General Surgical Oncology Research Articles

A Novel Curriculum for Surgical Oncology Fellowship Training in West Africa.

Low- and middle-income countries (LMICs) lack the surgical capacity to contend with the growing burden of cancer care. West Africa is particularly affected, where limited cancer surgery is performed primarily by general surgeons without any subspecialty training. As a first step to develop surgical oncology capacity in the region, the West African College of Surgeons (WACS) in partnership with the Global Oncology Group at Queen's University, Canada, co-created a novel surgical oncology fellowship training program. Curriculum development began with a literature review of publications, global position statements, and curricular documents from surgical oncology societies and accreditation bodies. The results were reviewed by the WACS team members to reach consensus on the competencies and objectives of the program based on the perceived needs and available resources in West Africa. Iterative discussions between the Queen's Global Oncology Group and WACS leadership led to the creation of the surgical oncology curricular documents. A curriculum tailored to the West African context was developed to deliver essential knowledge, skills, and competencies for surgical oncologists in the region. The curriculum focuses on the six core domains of general surgical oncology, highlighting specific knowledge base and procedural skills within each clinical domain. Educational activities were outlined and the curriculum format, delivery, and trainee assessment were also described. A surgical oncology curriculum developed specifically for the West African context will enhance the capacity for cancer surgery in the region. This curriculum may serve as a model for future surgical oncology program development in LMICs.

Essential Elements in Synoptic Operative Reports for Hepato-Pancreato-Biliary Cancer Surgery: An HPB/CGSO Training Program Survey.

Synoptic operative reports (SORs) are checklists or templates that contain standardized elements of an operation. These elements are associated with standardized inclusion of critical elements of the operative report that translate into numerous potential benefits. Whereas SORs for melanoma, breast, and colorectal cancer surgery have already been widely implemented, similar templates for hepato-pancreato-biliary (HPB) cancer surgery are currently lacking. An anonymous voluntary online survey was distributed to HPB attendings and fellows at HPB and complex general surgical oncology (CGSO) fellowship programs. The 54 participants in this study comprised 31 (57%) HPB surgery attendings, 15 (28%) HPB surgery fellows, and 8 (15%) CGSO fellows. Notably, only six (11%) participants reported consistent use of an HPB SOR. The most commonly reported barriers to SOR uptake were the "lack of a readily available template" (55%) and the "lack of consensus/guidelines" (49%). Despite these limiting factors, a majority of respondents indicated a strong willingness to use a standardized and readily available HPB SOR (mean, 4.13/5 ± 1.23). This interest did not differ between attendings and fellows (p = 0.52) or between the participants stratified by surgical experience (p = 0.58).Finally, the participants were provided a comprehensive list of possible elements to incorporate into a standardized pancreatic and hepatobiliary SOR. After the exclusion of elements with less than 75% agreement, the pancreatic SORs included 17 (57%) of 30 possible elements, and the hepatobiliary SORs included 19 (76%) of 25 possible elements. Broad consensus on several elements of the HPB SOR suggests that uptake should be accelerated in HPB surgery.

