Pub Date : 2020-09-01DOI: 10.30476/ACRR.2020.88275.1064
A. Hussain, Owais Manejula, A. Ghosh, S. Shuaib, H. Soliman, R. Hafeez, S. El-Hasani
Background There are limited data on emergency surgical practice during the covid-19 era. Objectives To evaluate the outcomes for emergency surgery before and during Covid-19. Methods This is a retrospective study of emergency admissions to one general surgery department during November 2019 (which is likely to represent our normal working pattern) and April 2020 (which was the peak of the Covid-19 crisis in our population). Data of each of these 2 months were collected separately. Patients demographic features, type of procedures, blood test results, procedure approach( open, laparoscopic), morbidities and mortality were reported. Statistical analysis using descriptive statistics, Chi-square, and Z -tests were used for statistical significance analysis value taken as The primary endpoints were Covid-19 diagnosis, the number and types of surgical admissions and procedures. The secondary endpoints were complications, mortality, laparoscopic and open approaches,CRP and white cell count, length of stay, age and gender. Results: 332 patients were admitted [146 patients during April 2020, and 177 patients during November 2019. There were 147 male and 176 female. The mean age was 51 year for November group and 49 years for April group. There were 146 procedures performed during November while 117 operations were conducted during April. Length of stay was 5.87 and 5.43 for November and April patients respectively. There were 7 patients tested +ve for Covid-19 and 3 mortality in each group. Acute cholecystitis, abscess, diverticulitis and CRP are showing significant differences between the two groups, P-value Conclusions The postoperative complications, mortality and acute cholecystitis are significantly higher while abscess and diverticulitis are significantly reduced
{"title":"Impact of COVID-19 on Emergency General Surgery","authors":"A. Hussain, Owais Manejula, A. Ghosh, S. Shuaib, H. Soliman, R. Hafeez, S. El-Hasani","doi":"10.30476/ACRR.2020.88275.1064","DOIUrl":"https://doi.org/10.30476/ACRR.2020.88275.1064","url":null,"abstract":"Background There are limited data on emergency surgical practice during the covid-19 era. Objectives To evaluate the outcomes for emergency surgery before and during Covid-19. Methods This is a retrospective study of emergency admissions to one general surgery department during November 2019 (which is likely to represent our normal working pattern) and April 2020 (which was the peak of the Covid-19 crisis in our population). Data of each of these 2 months were collected separately. Patients demographic features, type of procedures, blood test results, procedure approach( open, laparoscopic), morbidities and mortality were reported. Statistical analysis using descriptive statistics, Chi-square, and Z -tests were used for statistical significance analysis value taken as The primary endpoints were Covid-19 diagnosis, the number and types of surgical admissions and procedures. The secondary endpoints were complications, mortality, laparoscopic and open approaches,CRP and white cell count, length of stay, age and gender. Results: 332 patients were admitted [146 patients during April 2020, and 177 patients during November 2019. There were 147 male and 176 female. The mean age was 51 year for November group and 49 years for April group. There were 146 procedures performed during November while 117 operations were conducted during April. Length of stay was 5.87 and 5.43 for November and April patients respectively. There were 7 patients tested +ve for Covid-19 and 3 mortality in each group. Acute cholecystitis, abscess, diverticulitis and CRP are showing significant differences between the two groups, P-value Conclusions The postoperative complications, mortality and acute cholecystitis are significantly higher while abscess and diverticulitis are significantly reduced","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"31 1","pages":"120-124"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80232163","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 : 2020-09-01DOI: 10.30476/ACRR.2020.87993.1063
H. F. L. Junior, Luiz Henrique Minatti, João Oliveira, M. Gerber, Flávia Cristina de Novaes Gerber, D. Vieira, José Mauro dos Santos
Background: With the advances of neoadjuvant chemoradiotherapy, the identification of complete tumor responses, and the reduction of local recurrence even with the adoption of expectant approaches aimed at sphincter preservation, several authors have published results analyzing these aspects with conflicting results, which require further investigation. Objectives: This study aims to evaluate the anatomopathological changes in surgical specimens of rectal resection due to adenocarcinoma in patients undergoing neoadjuvant therapy, including the complete response rate, in addition to estimating the sensitivity and specificity indexes of the imaging methods used in the preoperative period. Methods: This was an observational, retrospective, cross-sectional study in which 44 medical records of patients with cancer of the middle and lower rectum who underwent neoadjuvant chemoradiotherapy and subsequently underwent oncological surgical resections over 10 years were studied. Demographic data, CT scans, colonoscopies, anatomopathological reports and surgical reports were analyzed. Results: Abdominoperineal resection of the rectum (APR) was performed in 16 cases (36.4%), and abdominal rectosigmoidectomy (AR) was performed in 28 cases (63.6%). Preoperative computerized tomography (CT) showed a sensitivity of 75% and specificity of 77.8% for the detection of lymph node metastases. The complete pathological response to neoadjuvant chemoradiotherapy was found in 11.36% of cases. The local recurrence was detected in 23.9% cases and distant metastasis in 15.2% of the patients on the follow-up period, additionally, there was a 77.7% 5-years disease-free survival and the overall survival was 73.9%. Conclusions: The rate of complete pathological response to neoadjuvant therapy was 11.36%. Locally advanced disease and angiolymphatic embolization were associated with a higher frequency of lymph node involvement. CT obtained high rates of sensitivity and specificity for comparison with anatomopathological results.
{"title":"Analysis of Rectal Neoplasms Operated After Neoadjuvant Therapy in A Period of 10 Years","authors":"H. F. L. Junior, Luiz Henrique Minatti, João Oliveira, M. Gerber, Flávia Cristina de Novaes Gerber, D. Vieira, José Mauro dos Santos","doi":"10.30476/ACRR.2020.87993.1063","DOIUrl":"https://doi.org/10.30476/ACRR.2020.87993.1063","url":null,"abstract":"Background: With the advances of neoadjuvant chemoradiotherapy, the identification of complete tumor responses, and the reduction of local recurrence even with the adoption of expectant approaches aimed at sphincter preservation, several authors have published results analyzing these aspects with conflicting results, which require further investigation. Objectives: This study aims to evaluate the anatomopathological changes in surgical specimens of rectal resection due to adenocarcinoma in patients undergoing neoadjuvant therapy, including the complete response rate, in addition to estimating the sensitivity and specificity indexes of the imaging methods used in the preoperative period. Methods: This was an observational, retrospective, cross-sectional study in which 44 medical records of patients with cancer of the middle and lower rectum who underwent neoadjuvant chemoradiotherapy and subsequently underwent oncological surgical resections over 10 years were studied. Demographic data, CT scans, colonoscopies, anatomopathological reports and surgical reports were analyzed. Results: Abdominoperineal resection of the rectum (APR) was performed in 16 cases (36.4%), and abdominal rectosigmoidectomy (AR) was performed in 28 cases (63.6%). Preoperative computerized tomography (CT) showed a sensitivity of 75% and specificity of 77.8% for the detection of lymph node metastases. The complete pathological response to neoadjuvant chemoradiotherapy was found in 11.36% of cases. The local recurrence was detected in 23.9% cases and distant metastasis in 15.2% of the patients on the follow-up period, additionally, there was a 77.7% 5-years disease-free survival and the overall survival was 73.9%. Conclusions: The rate of complete pathological response to neoadjuvant therapy was 11.36%. Locally advanced disease and angiolymphatic embolization were associated with a higher frequency of lymph node involvement. CT obtained high rates of sensitivity and specificity for comparison with anatomopathological results.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"58 1","pages":"141-147"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82021650","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 : 2020-09-01DOI: 10.30476/ACRR.2020.86258.1046
M. Jothimani, L. Loganathan, Prahashini Palanisamy, K. Muthusamy
Context: Cancer is the leading cause of death in the human population, ensuing from the accumulation of damage to genetic materials and affecting various parts of the organs. This review is focused on the cell signaling cross-talk mechanism of colorectal cancer (CRC) and its regulations. Genomic instability acts as the major driving force for CRC. The major CRC cascade mechanisms such as Wnt, Ras, TOPK, p53, and ubiquitin pathways were discussed. These interlinked signals cross-talk with one another in various regulatory mechanisms and play a unique role in CRC. Evidence Acquisition: The major cross-talking signals of CRC are the most significant part of this review. Wnt is a resource and center of axis for cross-talk and interlinked signaling mechanism. Wnt/β-catenin signaling was regulated by frizzled receptor, co-factors, Ras, TOPK, and many other mechanisms; related literature of CRC were collected through a literature survey and categorized using the keywords. The pathways with high specificity interlinked with Wnt were identified and used as the major targets for this review. Results and Conclusion: The interlinked signaling pathways and gene networks were explained with their specificity role in CRC. We highlighted the major regulatory signaling and interlinked pathways of CRC, as new multi targets approach. Furthermore, we discussed the potent targeted genes, bio-markers for a better prognosis, and therapies for CRC patients. Through highlighting the gene cross-talking signaling cascade; we have provided the source for gene network interaction and targeted therapy. This study paves the way for multi-targeting of interlinked pathways and suggesting these would be perfect for suppressing of CRC. The signaling pathways discussed in this review are not only focused on CRC but also the new potent targets and bio-markers for different types of cancers. Targeting multiple interlinked pathways could be useful for developing new potential bio-markers for treatment and diagnosis purposes.
{"title":"Regulatory pathways of colorectal cancer and their synergistic cross-talk mechanism","authors":"M. Jothimani, L. Loganathan, Prahashini Palanisamy, K. Muthusamy","doi":"10.30476/ACRR.2020.86258.1046","DOIUrl":"https://doi.org/10.30476/ACRR.2020.86258.1046","url":null,"abstract":"Context: Cancer is the leading cause of death in the human population, ensuing from the accumulation of damage to genetic materials and affecting various parts of the organs. This review is focused on the cell signaling cross-talk mechanism of colorectal cancer (CRC) and its regulations. Genomic instability acts as the major driving force for CRC. The major CRC cascade mechanisms such as Wnt, Ras, TOPK, p53, and ubiquitin pathways were discussed. These interlinked signals cross-talk with one another in various regulatory mechanisms and play a unique role in CRC. Evidence Acquisition: The major cross-talking signals of CRC are the most significant part of this review. Wnt is a resource and center of axis for cross-talk and interlinked signaling mechanism. Wnt/β-catenin signaling was regulated by frizzled receptor, co-factors, Ras, TOPK, and many other mechanisms; related literature of CRC were collected through a literature survey and categorized using the keywords. The pathways with high specificity interlinked with Wnt were identified and used as the major targets for this review. Results and Conclusion: The interlinked signaling pathways and gene networks were explained with their specificity role in CRC. We highlighted the major regulatory signaling and interlinked pathways of CRC, as new multi targets approach. Furthermore, we discussed the potent targeted genes, bio-markers for a better prognosis, and therapies for CRC patients. Through highlighting the gene cross-talking signaling cascade; we have provided the source for gene network interaction and targeted therapy. This study paves the way for multi-targeting of interlinked pathways and suggesting these would be perfect for suppressing of CRC. The signaling pathways discussed in this review are not only focused on CRC but also the new potent targets and bio-markers for different types of cancers. Targeting multiple interlinked pathways could be useful for developing new potential bio-markers for treatment and diagnosis purposes.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"1 1","pages":"105-119"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85522010","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 : 2020-09-01DOI: 10.30476/ACRR.2020.84600.1024
Arash Khashayar, Ahmad Khaleghnejad Tabari, L. Mohajerzadeh, J. Ghoroubi, Mahdieh Samami
Background: The corrosive esophageal injury would result in mucosal damage related to type, exposure time, and volume of ingested substance ranging from mild burn to severe necrosis. It is usually seen in childhood. Stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and would require surgery. However postoperative problems should also be considered. The purpose of this study was to determine the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube. Methods: In this observational descriptive-comparative study, 50 consecutive patients attending to Mofid children hospital since 2006 to 2016 were enrolled and the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube among them were determined and compared according to other variables. Results: The results in this study demonstrated that 68% required surgery that 82.3% had repeat surgery. Out of them 22 were performed with Gastric Pull up method that was successful in majority of subjects. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were most common preoperative problems and dysphagia (46%), stricture (36%), and vomiting (26%) were most common postoperative problems. There were 4 mortality cases. Conclusion: Totally, according to the obtained results, it may be concluded that esophagus substitution in the management of corrosive esophageal injury is effective that Gastric Pull up method is best option.
{"title":"Outcomes of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube","authors":"Arash Khashayar, Ahmad Khaleghnejad Tabari, L. Mohajerzadeh, J. Ghoroubi, Mahdieh Samami","doi":"10.30476/ACRR.2020.84600.1024","DOIUrl":"https://doi.org/10.30476/ACRR.2020.84600.1024","url":null,"abstract":"Background: The corrosive esophageal injury would result in mucosal damage related to type, exposure time, and volume of ingested substance ranging from mild burn to severe necrosis. It is usually seen in childhood. Stricture and dysphagia are common. Swallowing problems are due to prolonged stricture and would require surgery. However postoperative problems should also be considered. The purpose of this study was to determine the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube. Methods: In this observational descriptive-comparative study, 50 consecutive patients attending to Mofid children hospital since 2006 to 2016 were enrolled and the results of esophagus substitution in the management of corrosive esophageal injury in three methods; colon interposition, gastric pull up, and reverse gastric tube among them were determined and compared according to other variables. Results: The results in this study demonstrated that 68% required surgery that 82.3% had repeat surgery. Out of them 22 were performed with Gastric Pull up method that was successful in majority of subjects. Esophageal stricture (74%), vomiting (46%), and dysphagia (40%) were most common preoperative problems and dysphagia (46%), stricture (36%), and vomiting (26%) were most common postoperative problems. There were 4 mortality cases. Conclusion: Totally, according to the obtained results, it may be concluded that esophagus substitution in the management of corrosive esophageal injury is effective that Gastric Pull up method is best option.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"6 1","pages":"125-128"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88528609","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 : 2020-09-01DOI: 10.30476/ACRR.2020.87288.1056
Lesley Naik, S. Stefan, C. Ball, J. Khan
Abstract Locally advanced colonic cancers requiring multivisceral en-bloc resections are typically undertaken in an open or laparoscopic approach. Here, we report a case of a complex robotic subtotal colectomy with en-bloc resection of the chest wall and left 10th to 12th ribs for management of a locally advanced descending colon cancer and peritumoral abscess at our institution in June 2020. The procedure was augmented with intraoperative ultrasound scan-guided marking to delineate tumoural extent. Histologically, negative excision margins (R0) were achieved. We also undertook a brief review of relevant literature. There are very few publications on the multivisceral resections for advanced colonic cancer; this is the second reported case of robotic en-bloc colonic resection in English literature. A similar case report published in 2019 enforced the value of multidisciplinary team collaboration and the benefits of robotic over laparoscopic surgery in en-bloc resections. Considering improved short-term outcomes and comparable oncological safety granted by laparoscopic surgery, minimally-invasive surgery has a clear role in the surgical management of locally-advanced colorectal cancers. Key words: en-bloc resection, multivisceral resection, colonic cancer, robotic surgery, subtotal colectomy, peritumoural abscess
{"title":"Robotic Subtotal Colectomy with en-bloc Resection of the Left Chest wall for Locally Advanced Colonic Cancer: A Case Report and Literature Review","authors":"Lesley Naik, S. Stefan, C. Ball, J. Khan","doi":"10.30476/ACRR.2020.87288.1056","DOIUrl":"https://doi.org/10.30476/ACRR.2020.87288.1056","url":null,"abstract":"Abstract Locally advanced colonic cancers requiring multivisceral en-bloc resections are typically undertaken in an open or laparoscopic approach. Here, we report a case of a complex robotic subtotal colectomy with en-bloc resection of the chest wall and left 10th to 12th ribs for management of a locally advanced descending colon cancer and peritumoral abscess at our institution in June 2020. The procedure was augmented with intraoperative ultrasound scan-guided marking to delineate tumoural extent. Histologically, negative excision margins (R0) were achieved. We also undertook a brief review of relevant literature. There are very few publications on the multivisceral resections for advanced colonic cancer; this is the second reported case of robotic en-bloc colonic resection in English literature. A similar case report published in 2019 enforced the value of multidisciplinary team collaboration and the benefits of robotic over laparoscopic surgery in en-bloc resections. Considering improved short-term outcomes and comparable oncological safety granted by laparoscopic surgery, minimally-invasive surgery has a clear role in the surgical management of locally-advanced colorectal cancers. Key words: en-bloc resection, multivisceral resection, colonic cancer, robotic surgery, subtotal colectomy, peritumoural abscess","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"25 1","pages":"152-155"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84708456","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 : 2020-06-01DOI: 10.30476/ACRR.2020.46702
