Association Of Coloproctology Of Great Britain And Ireland Research Articles

From meeting presentation to peer-review publication--a UK review.

Annual academic surgical meetings provide a forum for the discussion of research. For the wide-spread dissemination of this information, peer-reviewed publication is required. The aim of this study was to compare the amount of presentations which go on to publication from 4 UK-based surgical meetings. We determined whether a presentation had led to a successful publication using PubMed, a median of 28 months following each meeting. We compared the ASGBI publication rate with the meetings of the Vascular Surgical Society (VSSGBI), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Transplantation Society (BTS). We also compared the median impact factor of journals used. The ASGBI and BTS had a similar rate of presentations resulting in publication, with 35% and 36% at 2 years, respectively. The VSS had a significantly greater proportion of presentations resulting in publication (54% at 2 years; P = 0.004), whilst the ACPGBI had significant fewer (24% at 2 years; P = 0.006). There was no difference in the median impact factors of the journals used between the meetings (Kruskal Wallis P = 0.883). There is a significant variation between meetings in terms of turning presentations into publications. However, the majority of abstracts have still not been fully published within 2 years of presentation at the meeting.

Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer

To study circumferential margin involvement (CMI) in patients undergoing restorative, compared with nonrestorative, surgery for rectal cancer. Descriptive multicentre study, using routinely collected clinical data from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) Bowel Cancer Audit database. The study encompassed 1403 newly diagnosed patients with rectal cancer undergoing either restorative (anterior resection (AR)), or nonrestorative (abdominoperineal excision of rectum (APER) or Hartmann's procedure), surgery. Operations were carried out in 39 hospitals during a variable period between April 1999 to March 2002. A logistic regression analysis was used to control for variables associated with circumferential margin involvement. One thousand and thirty-six patients satisfied the inclusion criteria. The average CMI was 12.5% (range 0-33.3% between hospitals). CMI for anterior resection was 7.5% (n = 629) compared with a CMI of 16.7% for APER (n = 306) and a CMI of 31.7% for Hartmann's procedure (n = 101); P < or = 0.001. CMI for patients undergoing curative surgery was 7.1% (423 anterior resections, CMI 3.8% (n = 16); 181 APER, CMI 13.3% (n = 24); 29 Hartmann's procedure, CMI 17.2%). On multivariate analysis, having controlled for Dukes' stage and operative intent, the CMI was significantly different between APER and AR (odds ratio 3.3, 95%CI 2.0-5.4), but less so between Hartmann's procedure and AR (odds ratio 2.2, 95%CI 1.1-4.2). APER is associated with a significantly higher CMI than anterior resection. Attention to surgical technique, with a wide perineal dissection and the use of pre-operative adjuvant therapy, may reduce CMI in patients undergoing APER.

Laparoscopic colorectal surgery in Great Britain and Ireland – Where are we now?

We aimed to gather information from the members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) to assess trends in the current practice of laparoscopic colorectal surgery. A postal questionnaire survey of the members of ACPGBI. The response rate was 37% (200/540). Only 45 surgeons currently perform laparoscopic colorectal work in Great Britain and Ireland mainly right hemicolectomy and laparoscopic stoma formation, of these about one third practiced laparoscopy for benign colorectal conditions only. The majority (68%) of surgeons had enough resources at their place of work, but further training seemed to be a major issue. Nearly 22% of surgeons had not had any formal training. Only 50% of surgeons trained their specialist registrars. The incidence of conversion rate was not different for benign or malignant conditions and also did not appear to be related to the duration of experience. Only four surgeons had noted port a site recurrence during the past 10 years. Seventy-five percent (150/200) felt that laparoscopic colorectal work could be carried out safely in a District General Hospital. Laparoscopic colorectal surgery was being performed by a small minority of members of the ACPGBI although more surgeons had started to work in this field in recent years. The main areas of concern appeared to be a wide variation in the range of experience as indicated by the number of operations performed and limited formal training for consultants.

Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models

To review two predictive models, based on the American Society of Anaesthesiologists (ASA) and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM)-used for estimating postoperative mortality in patients, undergoing surgery for colorectal disease, in the UK. Data was derived from three multicentre, UK-based studies involving a total of 16,006 patients with malignant or non-malignant bowel pathologies. Data sources were: The Colorectal-POSSUM (CR-POSSUM) Study population, comprising 6883 patients undergoing colorectal surgery in 15 UK hospitals between 1993 and 2001; The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Colorectal Cancer (CRC) Database, encompassing 8077 newly diagnosed CRC patients, undergoing surgical resections in 79 hospitals, between April 2000 and March 2002; The ACPGBI Malignant Bowel Obstruction (MBO) Study, encompassing 1046 patients with MBO in 148 hospitals, treated between April 1998 and March 1999. Multifactorial logistic regression analyses were used to adjust for case-mix, identify risk factors for in-hospital/30-day operative mortality and to accommodate the variability of outcomes between hospitals. In the ACPGBI CRC study, 7374 patients had surgery, 6622(89.8%) a major bowel resection and 1465(19.9%) emergency surgery. Nine hundred and eighty-nine (94.6%) patients with MBO had surgery and 854(86.3%) underwent bowel resection. In the CR-POSSUM study, of the 6790(98.6%) patients undergoing surgery, 3451(50.8%) had a major colorectal resection, including 2107(31.0%) as an emergency. The operative mortality was 7.5% for the ACPGBI CRC study, 15.7% for patients with MBO and 5.7% for patients in the CR-POSSUM study. When tested, the predictive models showed good discrimination, with an area under the receiver-operator characteristic curve of 77.5% for the ACPGBI CRC, 80.1% for the MBO and 89.8% for the CR-POSSUM. Prediction of postoperative death can be made by the clinician using simple, numerical, tables derived from the ACPGBI CRC, MBO and CR-POSSUM models. The models can be used in everyday practice for pre-operative counselling of patients and their carers, as a part of the process of informed consent. They may also be used to compare the outcomes between multidisciplinary CRC teams.

Operative mortality in colorectal cancer: prospective national study

Objective To develop a mathematical model that will predict the probability of death after surgery for colorectal cancer.Design Descriptive study using routinely collected clinical data.Data source The database of the...

The contemporary management of haemorrhoids.

New concepts in the management of haemorrhoidal disease have recently rekindled interest in this common pathology. General and subspecialist colorectal surgeons were surveyed to assess their impact on the current management of haemorrhoids. A questionnaire was sent to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the Association of Surgeons of Great Britain and Ireland (ASGBI). Regarding indications for surgery, surgical techniques, day case haemorrhoidectomy (DCH) and postoperative treatment regimens. ASGBI members were asked to state their subspecialist interest and estimated time devoted to colorectal practice. There were 406 (71%) ACPGBI respondents and 483 (68%) ASGBI respondents. Eighty-four (12%) ASGBI respondents performed no elective colorectal surgery. One hundred and ninety-nine (35%) of ACPGBI respondents saw between 6 and 10 new haemorrhoid patients per week whereas three hundred (42%) of ASGBI respondents saw between 1 and 5 per week. Non-operative management included routine advice on fluid and diet by the majority of surgeons, with banding carried out in 79% (ACPGBI) and 75% (ASGBI) and injection sclerotherapy in 61% (ACPGBI) and 56% (ASGBI). The Milligan Morgan haemorrhoidectomy was performed in 265 (46%; ACPGBI) and 336 (47%; ASGBI). ACPGBI members used Submucosal diathermy (148, 26%vs 67, 9%; ASGBI (P < 0.01; chi2 test with Yates correction)) and stapled anoplasty (61, 11%vs 14, 2%; ASGBI (P < 0.01; chi2 test with Yates correction)) more often. DCH was performed in 117 (20%; ACPGBI) and in 48 (7%; ASGBI)(P < 0.01; chi2 test with Yates correction). In this sample of surgeons, operative management varies according to specialist interest. There was a trend towards day case haemorrhoidectomy. Whilst more surgeons have accepted the use of postoperative techniques to reduce pain, only a small minority have, as yet, adopted new surgical techniques such as stapling.

List of members of the Council of The Association of Coloproctology of Great Britain and Ireland (ACGBI)

List of members of the Council of The Association of Coloproctology of Great Britain and Ireland (ACGBI)