763. TEXTBOOK ONCOLOGIC OUTCOME FOLLOWING TRIMODALITY THERAPY FOR ESOPHAGEAL ADENOCARCINOMA

Abstract Background Although the concept of textbook oncologic outcome (TOO) as an emerging quality benchmark has been validated in the general surgical oncology literature, data regarding the frequency of achieving TOO and its impact on subsequent survival outcomes in patients with esophageal adenocarcinoma (EAC) who undergo trimodality therapy remain undefined. Methods Patients with adenocarcinoma of the esophagus/gastroesophageal junction (GEJ, Siewert I/II) who underwent neoadjuvant chemoradiation and esophagectomy at a single institution (2000-2022) were retrospectively identified. Patients undergoing salvage resection were excluded. TOO was defined according to a published consensus definition: length of stay (LOS) ≤14 days, R0, ≥20 resected lymph nodes, no anastomotic leak (any grade), no Clavien-Dindo (CD) grade ≥3 complications, no hospital or intensive care unit (ICU) readmission, and no reoperation. Multivariable logistic regression was used to identify clinicopathologic features associated with TOO. Multivariable Cox regression and landmark analyses were used to quantify the association between TOO and OS. Results Of 1138 patients, TOO was observed in 38.2% (435): 90.9% (1034) R0, 60.9% (693) ≥20 lymph nodes, 89.9% (1023) no anastomotic leak, and 98.4% (1120) no in-hospital mortality. Features independently associated with reduced odds of TOO included: cervical anastomosis (OR 0.50, P=0.001), preoperative delay ≥90 days after neoadjuvant therapy (OR 0.62, P=0.004), induction chemotherapy (OR 0.74, P=0.039), coronary artery disease (OR 0.67, P=0.043). Among patients who underwent esophagectomy <90 days after neoadjuvant therapy and survived ≥30 days, TOO was independently associated with improved OS (HR 0.80, P=0.018). TOO remained associated with improved OS using 90-day (P=0.014) and 120-day (P=0.037) landmarks. Conclusions Although TOO is difficult to achieve following trimodality therapy for EAC, it is strongly associated with improved long-term overall survival. As such, further efforts are warranted to explore the utility of TOO as a quality benchmark in EAC patients and to validate its impact across varying practice settings.

Resident and Fellow Performance and Supervision in Surgical Oncology Procedures.

Previous research has highlighted concerns among trainees and attendings that general surgery training and fellowship are inadequately preparing trainees for practice. Providing trainees with supervision that matches their proficiency may help bridge this gap. We sought to benchmark operative performance and supervision levels among senior surgery residents (post-graduate year 4 or 5) and fellows performing general surgical oncology procedures. Observational data were obtained from the Society for Improving Medical Procedural Learning (SIMPL) OR application for core general surgical oncology procedures performed at 103 unique residency and fellowship programs. Procedures were divided into breast and soft tissue, endocrine, and hepatopancreatobiliary (HPB). Case evaluations completed by trainees and attendings were analyzed to benchmark trainee operative performance and level of supervision. There were 4,907 resident cases and 425 fellow cases. Practice-ready performance, as assessed by trainees and faculty, was achieved by relatively low proportions of residents and fellows for breast and soft tissue cases (residents: 38%, fellows: 48%), endocrine cases (residents: 22%, fellows: 41%), and HPB cases (residents: 10%, fellows: 40%). Among cases in which trainees did achieve practice-ready performance, supervision only was provided for low proportions of cases as rated by trainees (residents: 17%, fellows: 18%) and attendings (residents: 21%, fellows 25%). In a sample of 103 residency and fellowship programs, attending surgeons rarely provided senior residents and fellows with levels of supervision commensurate to performance for surgical oncology procedures, even for high performing trainees. These findings suggest a critical need for surgical training programs to prioritize providing greater levels of independence to trainees that have demonstrated excellent performance.

Defining the learning curve for robotic pancreaticoduodenectomy for a single surgeon following experience with laparoscopic pancreaticoduodenectomy.

Robotic pancreaticoduodenectomy (RPD) has a learning curve of approximately 30-250 cases to reach proficiency. The learning curve for laparoscopic pancreaticoduodenectomy (LPD) at Duke University was previously defined as 50 cases. This study describes the RPD learning curve for a single surgeon following experience with LPD. LPD and RPD were retrospectively analyzed. Continuous pathologic and perioperative metrics were compared and learning curve were defined with respect to operative time using CUSUM analysis. Seventeen LPD and 69 RPD were analyzed LPD had an inverted learning curve possibly accounting for proficiency attained during the surgeon's fellowship and acquisition of new skills coinciding with more complex patient selection. The learning curve for RPD had three phases: accelerated early experience (cases 1-10), skill consolidation (cases 11-40), and improvement (cases 41-69), marked by reduction in operative time. Compared to LPD, RPD had shorter operative time (379 vs 479min, p < 0.005), less EBL (250 vs 500, p < 0.02), and similar R0 resection. RPD also had improved LOS (7 vs 10days, p < 0.007), and lower rates of surgical site infection (10% vs 47%, p < 0.002), DGE (19% vs 47%, p < 0.03), and readmission (13% vs 41%, p < 0.02). Experience in LPD may shorten the learning curve for RPD. The gap in surgical quality and perioperative outcomes between LPD and RPD will likely widen as exposure to robotics in General Surgery, Hepatopancreaticobiliary, and Surgical Oncology training programs increase.

