No abstract

Because of an equivalent incidence of adenomatous polyps compared with the general population, current screening criteria should be used in patients posttransplant. Transplant patients are not more likely to develop metachronous polyps than the general population. Therefore, posttransplant polyp surveillance should not be more frequent than currently recommended for nontransplant patients with adenomatous polyps.

Our purpose was to evaluate long-term outcome in patients presenting with acute colonic perforation in the setting of colorectal cancer. We conducted a retrospective review of 48 consecutive patients presenting with acute colonic perforation associated with colorectal cancer at a single institution. Patients presented either with free air or acute peritonitis. No patients with colonic obstruction were included. Forty-eight patients presented with colon perforation. Thirty-six had perforation at the tumor, 11 proximal to the tumor, and one distal to the primary tumor. Patients who perforated proximal to the tumor were older (74.5 ± 2 vs 64.7 ± 3; P < 0.04) and had a longer length of stay (46.8 ± 17 vs 11.6 ± 1 P < 0.001). Fourteen patients had stage II disease, 19 stage III, and 15 stage IV. Thirty-day mortality was 14 per cent (n = 7) with nine in-hospital deaths. Of 30-day survivors 29 (60%) had curative resection (21 with local perforation and nine with proximal perforation). Of these 14 received adjuvant chemotherapy. Eleven patients (33%) had either unresectable or metastatic disease on exploration. Mean follow-up was 21.5 months. Ten patients developed metastatic disease after potentially curative resections. Of these nine patients had perforations of the primary tumor. Three patients developed local recurrence and all had local tumor perforations. One-year survival was 55 per cent (n = 16). Five-year disease-free survival was 14 per cent (n = 4). There were no long-term survivors after perforation proximal to the tumor, although disease stage was comparable in both groups. We conclude that perforation proximal to a cancer is associated with a higher perioperative mortality and worse long-term outcome when compared with acute perforations at the site of the tumor. Long-term survival requires both aggressive management of the concomitant sepsis and definitive oncologic surgery.

There are differences in what program directors and current/recent residents consider most important in making an applicant competitive for colorectal residency.

2 (pϽ0.01). The average age at the time of surgery was 58.2 years (range: 39 to 78 years) in group 1, and 54.3 years (range: 17 to 77 years) in group 2 (pϽ0.01). BMI was 26.7Ϯ3.4 in group 1, and 24.9Ϯ3.1 in group 2 (pϽ0.01). KLG was 1.4Ϯ0.8 in group 1, and 0.9Ϯ0.6 in group 2 (pϽ0.01). With regard to anatomical factors, only M.A.A showed significantly increased varus alignment in group 1 (4.5oϮ3.4o) than group 2 (2.4oϮ2.7o) (pϽ0.01). Environmental factors showed no differences in occupational, table use or not, and bed use or not, except sport activity level. There were 41 patients (42.7%) in group 1 and 77 patients (20.6%) in group 2, who did not participate in any recreational activity (pϽ0.01). Logistic regression analysis showed that female gender was associated with a 5.9-fold increase in risk (pϭ0.001), a varus M.A.A with a 3.3-fold increase (pϭ0.003), a more than 30 kg/m2 in BMI with a 4.9-fold increase (pϭ0.031). Conclusion:This study showed that MMPRT had significant advancing age, female gender preference, high BMI, increased KLG, varus M.A.A, low sport activity level. The contributing risk factors were gender, BMI, and M.A.A. Interestingly, oriental specific lifestyles like the cross legged position and kneeling showed no contribution to increased MMPRT. This suggests that intrinsic risk factors (similar to those that predispose to osteoarthritis) predispose to MMPRT.