John RT Monson

• MB, BCh, BAO, MD, FRCS (Ire, Eng, Ed (Hon), , FACS
• Managing Director at Florida Hospital

Background Management of rectal cancer has a number of potentially appropriate alternatives for each patient. Despite acceptance of standards, practices may vary among regions. There is significant paucity of data in this area. The objective was to create a snapshot of the regional differences. Design This online survey included 10 questions. Enqu...

A 61‐year‐old female presented to her primary care provider with painless bleeding per rectum and pelvic fullness. Digital rectal exam noted an anterior 5‐6 cm, firm, minimally‐mobile mass in the distal rectum. Colonoscopy confirmed a 5 cm ulcerated mass 2‐3 cm proximal and anterior to the dentate line. After failed endoscopic biopsy, a trans‐anal...

Background: Early observational data suggest that this approach is safe and feasible, but it is technically challenging and the learning curve has not yet been determined. The objective of this study was to determine the number of cases required achieve proficiency in transanal total mesorectal excision (TA-TME) for rectal adenocarcinoma. Methods...

Introduction: Opioid analgesia remains the mainstay of postoperative pain management strategies despite being associated with many adverse effects. A specific opioid-free protocol was designed to limit opioid usage. Objective: The aim of the study was to audit the opioid-free rate within this protocol and to identify factors that might contribut...

Background: The role of primary tumor resection (PTR) for asymptomatic stage IV colon cancer with unresectable metastases remains unclear. Increasingly there has been a trend away from resection. The aim of this study was to examine trends in the treatment of stage IV colon cancers, impact of different treatments on long-term mortality, and factor...

Background: The management of patients with a complete clinical response after neoadjuvant therapy for rectal adenocarcinoma is controversial. Those who advocate for resection point out the inaccuracy of N-staging with current imaging modalities. The objective of this study is to determine the impact of residual nodal involvement after complete tu...

Background: Current standards for lymph node harvest in colorectal cancer surgery may be inadequate. Higher lymph node yield may improve survival, but the number of lymph nodes needed to optimize survival is unknown. The objective of this study was to examine the relationship between lymph node yield and overall survival in patients undergoing col...

Background: Carbon dioxide embolus has been reported as a rare but clinically important risk associated with transanal total mesorectal excision surgery. To date, there exists limited data describing the incidence, risk factors, and management of carbon dioxide embolus in transanal total mesorectal excision. Objective: This study aimed to obtain...

Local excision is a safe alternative to radical resection for benign lesions and early rectal cancer. Technological advances in local excision, such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS), have led to improved pathologic specimens with higher negative margin rates and less specimen fragmentation...

Background/aims: Transfusion rates in colon cancer surgery are traditionally very high. Allogeneic red blood cell (RBC) transfusions are reported to induce immunomodulation that contributes to infectious morbidity and adverse oncologic outcomes. In an effort to attenuate these effects, the study institution implemented a universal leukocyte reduct...

Background Minimally invasive surgery (MIS) may improve surgical recovery and reduce time to adjuvant systemic therapy after colon cancer resection. The objective of this study was to determine the effect of MIS on the initiation of adjuvant systemic therapy and survival in patients with stage III colon cancer. Methods The 2010–2014 National Cance...

Transanal total mesorectal excision (TaTME) is the latest in a long list of developments in the surgical treatment of low rectal cancer. This article describes the evolution of the technique, a brief summation of the technical procedure, the current literature into its results, and the possible future direction that it might take. It is the authors...

Background Studies examining long‐term outcomes following resolution of an acute diverticular abscess have been limited to single‐institution chart reviews. This observational cohort study compared outcomes between elective colectomy and non‐operative management following admission for an initial acute diverticular abscess. Methods The Statewide P...

Ileocolic resection is the most common operation performed for Crohn's disease patients with terminal ileum involvement. We sought to evaluate the outcomes in Crohn's disease patients who underwent open ileocolic resection (OIC) and laparoscopic ileocolic resection (LIC) by using the ACS-NSQIP database from 2006 to 2015. Of 5670 patients, 48.3 per...

Background: The prognosis of tumor deposits in stage III colon adenocarcinoma is poorly described. Objective: The purpose of this study was to determine the impact of tumor deposits on oncologic outcomes in patients with stage III colon cancer. Design: This was a multicenter retrospective cohort study. Settings: The 2010 to 2014 National Can...