A Single Center Exploratory Survey of Patients and Nurses on post-Surgical Oral Opioid Delivery Through Patient-Controlled Analgesia.

The most common route of opioid delivery is nurse-administered pills. However, there are numerous challenges such as nursing burden, opioid diversion, medication delay, and patient dissatisfaction. In this study, we conducted two surveys, first to assess patients' and nurses' opinions on the current administration of opioids in pill form, followed by their attitudes towards an innovative concept of oral medication delivery based on a medical device currently undergoing research and development within the University, patient-controlled dispenser and deactivator (PCDD) that allows patients to self-administer liquid oral opioids on demand based on physician prescription. Questionnaires were developed, verified and deployed to assess nurse and post-surgical patient opinions on the current administration of opioids in pill form, as well as the proposed new concept of patient -controlled administration of oral liquid medication via an illustration of PCDD, from September 2022 through July 2023 at a major academic tertiary care center. Quantitative and qualitative data were collected from postoperative patients and nurses from surgical specialties including General Surgery, Surgical Oncology, Trauma Surgery, Orthopedics, and Neurosurgery. Forty-three patients and 53 nurses were interviewed. Seventy percent of patients frequently called nurses for pain medication post-surgery 1-4 times daily, and 32% of patients were told each day by nurses that they could not receive medication because they were not due yet. Medication delay caused 24% of patients to worry about nursing availability for medication delivery. Likewise, nurses reported that half of patients receive delayed medication (22 minutes median delay time) and half of nursing time was spent administering pain medication. Nurses expressed moderate satisfaction with their current delivery of medication (median satisfaction score 6.5 out of 10). When being introduced to the concept of PCDD via a product illustration, 15% of patients said that they prefer liquid medication and 51% said they prefer PCDD or were interested in trying it. Nurse-administered pills are a common but suboptimal method for postoperative pain management. Based on patient and nurse feedback, patient controlled self-administered liquid oral opioid delivery is conceptually innovative, practically viable and potentially a preferred alternative for timely and less nurse-exhaustive pain management.

OBSTRUCTIVE JAUNDICE: ETIOLOGY AND PATTERN OF PRESENTATION

Surgical jaundice mainly occurs due to obstruction in any duct from the liver to the gall bladder and then the small intestine. It can be divided into intra-hepatic or extra-hepatic causes. Biliary stones, iatrogenic or ischemic biliary stricture, pseudo-pancreatic cysts, carcinoma of the head of the pancreas, and periampullary carcinomas are common pathologies of obstructive jaundice. Common bile duct stones account for 10-15% of biliary stone disease and are the most common cause of obstructive jaundice. Obstructive jaundice presents with a wide range of associated features. Ultrasonography, MRCP, and ERCP are the primary diagnostic tools for diagnosing and managing obstructive jaundice, in addition to blood tests. This study aims to determine the pattern of presentation and causes of obstructive jaundice. This observational, retrospective study was conducted in general surgery and surgical oncology unit 2 of Sheikh Zayed Hospital, Lahore. The study lasted from January 2022 to April 2023. A non-probability convenience sampling technique was used. A total of 55 patients with obstructive jaundice were presented in the study area in a defined period, which included 17 (30.90%) males and 38 (69.09%) females. The mean age was 49 years, with age ranges from 28 years to 80 years. 13 (23.66%) patients were found to have malignant disease, whereas 42 (76.33%) patients presented with benign disease. The most common malignant cause of obstructive jaundice was carcinoma head of the pancreas (10.90%), whereas the least common causes were cholangiocarcinoma (1.82%), carcinoma gall bladder (1.82%) and malignant biliary stricture (1.82%). The most common benign cause and overall most common cause of obstructive jaundice was choledocholithiasis (32.73%), followed by referred biliary injuries (18.18%). The most common clinical feature presented in benign causes of obstructive jaundice was jaundice (100%), followed by itching (71.4%) and abdominal pain (64.28%). The most common clinical feature in malignant causes of obstructive jaundice was jaundice (100%), followed by loss of appetite (84.61%) and weight loss (84.61%). Female was the most common gender presented with obstructive jaundice. The most common benign cause of obstructive jaundice was Choledocholithiasis, while the most malignant cause was carcinoma head of the pancreas.

