Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is increasing in incidence and is associated with increased mortality in liver transplantation (LT) recipients. We performed a retrospective cohort study of all patients transplanted between January 2010 and January 2013 to identify the incidence and risk factors for post-LT CRKP infection and evaluate the impact of this infection on outcomes in a CRKP-endemic area. We studied 304 recipients, of whom 20 (6.6%) developed CRKP and 36 (11.8%) carbapenem-susceptible Klebsiella pneumoniae (CSKP) infections in the year following LT. Among the 20 recipients with post-LT CRKP infection, 8 (40%) were infected in ≥ 2 sites; 13 (65%) had surgical site–intra-abdominal infections; 12 (60%) had pneumonia; and 3 (15%) had a urinary tract infection. There were 6 patients with a CRKP infection before LT, 5 of whom developed a CRKP infection after LT. Significant risk factors for post-LT CRKP infection in multivariate analysis included laboratory Model for End-Stage Liver Disease at LT (odds ratio [OR], 1.07; P = 0.001), hepatocellular carcinoma (OR, 3.19; P = 0.02), Roux-en-Y biliary choledochojejunostomy (OR, 3.15; P = 0.04), and bile leak (OR, 5.89; P = 0.001). One-year estimated patient survival was 55% (95% confidence interval, 31%–73%), 72% (55%–84%), and 93% (89%–96%), for patients with CRKP, CSKP, and no Klebsiella pneumoniae infection, respectively. In multivariate analysis, CRKP (hazard ratio [HR], 6.92; P < 0.001) and CSKP infections (CSKP, HR, 3.84; P < 0.001), as well as bile leak (HR, 2.10; P = 0.03) were the strongest predictors of post-LT mortality. In an endemic area, post-LT CRKP infection is common, occurring in 6.6% of recipients, and is strongly associated with post-LT mortality. Improved strategies for screening and prevention of CRKP infection are urgently needed.

Primary colorectal sarcomas have been defined as a rare and diverse group of mesenchymal cancers distinct from gastrointestinal stromal tumors (GISTs). Primary colorectal sarcomas have been recognized as a distinct entity from GISTs due to the dramatically worse prognosis these sarcomas carry. Also, primary colorectal sarcomas when compared to the more common colorectal adenocarcinoma, demonstrate more aggressive biology, present at a younger age and carry worse outcomes. At this time, surgery remains the mainstay of treatment and adjuvant chemotherapy has an unclear role in treatment of primary colorectal sarcoma. This paper attempts to review the available data regarding primary colorectal sarcomas.

No abstract

No abstract

The standard treatment for locally advanced rectal cancer is neoadjuvant chemoradiation followed by radical proctectomy with total mesorectal excision. A significant percentage of patients exhibit a pathological complete response with associated survival benefit. The management of patients who exhibit a complete clinical response after neoadjuvant chemoradiation, and could potentially avoid major resection, is a topic of great interest in colorectal surgery today. This paper reviews treatment options for this population.

No abstract