The effective relief of pain is of the utmost importance to anyone treating patients undergoing surgery. Pain relief has significant physiological benefits; hence, monitoring of pain relief is increasingly becoming an important postoperative quality measure. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects. Various agents (opioid vs. nonopioid), routes (oral, intravenous, neuraxial, regional) and modes (patient controlled vs. ?as needed?) for the treatment of postoperative pain exist. Although traditionally the mainstay of postoperative analgesia is opioid based, increasingly more evidence exists to support a multimodal approach with the intent to reduce opioid side effects (such as nausea and ileus) and improve pain scores. Enhanced recovery protocols to reduce length of stay in colorectal surgery are becoming more prevalent and include multimodal opioid sparing regimens as a critical component. Familiarity with the efficacy of available agents and routes of administration is important to tailor the postoperative regimen to the needs of the individual patient.

These findings suggest that the 26S proteasome may provide a general predictive biomarker for radiotherapy outcome.

Laparoscopic adhesiolysis requires a specific skill set and may not be appropriate in all patients. Notwithstanding this, the laparoscopic approach demonstrates a benefit in 30-day morbidity and mortality even after controlling for preoperative patient characteristics. Given these findings in more than 9,000 patients and consistent rates of SBO requiring surgical intervention in the United States, increasing the use of laparoscopy could be a feasible way of to decrease costs and improving outcomes in this population.

Objective Magnetic resonance imaging (MRI) is increasingly accepted as the radiological modality of choice staging rectal cancer but is subject to error. Neoadjuvant therapy is increasingly used in rectal cancer and MRI is used to stage response and occasionally plan surgery. We aim to assess the staging accuracy of MRI following chemoradiotherapy in rectal cancer.Method Retrospective analysis of 86 patients with MRI stage pre-and postlong-course chemoradiotherapy and comparison with pathological assessment.Results Fourty-nine patients (34 men, 15 women) with median age 68 years (60-74) were analysed. The median time from completion of CRT to MRI was 32 days (16-37). Chemoradiotherapy led to significant down-staging (P < 0.001). MRI-staging accuracy was 43% (21 ⁄ 49) with over-and under-staging in 43% (21 ⁄ 49) and 14% (7 ⁄ 49) respectively. T-stage accuracy was 45% (22 ⁄ 49) with overstaging in 33% (16 ⁄ 49) and under-staging in 22% (11 ⁄ 49).MRI stage correlated poorly with pathological assessment for International Union Against Cancer (j = 0.255) and T stages (j = 0.112). MRI nodal assessment was 71% (35 ⁄ 49) accurate, with 82% (9 ⁄ 11) sensitivity, 68% (26 ⁄ 38) specificity and positive predictive value (PPV) of 43% (9 ⁄ 21) and negative predictive value of 93% (26 ⁄ 28). There was a significant difference in node positivity between MRI and pathological staging (P = 0.005, Fisher's exact). Complete radiological response was observed in 4% (2 ⁄ 49). Complete pathological response was observed in 10% (5 ⁄ 49), which were staged 0(1), I(1), II(2) and III(1) postchemoradiotherapy by MRI.Conclusion MRI staging following chemoradiation is poor. Over-staging occurs three times more commonly than under-staging. Over-staging is due to poor PPV of nodal assessment.