Our study demonstrates favorable long-term results for the ligation of intersphincteric fistula tract procedure. It appears that long tracts negatively affect healing, and late failures can occur up to 12 months postoperatively. Understanding the type of failure can help guide subsequent treatment to maximize healing success.

Preoperative serum albumin level is well recognized as a general predictor of adverse surgical outcomes in patients with gastrointestinal (GI) malignancy. Whether serum albumin or prealbumin levels can better predict postoperative surgical complications and death remains unknown. A retrospective review of 641 consecutive patients operated nonemergently for GI malignancies between January 1, 1997, and July 31, 2008, disclosed that 104 patients (16.2%) had complications and 23 (3.6%) subsequently died. All 641 patients had preoperative determination of serum albumin level (cost $0.13 per test), whereas 379 (59.1%) also had preoperative determination of serum prealbumin level (cost $2.27 per test). An albumin level below the discriminatory threshold of 3.2 g/dL was a significant predictor of overall postoperative morbidity, infectious and noninfectious complications, and mortality (all P < 0.001). In contrast, a prealbumin level below the discriminatory threshold of 18 mg/dL was a predictor of only overall morbidity ( P = 0.014) and infectious complications ( P = 0.024), but not of noninfectious complications or mortality ( P = nonsignificant). We conclude that compared with the preoperative serum prealbumin level, the albumin level has superior predictive value for overall postoperative morbidity, both infectious and noninfectious complications, and mortality. The inclusion of serum prealbumin level in the routine preoperative testing of patients with GI malignancy for the purpose of predicting postoperative outcomes is neither clinically necessary nor cost-effective.

Colorectal cancer (CRC) is third in mortality rate amongst Asian Americans. However, CRC characteristics in this patient population have been poorly defined. A retrospective review at an urban tertiary hospital located in an underserved region was performed to determine CRC characteristics for Asian Americans in comparison to other races. Four hundred fourteen patients were represented by Hispanics (n = 161), African Americans (n = 101), Asians (n = 83), and Whites (n = 69). The majority of Asian American patients (n = 70,84%) presented with a left-sided lesion. This proportion was higher than that seen in African Americans (59%, P < 0.0003), Hispanics (66%, P < 0.0033), and Whites (63%, P < 0.0036). Thirty-six Asian American patients presented with Stage III disease which was the most frequent presenting stage for this patient population and also statistically higher than all the other races. Furthermore, Asian Americans in this study still presented predominantly with left-sided lesions and in a more advanced stage. These findings suggest a potential benefit of initially offering flexible sigmoidoscopy given the decreased compliance among Asian Americans to obtain routine CRC screening. Ultimately, this modality may be more acceptable, leading to higher compliance for CRC screening in Asian Americans without likely degradation in cancer detection rates.