Objective: To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. Background: This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12...

Background: Local excision may be curative for benign and malignant rectal neoplasms. Because many early rectal cancers are discovered incidentally after local excision of clinically benign lesions, it is unclear whether preoperative imaging with transrectal ultrasound or MRI affects management. Objective: The purpose of this study was to determ...

Over many decades, advances in surgical technology, such as the use of the electrocautery Bovie, development of minimally invasive and advanced endoscopic platforms and the ability to create and maintain pneumorectum have propelled surgical techniques forward to today, with development of the transanal TME (taTME) for en bloc resection of rectal ca...

Objective: To compare the quality of surgical resection of transanal total mesorectal excision (TA-TME) and robotic total mesorectal excision (R-TME). Background: Both TA-TME and R-TME have been advocated to improve the quality of surgery for rectal cancer below 10 cm from the anal verge, but there are little data comparing TA-TME and R-TME. Me...

Background: Rectal cancer patients who are understaged may not be offered the highest quality treatment modalities, which are based on an accurate assessment of preoperative staging. The objective of this study was to evaluate heterogeneity in the probability of being understaged at Commission on Cancer hospitals in the United States and to assess...

Purpose: To evaluate the impact of surgeon case volumes on procedural, financial, and clinical outcomes in colorectal surgery and apply findings to improve hospital care quality. Methods: A retrospective review was performed using 2013-2014 administrative data from a large hospital system in Southeast U.S. region; univariate and multivariable re...

Introduction: Transanal minimally invasive surgery (TAMIS) is an endoscopic operating platform for local excision of rectal neoplasms. However, it may be technically demanding, and its learning curve has yet to be adequately defined. The objective of this study was to determine the number of TAMIS procedures for the local excision of rectal neopla...

Background: In an effort to improve the quality of rectal cancer care in the US, the American College of Surgeons Commission on Cancer has developed the National Accreditation Program for Rectal Cancer (NAPRC). We aimed to describe the current status of rectal cancer care before implementation of the NAPRC. Study design: The 2011-2014 National C...

Background: The management of the rectal wall defect after local excision of rectal neoplasms remains controversial, and the existing data are equivocal. Objective: This study aimed to determine the effect of open versus closed defects on postoperative outcomes after local excision of rectal neoplasms. Design: Data from 3 institutions were ana...

Objective: To identify sources of variation in the use of minimally invasive surgery (MIS) for colectomy. Background: MIS is associated with decreased analgesic use, shorter length of stay, and faster postoperative recovery. This study identified factors explaining variation in MIS use for colectomy. Methods: The Statewide Planning and Researc...

There is tremendous variability in care for patients with rectal cancer in the United States.¹ The Consortium for Optimizing the Surgical Treatment of Rectal Cancer (OSTRICH) was established in 2011, with 18 centers, to pursue a goal of improving the treatment of patients with rectal cancer.² As of April 2017, it has grown to more than 350 centers....

Objective: The aim of the study was to analyze recent trends in the rate of nonelective surgery and corresponding mortality for inflammatory bowel disease (IBD) patients since the rise of biologic use. Background: Modern biologic therapy has improved outcomes for IBD, but little is known about the impact on mortality rates after nonelective surg...

Background: Transanal total mesorectal excision is a new approach to curative-intent rectal cancer surgery. Training and surgeon experience with this approach has not been assessed previously in America. Objective: The purpose of this study was to characterize a structured training program and to determine the experience of delegate surgeons. D...

Background: This study identified variation and factors associated with ileal pouch-anal anastomosis after total colectomy for ulcerative colitis. Methods: The Statewide Planning & Research Cooperative System was used to identify patients with ulcerative colitis who underwent total colectomy in New York state from 2000-2013. Bivariate and mixed-...

Background: There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery. Objective: The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant re...

Background: Local excision (LE) alone is associated with worse survival compared to radical surgery (RS) for T2 rectal cancer, but LE with additional chemoradiation (CRT) may improve outcomes. The objective of this study was to compare combined CRT and LE versus RS for T2 rectal cancer. Methods: The 2004-2014 National Cancer Database was queried...

The risk of urethral injury during transanal total mesorectal excision (taTME) is delineated, and potential risk factors for iatrogenic transection are reviewed. A variety of applied and theoretical techniques can be used by surgeons to diminish the risk of injury in males undergoing this operation. Many of the approaches utilize non-optic media an...

