Articles related to Surgery, Colon & Rectal

A 51-year-old man presents with a 10-week history of intermittent bright red blood per rectum. His medical history is unremarkable, and he takes no medications. Physical examination reveals normal vital signs and a normal digital rectal examination. Fecal occult blood is positive. A colonoscopy identifies a nonobstructing lesion located 10 cm from the anal verge, while the rest of the colon appears normal. MRI scan results indicate that the lesion is invading into the muscularis but has not breached the full thickness, and there are no abnormal lymph nodes detected. Additionally, a contrast-enhanced CT scan of the chest and abdomen shows no signs of metastases. Biopsy results confirm the presence of adenocarcinoma. What is the most appropriate treatment for this patient?

The Organ Transplant and Procurement Network (OTPN) is set to undergo modernization and improvement after being criticized for lack of transparency, long waits, mishandling of organs, and the number of people who die on the waitlist each year. The Health Resources and Services Administration (HRSA) has launched the OTPN modernization project, which will focus on accountability. The current system is outdated and has been responsible for 70 deaths between 2010 and 2020, according to a 2022 senate report. The HRSA plans to take steps, such as creating a new dashboard, to provide transparency and better serve patients and their families. Additional modernization will focus on overhauling the operations of the OTPN system to ensure higher compliance and a greater focus on patient safety. Organ transplants and the OTPN disproportionately affect the Black community in the US. About 30% of the ONTP waitlist is Black Americans, and about 90% are waiting for kidney transplants. The HRSA’s plan hopes to address the inequality by improving accountability, transparency, and systems of organ retrieval and matching. The changes will benefit patients, and physicians might be able to see more of their patients receive the life-saving transplants they need.

In this randomized trial from Poland, Norway, Sweden, and the Netherlands, the study population of approximately 85,000 individuals were randomly assigned to colonoscopy screening or usual care. The risk of colorectal cancer at 10 years was 18% lower in the screening cohort.

The study, led by Michael Bretthauer, MD, PhD, of the University of Oslo in Norway, found that people who were invited to have a screening colonoscopy had a lower risk of colorectal cancer than those who were not, though at a lower rate than researchers expected. Furthermore, no significant difference in colorectal cancer-related mortality was discovered between the two groups.

This MashupMD link provides a video critique on YouTube of an NEJM paper on colonoscopy screening.

A coming 8.5% cut in Medicare payments for surgery may be the proverbial straw in an already stressed system of surgical training, leading some to abandon their commitment to medicine.