A prospective audit to assess the feasibility of sentinel lymph node biopsy and/or low axillary sampling in clinicoradiologically node-negative axilla for early breast carcinoma

Background: Sentinel lymph node (SLN) dissection was designed to minimize side effects of lymph node surgery but still offer outcomes of axillary lymph node dissection. Aims and Objectives: Our study is designed to determine whether SLN resection achieves the same therapeutics outcome as complete axillary dissection but with fewer side effects for node-negative axilla in clinicoradiologically operable breast cancer patients. Materials and Methods: Duration-based prospective observational study was carried out at the General Surgery and Surgical Oncology Department at Government Medical College and Hospital, Aurangabad with a duration of 2 ½ years from July 2019 to January 2022. A total of 36 patients of breast cancers with stages T1-T2, N0 with clinically and radiologically negative axilla from July 2019 to January 2022 duration were included in our study. Results: When the histopathological status of axillary lymph nodes was compared to the histopathology of SLNs it was seen that out of 36 patients, the histopathology of sentinel node was positive in 10 patients (10/36) however the rest of the axilla was positive in 6 cases and negative in 4 cases and the histopathology sentinel node was negative in 26 patients out of 36 cases (26/36) however the rest of the axilla was also negative in 24 cases and positive in 2 cases. Conclusion: SLN biopsy using methylene blue dye alone is a highly reliable and predictable technique to stage the axilla in breast cancer patients as this study shown a low false-negative rate (7.69%). This technique may help to avoid complete axillary lymph node dissection in sentinel node-negative patients thereby minimizing the morbidity of axillary lymph node dissection. This study demonstrates that sentinel node localization is possible with methylene blue dye alone.

ASO Visual Abstract: Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study.

ASO Visual Abstract: Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study.

Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study

BackgroundSurgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model.MethodsThe Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022.ResultsThe overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being “very prepared”. Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery.ConclusionsThis study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.

Trends in Racial and Gender Diversity Among Complex General Surgical Oncology Fellowship Trainees.

This study examines trends in racial and gender diversity of trainees within Complex General Surgical Oncology Fellowships, and compares the racial and gender proportions of trainees across different fields to assess potential barriers to increasing diversity within surgical oncology training programs. Accredited Council for Graduate Medical Education (ACGME) data were queried to identify surgical trainees between 2013 and 2021. Trainees were identified based on self-reported race and gender and were stratified based on residency type and fellowship program type if applicable. Chi-square tests were used to assess differences between groups and trends. A significantly lower proportion of individuals who are underrepresented in medicine (URMs) trained in surgical oncology fellowships (8.9%) compared with both the overall trainee pool (12.8%) and general surgery residency programs (13.1%) [p<0.05]. There was no significant increase in URM representation in surgical oncology fellowships across the study period. Furthermore, there was a significantly lower proportion of females training in surgical oncology fellowships (38.6%) compared with the overall trainee pool (45.6%) [p<0.05]. Despite a significant increase in female representation in general surgery residency and other surgical fellowships, there was no significant increase in female representation in surgical oncology fellowships across the study period. This study identifies disparities in gender and racial minority representation within ACGME-accredited Complex General Surgical Oncology Fellowship training programs. While steps have been taken to expand diversity, more needs to be done to combat the systemic barriers that both racial minorities and women face during their training.