Pelvic hernias are rare, predominantly seen in the elderly and difficult to diagnose clinically. Imaging has made diagnosis of these unusual diagnoses easier. Due to the low incidence and subsequently little individual experience, inadequate data exists on the optimal methods for repair. The evidence available to guide management is limited to smal...

Background: No study has evaluated the relative importance of patient, surgeon, and hospital-level factors on surgeon and hospital variation in hernia reoperation rates. This population-based retrospective cohort study evaluated factors associated with variation in reoperation rates for recurrence after initial ventral hernia repair and inguinal h...

Purpose: Although radiation therapy (RT) can provide palliative benefits for patients with metastatic rectal cancer, its role at the end of life remains unclear. The objective of this study was to assess sociodemographic and clinical factors associated with the use of RT during the last 30 days of life and to evaluate yearly time trends in RT util...

This study examined a thematic network aimed at identifying experiences that influence patients’ outcomes (e.g., patients’ satisfaction, anxiety, and discharge readiness) in an effort to improve care transitions and reduce patient burden. We drew upon the Sociology and Complexity Science Toolkit to analyze themes derived from 61 semistructured, lon...

Colonoscopy is both a diagnostic and therapeutic tool. Periprocedural management of patients on anticoagulation remains a clinical challenge. A risk assessment balancing bleeding and thrombosis upon cessation of the medication is essential. Further, colonoscopic procedures may increase the risk of infectious complications in certain group of patien...

Objective: This study describes the outcomes for 200 consecutive transanal minimally invasive surgery (TAMIS) local excision (LE) for rectal neoplasia. Background: TAMIS is an advanced transanal platform that can result in high quality LE of rectal neoplasia. Methods: Consecutive patients from July 1, 2009 to December 31, 2015 from a prospecti...

Purpose and design: Optimal surgical strategy for resectable synchronous colorectal cancer with liver metastasis (SCRLM) remains a therapeutic dilemma. Multiple retrospective studies including several meta-analyses have been published since 2001 to help facilitate the decision making process and identify the optimal surgical approach. Controversy...

Background: Little is known regarding recent trends in the rate of nonelective colon cancer resection in the United States and its impact on both short-term and long-term outcomes. Methods: The New York State Cancer Registry and Statewide Planning & Research Cooperative System identified stage I-III colon cancer resections from 2004-2011. Propen...

Background: The purpose of this study was to examine the long-term overall survival (OS) of colon cancer patients who underwent emergent resection versus patients who were resected electively. Methods: The 2006-2012 National Cancer Data Base was queried for colon cancer patients who underwent surgical resection. Emergent resection was defined as...

Background: The goals of this study were to characterize the variation in suboptimal lymph node examination for patients with colon cancer across individual surgeons, pathologists, and hospitals and to examine if this variation affects 5-year, disease-specific survival. Methods: A retrospective cohort study was conducted by merging the New York...

Background: Given scarce data regarding the relationship among age, complications, and survival beyond the 30-day postoperative period for oncology patients in the United States, this study identified age-related differences in complications and the rate and cause of 1-year mortality following colon cancer surgery. Methods: The NY State Cancer R...

Is surgery necessary for all patients with rectal cancer who respond to chemoradiation?—No.

Aims Lymph node yield (LNY) is used as a marker of adequate oncological resection. The American Joint Committee on Cancer (AJCC) currently recommends that at least 12 nodes are necessary to confirm node-negative disease for rectal cancer. A LNY of 12 is not always achieved, particularly in patients who have undergone neoadjuvant treatment. This stu...

Background There is a paucity of literature quantifying the extent to which time to adjuvant chemotherapy for stage III colon cancer patients varies between individual surgeons, medical oncologists, and hospitals. MethodsA retrospective cohort study was conducted by merging the New York State Cancer Registry with the Statewide Planning & Research C...

Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of...

Objective: To investigate the potential additive effects of blood transfusion and sepsis on colon cancer disease-specific survival, cardiovascular disease-specific survival, and overall survival after colon cancer surgery. Background: Perioperative blood transfusions are associated with infectious complications and increased risk of cancer recur...

Background: Little is known about between-hospital differences in the rate of suboptimal lymphadenectomy. This study characterizes variation in hospital-specific rates of suboptimal lymphadenectomy and its effect on overall survival in a national hospital-based registry. Methods: Stage I-III colon cancer patients were identified from the 2003-20...

