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Current Teaching in United States
Feza H. Remzi,M.D. F.A.C.S., F.A.S.C.R.S., F.T.S.S. ( Hon)
Department of Colorectal SurgeryDigestive Disease Institute
Cleveland Clinic, Ohio
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• Aim:– To demonstrate trends in CR practice from 1989 to 1996– To compare the 1 year technical experience of a CR resident
with the 5 years total of a GS resident• CR resident performs
– more anorectal operations– more endoscopic procedures– more index abdominal operations in 1 year than GS resident
does in 5 years• 1 year of training in CR trains a true specialist with unique
expertise Schoetz DCR 1998
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• Data from American Board of Colon and Rectal Surgery (ABCRS) database (1994 to 2005)– CR training programs increased from 28 to 39 (28% increase)
– CR residency positions increased from 50 to 66 (24% increase)
– Anorectal patients per resident remained constant over the study period
– Sigmoidoscopy decreased substantially• Rigid (67 to 44 per resident)• Flexible (135.5 to 39 per resident)
– Colonoscopy increased (209 to 264 per resident)
Schoetz J Am Coll Surg 2006
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• Perineal procedures for rectal prolapse consistently comprise 50% to 60% of the total procedures for prolapse
• Low anterior resection APR ratio=3/1
• Coloanal anastomoses have steadily increased
• Radical cancer operations continue to make up a sizeable portion of abdominal surgery volume in training programs
• Surgery for colon cancer have been between 52.4% and 57.9% of the total number of resections for colorectal cancer
Schoetz Jr J Am Coll Surg 2006
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• General Surgery Colorectal Surgery
Colectomy 14.9 62.2
IPAA 1.5 10.7
APR 3.2 7.3
Gen Surgery versus Colon Rectal Surgery Residents Colon Procedures 1995-1996
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• Laparoscopic Colorectal Surgery– 3.6% laparoscopic procedures
performed in 1994, vs. 24.3% in 2005
– The greatest increase being in diverticular resections (6.5 % in 1994 vs. 44.7% in 2005)
– In 1994 5.6% of colon resections performed laparoscopically for cancer vs. 41.1% in 2005
Schoetz Jr J Am Coll Surg 2006
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• Data from Accreditation Council for GME• General surgery residents (2000-2004)
– The average number of LAP colectomy/GS resident/career increased from 1.84 to 4.61
• Colorectal surgery residents (1994-2005)– Number of CR residents steadily increased to 66 by
2005– The total number of open or LAP cases increased
from 8342 to 13267– The average LAP cases/CR resident increased from
6.3 in 1993-1994 to 45.3 in 2004-2005Charron DCR 2007
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• Colorectal surgery residents (1994-2005)– A total of 2987 LAP cases were performed in 2005
• Average CR resident recorded 45.3 LAP cases in 2005 (colon=30, rectal=9.4, other=5.9)
– 1999-2000, 3098 segmental colectomy performed (LAP=330)
– 2004-2005, 4394 segmental colectomy performed (LAP=1771)
– LAP low anterior resection increased from 32 to 248 (1999 to 2005)
– LAP APR increased from 11 to 48 (1999 to 2005)Charron DCR 2007
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• Comparison of LAP colon resection experience for GS vs. CR residents– 2003-2004
– The average number of laparoscopic colon resections by GS vs. CR (4.61 vs. 20.2)
– The majority of GS resident experience was acquired in the chief year , with an average of 2.69 of 4.61 cases
Charron DCR 2007
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• Conclusions– Learning curves for LAP colectomy are reported in the
range of 20 to 60 cases
– CR resident experience is trending toward this threshold
– Recent general surgery graduates may be lacking the appropriate volume to reach proficiency in LAP colorectal surgery
Charron DCR 2007
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• Segmental Colectomy 37
• LAR 11
• APR 4
• IPAA 7
Minimum Numbers ABCRS
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