Learning Curves in Establishing a New Minimally Invasive Pancreas Program.

Robotic pancreaticoduodenectomy (rPD) is a complex operation with a reported learning curve of 80 cases. Two recent graduates of a formal robotic complex general surgical oncology training program have been performing rPD at our institution since 2016, which had no previous institutional experience with rPD. To evaluate the learning curve associated with developing a new robotic pancreaticoduodenectomy (rPD) program by fellowship trained surgeons with institutional support. Sixty patients undergoing rPD from 2016 to 2022 were reviewed for and compared with proficiency benchmarks set by the University of Pittsburg experience. By 30 cases, operative time met the proficiency benchmark of 391minutes. Additionally, the entire cohort had comparable rates of clinically relevant postoperative pancreatic fistula (6.7% vs 3%, P = .6), 30-day mortality (0% vs 3%, P = .18), major complications (Clavien >2; 23% vs 17%, P = .14), and length of stay (6 vs 7days, P = .49) when compared to the benchmark. Perioperative outcomes were comparable to proficiency benchmarks from initiation of the new rPD program, and operative time reached proficiency benchmark by 30 cases. This data suggests that graduates of formal rPD training programs can safely establish new minimally invasive pancreas programs at sites with no previous institutional rPD experience.

ASO Visual Abstract: Assessing the Complex General Surgical Oncology Pipeline-Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

ASO Visual Abstract: Assessing the Complex General Surgical Oncology Pipeline-Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

Assessing the Complex General Surgical Oncology Pipeline: Trends in Race and Ethnicity Among US Medical Students, General Surgery Residents, and Complex General Surgical Oncology Trainees.

Cancer incidence is expected to increase in coming decades, disproportionately so among minoritized communities. Racially and ethnically concordant care is essential to addressing disparities in cancer outcomes within at-risk groups. Here, we assess trends in racial and ethnic representation of medical students (MS), general surgery (GS) residents, and complex general surgical oncology (CGSO) fellows. This is a retrospective review of data from the American Association of Medical Colleges and the Accreditation Council of Medical Education (ACGME) from 2015 to 2020. Self-reported race and ethnicity was obtained for MS, GS, and CGSO trainees. Race and ethnicity proportions were compared with respective representation in the 2020 US Census. Mann-Kendall, Wilcoxon rank sum, and linear regression were used to assess trends, as appropriate. A total of 316,448 MS applicants, 128,729 MS matriculants, 27,574 GS applicants, 46,927 active GS residents, 710 CGSO applicants, and 659 active CGSO fellows were included. With every progressive stage in training, there was a smaller proportion of URM active trainees than applicants. Further, URM, Hispanic/Latino, and Black/African American trainees were significantly underrepresented compared with 2020 Census data. While the proportion of White CGSO fellows increased over time (54.5-69.2%, p = 0.009), the proportion of Black/African American and Hispanic/Latino (URM) CGSO fellows did not significantly change over the study period, though URM representation was lower in 2020 as compared with 2015. From 2015 to 2020, minority representation decreased at every advancing stage in surgical oncology training. Efforts to address barriers for URM applicants to CGSO fellowships are needed.

A propensity score matching analysis: Impact of senior resident versus fellow participation on outcomes of complex surgical oncology