Background: National Comprehensive Cancer Network treatment guidelines for patients with locally advanced rectal cancer include neoadjuvant chemoradiation followed by total mesorectal excision and adjuvant chemotherapy. The objective of the current study was to examine the rate of adjuvant chemotherapy and associated survival in patients with stag...

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 s...

Background: Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal. Methods: The Statewide Planning and Research Co...

Objective: To evaluate the impact of a primary medical versus surgical service on healthcare utilization and outcomes for adhesive small bowel obstruction (SBO) admissions. Summary background data: Adhesive-SBO typically requires hospital admission and is associated with high healthcare utilization and costs. Given that most patients are managed...

Stereotactic navigation allows for real-time, image-guided surgery, thus providing an augmented working environment for the operator. This technique can be applied to complex minimally invasive surgery for fixed anatomic targets. Transanal minimally invasive surgery represents a new approach to rectal cancer surgery that is technically demanding an...

Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nua...

Background: Hospital readmissions remain a major medical and financial concern to the healthcare system and have become an area of interest in health outcomes performance metrics. There is a pressing need to identify process measures that may help reduce readmissions. Objective: Our aim was to assess the patient characteristics and surgical fact...

Background: Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects. Objective: The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complica...

BACKGROUND: Hospital-acquired Clostridium difficile infection is associated with adverse patient outcomes and high medical costs. The incidence and severity of C. difficile has been rising in both medical and surgical patients. OBJECTIVE: Our aim was to assess risk factors and variation associated with the development of nosocomial C. difficile col...

Aims To explore the feasibility of recruiting surgical oncology patients and implementing a surgical integrated discharge (SID) programme led by advanced practice providers (APP). Background Burden of illness and complexity of treatment regimen makes it challenging for surgical oncology patients to participate in research. Surgical oncology nurses...

Background: Current guidelines recommend extended-duration thromboprophylaxis for all abdominal oncologic resections. However, other high-risk patients may benefit from extended thromboprophylaxis. Objective: The purpose of this study was to identify risk factors for postdischarge venothromboembolism after colorectal procedures. Design: This w...

Objectives: Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall...

Introduction: Between 10 and 30 % of rectal cancer patients experience pathological complete response after neoadjuvant treatment. However, physiological factors predicting which patients will experience tumor response are largely unknown. Previous single-institution studies have suggested an association between elevated pretreatment carcinoembryon...

Hospital-acquired infections (HAI) are defined as infections developing after 48 hours of hospitalization or stay at a healthcare facility that was not present or incubating at the time of admission. HAI have been associated with increasing medical costs, length of stay, complication rates, and worsening overall morbidity and mortality. Many countr...

Objectives: To identify predictors of positive circumferential resection margin following rectal cancer resection in the United States. Background: Positive circumferential resection margin is associated with a high rate of local recurrence and poor morbidity and mortality for rectal cancer patients. Prior study has shown poor compliance with na...

Importance Evidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease.Objective To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen.Design,...

Objective: To investigate the effect of a laparoscopic approach on the rate of adhesion-related small bowel obstruction (SBO) following colorectal resection. Background: Currently, there is little compelling evidence with regard to rates of SBO after laparoscopic versus open abdominal surgery. Few studies have compared risk-adjusted rates of SBO...

Perioperative blood transfusions are costly and linked to adverse clinical outcomes. We investigated the factors associated with variation in blood transfusion utilization following upper gastrointestinal cancer resection and its association with infectious complications. The Statewide Planning and Research Cooperative System was queried for electi...

Many rectal cancer patients experience tumor downstaging and some are found to achieve a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT). Previous data suggest that there is an association between the time interval from nCRT completion to surgery and tumor response rates, including pCR. However, these studies have been...

There is currently little information regarding the impact of procedure volume on outcomes after open inguinal hernia repair in the United States. Our hypothesis was that increasing procedure volume is associated with lesser rates of reoperation and resource use. The database of the Statewide Planning and Research Cooperative System was queried for...

There is strong evidence supporting the efficacy of adjuvant chemotherapy for patients with pathologic, stage III colon cancer. This study examines differences in adherence to evidence-based adjuvant chemotherapy guidelines for pathologic, stage III colon cancer cases across hospital and patient subgroups. Patients with stage III colon cancer were...