EP154 - Evolving Rectal Cancer Case Exposure in Colorectal Surgery Training: A 17-Year Review of ACGME Case Logs

ePoster Presenter(s)

• CA

  Cenk Atillasoy, MD

  General Surgery Resident
  University Hospitals Cleveland Medical Center
  Cleveland, Ohio, United States

  Disclosure information not submitted.

Author(s)

• 

  Emily F. Simon, MD (she/her/hers)

  General Surgery Resident
  University Hospitals Cleveland Medical Center, Department of Surgery
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Kayvan Barekatain, MD (he/him/his)

  Resident Physician
  Case Western Reserve University Hospitals
  University Hospitals, Cleveland Medical Center
  Cleveland, OH, United States

  Disclosure information not submitted.
• 

  Lindsay Welton, MD (she/her/hers)

  General Surgery Resident
  University of Minnesota
  University of Minnesota
  Minneapolis, MN, United States

  Disclosure information not submitted.
• ES

  Emily Steinhagen, MD, FACS, FASCRS

  Associate Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, Ohio, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• MC

  Meagan Costedio, MD (she/her/hers)

  Medical Director of Colorectal Surgery
  Ahuja Medical Center of University Hospitals
  Case Western University
  Beachwood, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Ronald Charles, MD (he/him/his)

  Assistant Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, OH, United States

  Disclosure information not submitted.
• 

  Michael A. Valente, DO

  Associate Professor of Surgery
  Cleveland Clinic
  cleveland, Ohio, United States

  Disclosure information not submitted.

Senior Author(s)

• 

  Kristen Westfall, MD, MPH (she/her/hers)

  Assistant Professor of Surgery
  University Hospitals/Cleveland Medical Center
  Case Western Reserve University
  Cleveland, OH, United States

  Disclosure information not submitted.

Purpose/Background: The "watch and wait" strategy after total neoadjuvant therapy for rectal cancer has become more commonly accepted by colorectal surgeons over the past twenty years. Given the shift of rectal cancer care towards nonoperative management, there have been concerns about decreased rectal cancer case exposure for colorectal surgery residents. The aim of this study was to evaluate colorectal resident exposure to rectal cancer and pelvic surgery cases over time.

Methods/Interventions: ACGME colorectal resident case logs from 2007 to 2024 were reviewed. Mean number of procedures were evaluated over time. Defined category procedures that were included were: low anterior resection (LAR), abdominoperineal resection (APR), transanal excision (TAE), total pelvic dissections, laparoscopic resections (after 2011), and rectal cancer cases (after 2011).

Results/Outcomes: From 2007 to 2024, colorectal surgery resident case volumes increased across all rectal cancer-related procedures. LAR volume rose from 28.3 to 45.9 cases (+62.2%), and APR volume increased from 8.7 to 11.5 (+32.2%). TAE cases increased modestly from 13.0 to 14.8 (+13.9%), while total pelvic dissections rose from 48.2 to 67.0 (+39.0%). From 2011 to 2024, mean laparoscopic bowel resections increased from 72.4 to 120.6 (+66.6%), and rectal cancer-specific cases increased from 24.6 to 26.0 (+5.7%).

Conclusion/Discussion: Contrary to concerns that total neoadjuvant therapy and nonoperative management of rectal cancer would diminish operative exposure, colorectal surgery resident experience with rectal and pelvic procedures has increased over time - particularly with LAR and minimally invasive approaches. This trend may reflect the rising incidence of rectal cancer in younger patients and greater overall pelvic surgical volume, including cases that may not have previously involved trainees.

Although it cannot be confirmed that all LAR, APR, and TAE cases were performed for rectal cancer, rectal cancer specific cases themselves also increased over time, supporting the observed trend. However, the growing ease of real-time case logging through smartphones and integrated digital platforms may contribute to higher reported volumes, introducing potential reporting bias.

Overall, our findings suggest that evolving oncologic management has not reduced operative experience for trainees. However, ongoing attention is warranted to ensure continued exposure to complex rectal surgery within colorectal training programs.

Rectal Cancer Case Logs Over Time
Colorectal surgery resident case logs of rectal cancer-related cases over time, including low anterior resection (LAR), abdominoperineal resection (APR), transanal excision (TAE), rectal cancer, and pelvic dissection cases.