BackgroundTeaching hospitals that train both general surgery residents and fellows in complex general surgical oncology have become more common. This study investigates whether participation of a senior resident versus a fellow has an impact on outcomes of patients undergoing complex cancer surgery. MethodsPatients who underwent esophagectomy, gastrectomy, hepatectomy, or pancreatectomy between 2007 and 2012 with assistance from a senior resident (post-graduate years 4–5) or a fellow (post-graduate years 6–8) were identified from the ACS NSQIP. Based on age, sex, body mass index, ASA classification, diagnosis of diabetes mellitus, and smoking status, propensity-scores were created for odds of undergoing the operation assisted by a fellow. Patients were matched 1:1 based on propensity score. Postoperative outcomes including risk of major complication were compared after matching. ResultsIn total, 6934 esophagectomies, 13,152 gastrectomies, 4927 hepatectomies, and 8040 pancreatectomies were performed with assistance of a senior resident or fellow. After matching, overall rates of major complications were equivalent across all four anatomic locations between cases performed with the participation of a senior resident versus a surgical fellow: esophagectomy (37.0%% vs 31.6%, p = 0.10), gastrectomy (22.6% vs 22.3%, p = 0.93), hepatectomy (15.8% v 16.0%, p = 0.91), and pancreatectomy (23.9% vs 25.2%, p = 0.48). Operative time was shorter for gastrectomy (212 vs. 232 min; p = 0.004) involving a resident compared to a fellow, but comparable for esophagectomy (330 vs. 336 min; p = 0.41), hepatectomy (217 vs. 219 min; p = 0.85), and pancreatectomy (320 vs. 330 min; p = 0.43). ConclusionsSenior resident participation in complex cancer operations does not appear to negatively impact operative time or postoperative outcomes. Future research is needed to further assess this domain of surgical practice and education, particularly with regard to case selection and operative complexity.

ASO Author Reflections: Is the Future Ripe for Integrated Complex General Surgical Oncology Residency Training?

ASO Author Reflections: Is the Future Ripe for Integrated Complex General Surgical Oncology Residency Training?

Current status and the necessity for enterostomy training: Results of a national survey in China

Objective: To investigate the perceptions, attitudes, and surgical strategies of Chinese surgeons, toward stoma management. Methods: We conducted a nationwide, cross-sectional, questionnaire-based survey among individuals working at relevant departments in any tier of hospitals, including general surgery, gastrointestinal surgery, surgical oncology, emergency, and others, that was involved in managing enterostomies. We required that participants be senior surgeons who had participated in performing enterostomy surgery. The questionnaire consisted of five dimensions: personnel qualification and training, attitude toward ostomy complications, preoperative siting, the process of acquiring ostomy-related surgical skills, and awareness and adoption of relevant techniques. Descriptive statistical analysis was performed. Results: From July 2021 to July 2022, we sent 488 questionnaires through a WeChat link or two-dimensional barcode. We received 467 (95.7%) responses from 196 hospitals in 26 provinces. Among the respondents, 426 (91.2%) were from tertiary hospitals, the departments of which comprised general surgery (130, 27.8%), gastrointestinal surgery (210, 45.0%), surgical oncology (116, 24.8%), and other departments (11, 2.4%). Senior surgeons accounted for 311(66.6%) of the participants. We found that: (1) mentorship by senior surgeons was the primary source of knowledge about ostomies (83.3%, 389/467), followed by mentorship by others and surgical atlases (44.8%, 209/467), and self-education (42.0%, 196/467). (2) Concerns about correlations between complications and surgical procedures that were believed to be "closely" or "probably" related to complications (79.0%, 369/467) were expressed by 99.4% (464/467) of the surgeons. Stenosis and intestinal obstruction requiring unplanned surgery were not uncommon (61.0%, 285/467). Of the listed complications, 46.7% (218/467) were believed to be related to surgical procedures and 79.0% (369/467) avoidable. Only 58.7% (274/467) of surgeons had participated in training and discussion of stoma complications whereas 99.1% (463/467) believed that joint training and discussions between surgeons and enterostomal therapists were necessary. (3) The main reasons for creation of stomas that were not consistent with prior siting included: stoma site marked preoperatively not a suitable trocar site (56.1%, 262/467), defunctioning stoma marking according to standards for permanent stomas (50.7%, 237/467), and inappropriate marking (43.3%, 202/467). (4) The rate of awareness of relevant procedures was generally high; however, it was less than 75% for stoma creation by circular stapler (64.1%, 257/401) and parastomal drainage (44.1%, 177/401). Eversion suture of mucosa and supporting rods were utilized in 65.6% (263/401) and 56.4% (226/401), respectively. Peritoneum (or posterior rectus abdominis sheath) (68.3%, 274/401), anterior rectus abdominis sheath (54.4%, 218/401), and skin (80.6%, 323/401) were the most commonly used tissues for fixation and suture layers of defunctioning and permanent stomas. However, closure of subcutaneous tissue was controversial, suturing being advocated by 26.7% (107/401) and 32.7% (131/401) of surgeons, respectively. Complications were considered to depend mainly on technical skills rather than the amount of suturing by 81.5% (327/401) of the participating surgeons. Conclusions: The complications of stoma surgery are related to the awareness and technical skills of surgeons, indicating there are insufficient training, education, management, and research. Standardization of enterostomy technical strategies and stoma management are therefore imperative.

