The Saudi Fellowship in Colon and Rectal Surgery (SCFHS) is examined in two steps: a 100-question written paper blueprinted by domain — colorectal cancer, anorectal disease, IBD, complications, hereditary tumours, endoscopy — and a Final Clinical and Oral Examination in SOE format with two long cases and four short cases. Practise by blueprint domain, or sit a 100-question paper composed in the official proportions, with every question carrying a guideline-referenced explanation.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 63-year-old woman underwent neoadjuvant long-course chemoradiation (50.4 Gy + capecitabine) for T3N1 mid-rectal cancer 8 weeks ago, achieving a good clinical response. She is now scheduled for laparoscopic low anterior resection with total mesorectal excision (TME) and colorectal anastomosis at 4 cm from the anal verge. Her preoperative BMI is 18.5 kg/m² and serum albumin is 2.9 g/dL. Intraoperatively, significant blood loss occurs (estimated 600 mL) requiring transfusion, and a technically challenging pelvic dissection is performed. Which combination of factors in this patient represents the highest independent risk profile for anastomotic leak?
Correct answer: C
✓ Correct answer: Anastomotic leak after rectal cancer surgery is multifactorial. The highest-risk constellation in this patient includes: (1) Neoadjuvant pelvic radiation — radiation impairs tissue vascularity, collagen synthesis, and microcirculation in the anastomotic zone, increasing leak risk 2–3 fold; (2) Malnutrition — low albumin (<3.0 g/dL) and low BMI impair tissue healing, collagen cross-linking, and immune function, all critical for anastomotic integrity; (3) Intraoperative hemodynamic compromise with significant blood loss — anastomotic perfusion is critically dependent on adequate systemic blood pressure and oxygen delivery; hypotension during the critical period of anastomotic formation compromises healing; (4) Low anastomotic level (4 cm from anal verge) — anastomoses below 6–7 cm from the anal verge have significantly higher leak rates (up to 15–20%) than high rectal or colonic anastomoses, partly due to deficient blood supply to the distal rectal stump and higher intraluminal pressures. Multiple meta-analyses (Rahbari 2010; Trencheva 2013) confirm these as independent risk factors with multiplicative effect when combined.
Referenced to Rahbari NN et al., Ann Surg 2010; Trencheva K et al., Ann Surg 2013
Every question is explained like this — start with 50 free ›Final written examination of 100 questions, followed by the Final Clinical and Oral Examination (2 long cases, 4 short cases). Questions are tagged by the domain the Commission examines, so you can drill a single domain or sit a paper weighted the way the real one is.
930 questions carry a blueprint domain. They were assigned by a published rule-based classifier and a hand-audited sample, not by individual expert review of every question, and only assignments above a confidence threshold are counted — the rest of the bank remains available in ordinary practice. The SCFHS curriculum states that the published distribution is for demonstration and that the current blueprint lives on the Commission website. The same blueprint governs the end-of-year written examination for F1 and F2 trainees. Always confirm the current blueprint with the Commission.
Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Scope of authorship. SCFHS-CRS sits outside the author’s own subspecialty practice, which is surgical oncology — peritoneal malignancy, sarcoma, hepatopancreatobiliary and complex pelvic surgery. No diplomate of this board has signed these questions off. What they offer is traceability rather than personal authority: every answer names the current guideline or trial it rests on, so you can check it at the source before you trust it. Found an error? Tell us — it gets corrected or withdrawn.
The final written examination carries 100 questions distributed by domain, with colorectal cancer the largest block (20 questions) followed by intraoperative and postoperative complications (15) and anorectal disease (12). Passing it makes you eligible for the Final Clinical and Oral Examination, which is held once a year as six stations: two long cases and four short cases.
Work the blueprint in proportion rather than by textbook order: cancer, complications and anorectal disease together account for almost half the paper. Then rehearse the oral out loud in the FCOE shape — two long cases on cancer, IBD, diverticular disease, bleeding or polyposis, and four short cases on emergencies, complications, anorectal and functional disorders.
SurgBoardsQ&A provides more than 1,600 colorectal practice questions mapped to the SCFHS blueprint domains, each with a full explanation referenced to current guidelines.
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