James W. Fleshman M.D.

Haskins, I. N., J. W. Fleshman, R. L. Amdur and S. Agarwal (2016). “The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients.” J Surg Oncol 114(7): 810-813.

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BACKGROUND AND OBJECTIVES: The routine use of preoperative bowel preparation (BP) is heavily debated in the colorectal surgery literature. To date, no study has investigated the effect preoperative BP has on patients with an established anastomotic leak. We therefore seek to compare the severity of patient morbidity and mortality in patients with a known anastomotic leak based on type of preoperative BP using the Targeted Colectomy American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP). METHODS: All elective colon cancer operations performed with primary anastomosis were identified within the targeted colectomy database from 2012 to 2013. Patients who experienced a postoperative anastomotic leak were identified and stratified based on preoperative BP. Variables that had an association with mechanical BP at P < 0.10 were included in a multivariate logistic regression model to determine if BP was independently associated with postoperative morbidity and mortality. RESULTS: A total of 6,297 patients underwent elective colon resection with primary anastomosis for colon cancer. Two hundred and nineteen (3.5%) patients experienced an anastomotic leak. Thirty-day wound morbidity and mortality was not worse in patients who underwent preoperative BP. CONCLUSIONS: BP is not associated with worse patients outcomes in those patients with an established anastomotic leak following elective colon research with primary anastomosis.

Chadi, S. A., A. Fingerhut, M. Berho, S. R. DeMeester, J. W. Fleshman, N. H. Hyman, D. A. Margolin, J. E. Martz, E. C. McLemore, D. Molena, M. I. Newman, J. F. Rafferty, B. Safar, A. J. Senagore, O. Zmora and S. D. Wexner (2016). “Emerging trends in the etiology, prevention, and treatment of gastrointestinal anastomotic leakage.” J Gastrointest Surg 20(12): 2035-2051.

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Anastomotic leaks represent one of the most alarming complications following any gastrointestinal anastomosis due to the substantial effects on post-operative morbidity and mortality of the patient with long-lasting effects on the functional and oncologic outcomes. There is a lack of consensus related to the definition of an anastomotic leak, with a variety of options for prevention and management. A number of patient-related and technical risk factors have been found to be associated with the development of an anastomotic leak and have inspired the development of various preventative measures and technologies. The International Multispecialty Anastomotic Leak Global Improvement Exchange group was convened to establish a consensus on the definition of an anastomotic leak as well as to discuss the various diagnostic, preventative, and management measures currently available.

Chadi, S. A., A. Fingerhut, M. Berho, S. R. DeMeester, J. W. Fleshman, N. H. Hyman, D. A. Margolin, J. E. Martz, E. C. McLemore, D. Molena, M. I. Newman, J. F. Rafferty, B. Safar, A. J. Senagore, O. Zmora and S. D. Wexner (2016). “Emerging trends in the etiology, prevention, and treatment of gastrointestinal anastomotic leakage.” J Gastrointest Surg: 2016 Sep [Epub ahead of print].

Full text of this article.

Anastomotic leaks represent one of the most alarming complications following any gastrointestinal anastomosis due to the substantial effects on post-operative morbidity and mortality of the patient with long-lasting effects on the functional and oncologic outcomes. There is a lack of consensus related to the definition of an anastomotic leak, with a variety of options for prevention and management. A number of patient-related and technical risk factors have been found to be associated with the development of an anastomotic leak and have inspired the development of various preventative measures and technologies. The International Multispecialty Anastomotic Leak Global Improvement Exchange group was convened to establish a consensus on the definition of an anastomotic leak as well as to discuss the various diagnostic, preventative, and management measures currently available.

Haskins, I. N., J. W. Fleshman, R. L. Amdur and S. Agarwal (2016). “The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients.” J Surg Oncol: 2016 Sep [Epub ahead of print].

Full text of this article.

BACKGROUND AND OBJECTIVES: The routine use of preoperative bowel preparation (BP) is heavily debated in the colorectal surgery literature. To date, no study has investigated the effect preoperative BP has on patients with an established anastomotic leak. We therefore seek to compare the severity of patient morbidity and mortality in patients with a known anastomotic leak based on type of preoperative BP using the Targeted Colectomy American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP). METHODS: All elective colon cancer operations performed with primary anastomosis were identified within the targeted colectomy database from 2012 to 2013. Patients who experienced a postoperative anastomotic leak were identified and stratified based on preoperative BP. Variables that had an association with mechanical BP at P < 0.10 were included in a multivariate logistic regression model to determine if BP was independently associated with postoperative morbidity and mortality. RESULTS: A total of 6,297 patients underwent elective colon resection with primary anastomosis for colon cancer. Two hundred and nineteen (3.5%) patients experienced an anastomotic leak. Thirty-day wound morbidity and mortality was not worse in patients who underwent preoperative BP. CONCLUSIONS: BP is not associated with worse patients outcomes in those patients with an established anastomotic leak following elective colon research with primary anastomosis.

Glasgow, S. C., A. M. Morris, N. N. Baxter, J. W. Fleshman, K. S. Alavi, M. A. Luchtefeld, J. R. Monson, G. J. Chang and L. K. Temple (2016). “Development of the American Society of Colon and Rectal Surgeons’ rectal cancer surgery checklist.” Dis Colon Rectum 59(7): 601-606.

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BACKGROUND: There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality. OBJECTIVE: The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer. DESIGN: A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed. SETTINGS: The study was conducted through meetings and discussion to consensus. PATIENTS: Patient data were extracted from an initial literature review. MAIN OUTCOME MEASURES: The checklist was measured by its ability to improve care in complex rectal surgery cases by reducing the possibility of omission through the division of treatment into 3 distinct phases. RESULTS: The process generated a 25-item checklist covering the spectrum of care for patients with rectal cancer who were undergoing surgery. LIMITATIONS: The study was limited by its lack of prospective validation. CONCLUSIONS: The American Society of Colon and Rectal Surgeons rectal cancer surgery checklist is composed of the essential elements of preoperative, intraoperative, and postoperative care that must be addressed during the surgical treatment of patients with rectal cancer.