annual Dinner Dance

Special Programs for Spouses and Guests

Spouse/Guest Hospitality Suite

Robotic-assisted Colorectal Surgery Training in Combined Laparoscopy and CO2 Colonoscopy

Sunday, May 3 (continued)

continues on the following page …

Monday, May 4 (continued)

6:00 – 9:00 am Prayer Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205

Tuesday, May 5 (continued)

continues on the following page …

1899-1900 Joseph M. Mathews 1936-1937 Marion C. Pruitt 1974-1975 Rupert B. Turnball

Transanal Endoscopic Microsurgery

8:00 am TEM for Benign Disease (Adenoma,

* This session addresses MOC requirements as explained on page 11.

Director: Conor Delaney, MD, Cleveland, OH

6:30 am Introduction and Goals 8:25 am HALS Left/Sigmoid Colectomy

7:55 am Laparoscopic Left/Sigmoid Colectomy (I) 9:30 am HALS Rectal Dissection

9:45 am Optimizing Peri-Operative Care 10:15 am Fistulas, Abscesses, and Inflammatory

10:00 am Managing Complications, Reoperative 10:30 am Panel Discussion

Hand-Assist Laparoscopic Intestinal Surgery Workshop

The course will emphasize:

* This session addresses MOC requirements as explained on page 11.

Laparoscopic Colectomy Workshop

The workshop will cover:

* This session addresses MOC requirements as explained on page 11.

Professionalism and Communication

Director: Guy Orangio, MD, Atlanta, GA

Physician Leadership in Both the Academic Negative Behavior and Communication

Positive Communication Skills

* This session addresses MOC requirements as explained on page 11.

2:00 pm Colonoscopic High Frequency 2:38 pm Discussion

2:16 pm Combined Laparoscopy and CO2 2:54 pm Discussion

2:30 pm Discussion 3:10 pm Discussion

3:30 – 4:00 pm Refreshment Break in Foyer

Director: Charles Whitlow, MD, New Orleans, LA

4:00 pm Welcome/Introduction 4:45 pm CT Colonography

* This session addresses MOC requirements as explained on page 11.

Director: Charles Littlejohn, MD, Stamford, CT

Diversity in Colorectal Practice: Creating and Building a Partnership: