Pub Date : 2009-05-05DOI: 10.2174/1876820200902010011
M. Chand, T. Andrews, G. Nash
The most common investigation carried out in UK hospitals to investigate bright red rectal bleeding is a flexi- ble sigmoidoscopy (FS). The role of flexible sigmoidoscopy in colorectal screening has not yet been fully ascertained and colonoscopy remains the investigation of choice for the diagnosis of colonic pathology. However, FS is a simple, quick, sensitive and specific investigation to diagnose and even treat some left sided colorectal lesions. We investigated whether there was any difference between male and female patients undergoing FS in terms of duration and extent of procedure, and describe for the first time a significant increase in time taken to complete the examination in females. As eleven males may be scoped in a similar time to ten females this may have bearing on service efficiency.
{"title":"Gender Determined Flexible Sigmoidoscopy Planning","authors":"M. Chand, T. Andrews, G. Nash","doi":"10.2174/1876820200902010011","DOIUrl":"https://doi.org/10.2174/1876820200902010011","url":null,"abstract":"The most common investigation carried out in UK hospitals to investigate bright red rectal bleeding is a flexi- ble sigmoidoscopy (FS). The role of flexible sigmoidoscopy in colorectal screening has not yet been fully ascertained and colonoscopy remains the investigation of choice for the diagnosis of colonic pathology. However, FS is a simple, quick, sensitive and specific investigation to diagnose and even treat some left sided colorectal lesions. We investigated whether there was any difference between male and female patients undergoing FS in terms of duration and extent of procedure, and describe for the first time a significant increase in time taken to complete the examination in females. As eleven males may be scoped in a similar time to ten females this may have bearing on service efficiency.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132395388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-02-26DOI: 10.2174/1876820200902010007
A. Alvi, L. Wood, R. Davies
Introduction: Integration of laparoscopic colorectal surgery into consultant practice can be a challenge. We pre- sent the first year of practice for a suitably trained surgeon using a selective policy. Materials and Methodology: Patients requiring an elective colorectal resection under the care of a newly appointed con- sultant surgeon were considered for laparoscopic surgery. Exclusion criteria included multiple previous abdominal opera- tions, rectal cancer less than 12cm from the anal verge, radiological/clinical suspicion of tumor involvement of adjacent organs and a mass � 6cm. Prospective data collected from August 2007 to August 2008 included types of surgeries, body mass index (BMI), median operating time, lymph node yield, complications, 30 days mortality, length of stay and 30 days readmissions. Results: Laparoscopic colorectal resection was performed in 42 patients (26 females), with a median age of 65 years (range 14-83 years). There were 18 right hemicolectomies/ileocaecal resections, 15 sigmoid colectomies/high anterior re- sections, 7 subtotal colectomies and 2 reversal of Hartmann's. Indications for surgery were colorectal cancer (n=27), in- flammatory bowel disease (n=10), diverticular disease (n=3) and others (n=2). There were 5 (11.9%) conversions. Median operating time was 150 minutes (range 75-280 minutes) and BMI was 25.5 (range 16-38). There were no deaths reported. Eight (19%) patients had complications. Median lymph node yield in malignant cases was 13 (range 8-30). Median length of stay was 4 days (range 3 to 20 days) and there were 3 (7%) readmissions. Conclusions: Laparoscopic colorectal resection can be safely integrated into the practice of a suitably trained, newly ap- pointed consultant surgeon if a selective policy is employed. With greater experience, a less selective policy may become appropriate.
{"title":"A Selective Policy Ensures Safe Integration of Laparoscopic Colorectal Resection into the Practice of a Newly Appointed Consultant Surgeon","authors":"A. Alvi, L. Wood, R. Davies","doi":"10.2174/1876820200902010007","DOIUrl":"https://doi.org/10.2174/1876820200902010007","url":null,"abstract":"Introduction: Integration of laparoscopic colorectal surgery into consultant practice can be a challenge. We pre- sent the first year of practice for a suitably trained surgeon using a selective policy. Materials and Methodology: Patients requiring an elective colorectal resection under the care of a newly appointed con- sultant surgeon were considered for laparoscopic surgery. Exclusion criteria included multiple previous abdominal opera- tions, rectal cancer less than 12cm from the anal verge, radiological/clinical suspicion of tumor involvement of adjacent organs and a mass � 6cm. Prospective data collected from August 2007 to August 2008 included types of surgeries, body mass index (BMI), median operating time, lymph node yield, complications, 30 days mortality, length of stay and 30 days readmissions. Results: Laparoscopic colorectal resection was performed in 42 patients (26 females), with a median age of 65 years (range 14-83 years). There were 18 right hemicolectomies/ileocaecal resections, 15 sigmoid colectomies/high anterior re- sections, 7 subtotal colectomies and 2 reversal of Hartmann's. Indications for surgery were colorectal cancer (n=27), in- flammatory bowel disease (n=10), diverticular disease (n=3) and others (n=2). There were 5 (11.9%) conversions. Median operating time was 150 minutes (range 75-280 minutes) and BMI was 25.5 (range 16-38). There were no deaths reported. Eight (19%) patients had complications. Median lymph node yield in malignant cases was 13 (range 8-30). Median length of stay was 4 days (range 3 to 20 days) and there were 3 (7%) readmissions. Conclusions: Laparoscopic colorectal resection can be safely integrated into the practice of a suitably trained, newly ap- pointed consultant surgeon if a selective policy is employed. With greater experience, a less selective policy may become appropriate.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134301777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2009-01-26DOI: 10.2174/1876820200902010001
V. Ellensen, J. Elshove-Bolk, G. Baatrup
Aim: The aim of this study was to determine short and long-term morbidity and mortality rates after emergency colorectal surgery for benign and malignant disease in a high volume tertiary referral hospital in order to define factors predictive for outcome. Material and Methods: Characteristics and outcome of 196 consecutive emergency and 292 consecutive elective colorec- tal procedures were studied. A total of 91/196 emergency procedures were performed for malignant disease. The proce- dures reviewed included both palliative and curative procedures performed on an unselected patient population. Results were analysed by Cox regression and Kaplan-Meier analysis. Results: The total 30-day mortality for emergency and elective surgery was 20% and 3 % respectively, 36-month mortal- ity was 48% and 27%. The frequency of major or moderate complications after emergency procedures was 39%. The strongest predictors for 30 day mortality after emergency surgery were ASA score (Odds Ratio 2.5) and age (OR 1.5). Predictors for early postoperative complications were faecal contamination during surgery (OR 4.2) and ASA score (OR 2.0). The strongest predictor for 3 year mortality after emergency surgery was malignant disease (OR = 5.0). Other predic- tors for long-term outcome were procedures performed and degree of specialization of the surgeon. Conclusions: Short-term outcome is associated with patient and disease related factors, whereas long-term outcome is also correlated to the primary diseases, procedures performed and the degree of specialization of the surgeon. Decisions concerning the level of qualifications required for emergency procedures should be based upon patient and disease related factors as well as the procedure to be performed.
{"title":"Morbidity and Mortality after Emergency and Urgent Colorectal Surgery for Malignant and Benign Disease","authors":"V. Ellensen, J. Elshove-Bolk, G. Baatrup","doi":"10.2174/1876820200902010001","DOIUrl":"https://doi.org/10.2174/1876820200902010001","url":null,"abstract":"Aim: The aim of this study was to determine short and long-term morbidity and mortality rates after emergency colorectal surgery for benign and malignant disease in a high volume tertiary referral hospital in order to define factors predictive for outcome. Material and Methods: Characteristics and outcome of 196 consecutive emergency and 292 consecutive elective colorec- tal procedures were studied. A total of 91/196 emergency procedures were performed for malignant disease. The proce- dures reviewed included both palliative and curative procedures performed on an unselected patient population. Results were analysed by Cox regression and Kaplan-Meier analysis. Results: The total 30-day mortality for emergency and elective surgery was 20% and 3 % respectively, 36-month mortal- ity was 48% and 27%. The frequency of major or moderate complications after emergency procedures was 39%. The strongest predictors for 30 day mortality after emergency surgery were ASA score (Odds Ratio 2.5) and age (OR 1.5). Predictors for early postoperative complications were faecal contamination during surgery (OR 4.2) and ASA score (OR 2.0). The strongest predictor for 3 year mortality after emergency surgery was malignant disease (OR = 5.0). Other predic- tors for long-term outcome were procedures performed and degree of specialization of the surgeon. Conclusions: Short-term outcome is associated with patient and disease related factors, whereas long-term outcome is also correlated to the primary diseases, procedures performed and the degree of specialization of the surgeon. Decisions concerning the level of qualifications required for emergency procedures should be based upon patient and disease related factors as well as the procedure to be performed.","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129428256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2008-11-18DOI: 10.2174/1876820200801010001
M. Chand, J. Coyne, G. Nash
