Focal Cancer in Colitis.

Colorectal cancer (CRC) is a known complication of inflammatory bowel disease (IBD). Widely accepted guidelines recommend that patients with ulcerative colitis diagnosed with CRC undergo total proctocolectomy with or without ileal pouch-anal anastomosis, and that patients with Crohn's disease and CRC undergo either total colectomy or proctocolectomy. These approaches are ideal for preventing synchronous and metachronous cancer, minimizing risk of refractory colitis requiring reoperation, and is the appropriate treatment for the vast majority of patients with IBD who are diagnosed with CRC and require surgical intervention. Segmental colectomy, however, may be considered in select patients with IBD and CRC, specifically in elderly patients with short disease duration, in patients with mild colitis identified preoperatively, in patients with high operative risk and prohibitive comorbidities, and in patients whose CRC appears to be sporadic as opposed to colitis-associated. Patients undergoing segmental resection must be closely surveilled postoperatively for dysplasia, recurrent cancer, and refractory colitis.

Colon and Rectal Surgery Residency Selection Criteria: A National Program Director Survey.

OBJECTIVE: Colon and Rectal Surgery has established itself as a highly competitive specialty over recent years, with demand for residency positions growing and becoming increasingly difficult to obtain each year. However, limited information exists as to which characteristics make for a successful colorectal surgery applicant. This study aims to identify which academic benchmarks and applicant characteristics impact successful matriculation into Colon and Rectal Surgery residency. DESIGN: Each Colon and Rectal Surgery residency program was sent a web-based survey comprised of 28 questions. Questions were designed to assess which factors were considered when evaluating an applicant prior to offering an interview and during rank determination. SETTING: The study was conducted as an anonymous web-based survey. PARTICIPANTS: Each Colon and Rectal Surgery residency program in the United States accredited by the Accreditation Council for Graduate Medical Education (N = 63) was included in the study. Forty-four of 63 programs completed the survey for an overall response rate of 70%. RESULTS: Ninety-one percent of the programs reported having a prerequisite American Board of Surgery In-Training Examination score for interview, with 50% of these programs requiring scores above the 50th percentile. During the ranking process, the most important factors considered by programs were interpersonal skills and communication, letters of recommendation, and interaction with other applicants and nonclinical staff. The majority of program directors felt that interview performance was the most important factor in ranking an applicant highly. CONCLUSIONS: Successful matriculation into Colon and Rectal Surgery requires the applicant to achieve the necessary academic benchmarks while also demonstrating a variety of desirable characteristics, which are most importantly assessed during an interview.