ASO Visual Abstract: Application and Match Rates in the Complex General Surgical Oncology Match.

ASO Visual Abstract: Application and Match Rates in the Complex General Surgical Oncology Match.

Feasibility of perioperative remote monitoring of patient-generated health data in complex surgical oncology.

The feasibility of remote perioperative telemonitoring of patient-generated physiologic health data and patient-reported outcomes in a high risk complex general and urologic oncology surgery population is evaluated. Complex general surgical/urologic oncology patients wore a pedometer, completed ePROs (electronic patient-reported outcome surveys) and record their vitals (weight, pulse, pulse oximetry, blood pressure, and temperature) via a telehealth app platform. Feasibility (% adherence) was assessed as the primary outcome measure. Twenty-one patients with a median age 58 (32-82) years were included. The readmission rate was 33% and the incidence of ≥Grade 3a morbidity was 24%. Adherence to vital sign and ePRO measurements was 95% before surgery, 91% at discharge, and 82%, 68%, and 64% at postdischarge d2, 7, 14, and 30, respectively. There was significant worsening of mobility, self-care and usual daily activity at postdischarge d2 compared to preoperative baseline (p < 0.05). Median daily preoperative steps taken by patients with <Grade 3a versus ≥Grade 3a postoperative morbidity was 6062 versus 4166 (p < 0.05). Of those interviewed, 87% (13/15) viewed vital sign devices as helpful in recovery. Telemonitoring is feasible in a general surgical and urologic oncology setting. Future studies will ascertain optimal patient selection, duration, and extent of perioperative monitoring.

Application and Match Rates in the Complex General Surgical Oncology Match.

BackgroundThe Society of Surgical Oncology collaborates with the National Resident Matching Program (NRMP) to facilitate the Complex General Surgical Oncology (CGSO) Match.ObjectiveThe purpose of this study was to understand trends in CGSO Match outcomes. We hypothesized that (1) match rates would increase with time; (2) US allopathic graduates would have higher match rates than non-US allopathic graduates; and (3) most applicants would match at one of their top three ranked choices.MethodsThe NRMP provided applicant and program data from the CGSO Match (2014–2021). Chi-square tests elucidated temporal trends and match rates by applicant archetype.ResultsThe annual number of applicants decreased from 103 to 90 (13% decrease), while the annual number of fellowship positions increased from 56 to 67 (20% increase) from 2014–2021. The annual percentage of applicants who did not match decreased from 46% to 26% (p < 0.05). Annual match rates increased from 54% to 74% (p < 0.05). US allopathic graduates had higher match rates than non-US allopathic graduates but this disparity narrowed over time (84% vs. 55% in 2021; p < 0.001). Approximately half of all applicants matched at one of their top three choices (first, 29%; second, 12%; third, 8%). Applicants matching at one of their top three choices increased from 36% to 50% (p < 0.05).ConclusionsCGSO Match rates have increased over the past decade, thus primarily benefiting non-US allopathic graduates. Most applicants match at one of their top three choices. More research is needed to understand disparities in match rates by applicant and residency program characteristics.