{"title":"Atypical Presentation of a Common Disease; Intussuscepting Colorectal Cancers","authors":"M. Chand, J. Coyne, G. Nash","doi":"10.2174/1876820200801010001","DOIUrl":"https://doi.org/10.2174/1876820200801010001","url":null,"abstract":"","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"492 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2008-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123193777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.2174/1876820200902010027
K. Thorne, H. Hutchings, G. Elwyn
Aim: To systematically review the impact of the Two-Week Rule in increasing the pick-up rate of colorectal cancers and Upper Gastrointestinal (GI) cancers in the NHS. Materials and Methods: Data were combined for meta-analyses to determine (1) the Two-Week Rule pick-up rate for each cancer type and (2) the proportion of patients referred using the Two-Week Rule. Overall results were given as weighted averages. Results: There were 20 articles and 27 peer-reviewed abstracts included in this review. Colorectal Cancer: Only 9.5% of patients referred by the Two-Week Rule were eventually diagnosed with colorectal cancer (n = 24). When examining the referral origin of all colorectal cancer patients diagnosed during the time of 19 studies with this data, 32.2% had been re- ferred using the Two-Week Rule. Upper GI Cancer: Only 5.5% of patients referred by the Two-Week Rule were eventu- ally diagnosed with Upper GI cancer (n = 23). When examining the referral origin of all Upper GI cancer patients diag- nosed during the time of 17 studies with this data, 23.6% had been referred using the Two-Week Rule. Conclusion: The Two-Week Rule is not sufficiently effective in diagnosing neither upper GI nor colorectal cancers in pa- tients presenting to their General Practitioner. BACKGROUND The Two-Week Rule (TWR) referral (1) was introduced by the UK's New Labour government in 2000 as one of many initiatives tackling the increasing problem of patients presenting to their General Practitioner (GP) with symptoms indicative of a cancer who, although urgently referred, did not get a hospital appointment in sufficient time to signifi- cantly improve their health outcome. It was hoped that the TWR referral route would help to reduce the number of can- cer-related deaths by 20% in people under the age of 75 years by 2010, thereby saving approximately 130,000 lives (2). The scheme allowed GPs to "fast-track" these patients to shorten the length of time they waited for a diagnosis fol- lowed by potentially life saving treatment. TWR referrals were faxed to the relevant diagnostic unit using a dedicated number and an appointment was made for the patient within two weeks. Only delays due to patient choice were accept- able reasons to over-run the two week target. Disease-specific guidelines (3, 4) were published with the aim of helping GPs make decisions about when to refer people to specialists when they presented with symptoms that could have been caused by cancer. This would facilitate the appropriate referral of suspected cancer patients using the TWR. In the case of gastrointestinal (GI) cancers, the referral guidelines applied to upper GI cancers (UGCs) including oesophageal and gastric cancer, and colorectal cancers (CRCs).
{"title":"The Two-Week Rule for NHS Gastrointestinal Cancer Referrals: A Systematic Review of Diagnostic Effectiveness","authors":"K. Thorne, H. Hutchings, G. Elwyn","doi":"10.2174/1876820200902010027","DOIUrl":"https://doi.org/10.2174/1876820200902010027","url":null,"abstract":"Aim: To systematically review the impact of the Two-Week Rule in increasing the pick-up rate of colorectal cancers and Upper Gastrointestinal (GI) cancers in the NHS. Materials and Methods: Data were combined for meta-analyses to determine (1) the Two-Week Rule pick-up rate for each cancer type and (2) the proportion of patients referred using the Two-Week Rule. Overall results were given as weighted averages. Results: There were 20 articles and 27 peer-reviewed abstracts included in this review. Colorectal Cancer: Only 9.5% of patients referred by the Two-Week Rule were eventually diagnosed with colorectal cancer (n = 24). When examining the referral origin of all colorectal cancer patients diagnosed during the time of 19 studies with this data, 32.2% had been re- ferred using the Two-Week Rule. Upper GI Cancer: Only 5.5% of patients referred by the Two-Week Rule were eventu- ally diagnosed with Upper GI cancer (n = 23). When examining the referral origin of all Upper GI cancer patients diag- nosed during the time of 17 studies with this data, 23.6% had been referred using the Two-Week Rule. Conclusion: The Two-Week Rule is not sufficiently effective in diagnosing neither upper GI nor colorectal cancers in pa- tients presenting to their General Practitioner. BACKGROUND The Two-Week Rule (TWR) referral (1) was introduced by the UK's New Labour government in 2000 as one of many initiatives tackling the increasing problem of patients presenting to their General Practitioner (GP) with symptoms indicative of a cancer who, although urgently referred, did not get a hospital appointment in sufficient time to signifi- cantly improve their health outcome. It was hoped that the TWR referral route would help to reduce the number of can- cer-related deaths by 20% in people under the age of 75 years by 2010, thereby saving approximately 130,000 lives (2). The scheme allowed GPs to \"fast-track\" these patients to shorten the length of time they waited for a diagnosis fol- lowed by potentially life saving treatment. TWR referrals were faxed to the relevant diagnostic unit using a dedicated number and an appointment was made for the patient within two weeks. Only delays due to patient choice were accept- able reasons to over-run the two week target. Disease-specific guidelines (3, 4) were published with the aim of helping GPs make decisions about when to refer people to specialists when they presented with symptoms that could have been caused by cancer. This would facilitate the appropriate referral of suspected cancer patients using the TWR. In the case of gastrointestinal (GI) cancers, the referral guidelines applied to upper GI cancers (UGCs) including oesophageal and gastric cancer, and colorectal cancers (CRCs).","PeriodicalId":331708,"journal":{"name":"The Open Colorectal Cancer Journal","volume":"240 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122817700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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