Yiu Ming Ho, Jai Hoff, A. May, Clay Renwick
Background - The risk of local recurrence in colorectal cancer has been associated with the length of clear distal margin in the specimen taken during original resection. It has been reported that there is significant specimen shrinkage after fixation in formalin. This study is aimed to quantify this degree of shrinkage and to investigate the factors for specimen shrinkage. Methods – This research was a single centre prospective study. All adult patients who underwent colorectal surgery for cancer had demographics, surgical details and cancer staging and pathology recorded. Colonic specimens were measured immediately post resection including the total length, the mesenteric length and the distal length from the palpable tumour. Multiple logistic linear regression was applied to identify factors associated with distal margin shrinkage. Results – Right-sided colectomy specimens had an inconsistent degree of shrinkage. Left-sided colectomy specimens showed an average shrinkage of 20% (CI 4% – 36%). The only other factor observed that had statistically significant association on the shrinkage of distal margins in specimens was increasing tumour size. Conclusions - Specimens resected during anterior resection for colorectal cancer have a consistent level of shrinkage. Locally advanced tumours were observed to have an association with specimen distal margin shrinkage, however the mechanism is unclear. This new evidence can assist intra-operative decision making to allow adequate distal margin resection.
{"title":"Distal Margin Shrinkage Factor – A Consideration Before Dividing the Specimen in Colorectal Cancer Surgery","authors":"Yiu Ming Ho, Jai Hoff, A. May, Clay Renwick","doi":"10.30476/ACRR.2020.46702","DOIUrl":"https://doi.org/10.30476/ACRR.2020.46702","url":null,"abstract":"Background - The risk of local recurrence in colorectal cancer has been associated with the length of clear distal margin in the specimen taken during original resection. It has been reported that there is significant specimen shrinkage after fixation in formalin. This study is aimed to quantify this degree of shrinkage and to investigate the factors for specimen shrinkage. Methods – This research was a single centre prospective study. All adult patients who underwent colorectal surgery for cancer had demographics, surgical details and cancer staging and pathology recorded. Colonic specimens were measured immediately post resection including the total length, the mesenteric length and the distal length from the palpable tumour. Multiple logistic linear regression was applied to identify factors associated with distal margin shrinkage. Results – Right-sided colectomy specimens had an inconsistent degree of shrinkage. Left-sided colectomy specimens showed an average shrinkage of 20% (CI 4% – 36%). The only other factor observed that had statistically significant association on the shrinkage of distal margins in specimens was increasing tumour size. Conclusions - Specimens resected during anterior resection for colorectal cancer have a consistent level of shrinkage. Locally advanced tumours were observed to have an association with specimen distal margin shrinkage, however the mechanism is unclear. This new evidence can assist intra-operative decision making to allow adequate distal margin resection.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"63 1","pages":"75-78"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76520987","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 : 2020-06-01DOI: 10.30476/ACRR.2020.46754
Muhamad Izwan Ismail, H. Chong, Wan Khamizar Wan Khazim
INTRODUCTION : Anterior resection is a commonly performed surgery for rectal cancer worldwide. It is associated with a wide spectrum of complications which include haemorrhage, pelvic sepsis, wound infection, anastomotic breakdown, deep vein thrombosis, peripheral nerves injury, impotence and urological dysfunction. However acute aortic thrombosis post anterior resection is a very rare complication. CASE PRESENTATION : We report a rare case of aortic thrombosis in a 67 year old gentleman following anterior resection for rectal cancer. DISCUSSION : We also discuss its possible causes as there are many postulations to the cause of this devastating complication. Prolonged surgery, abnormal blood coagulation in cancer patient, lithotomy position and the presence of peripheral vascular disease are predisposing factors contributing to this rare acute aortic thrombosis in our patient. A standard routine neurovascular examination of the extremities should be done in the postoperative period to help detect early any neurovascular complication. The use of prophylactic anticoagulant such as fondaparinux, low molecular weight heparin or low dose unfractionated heparin are strongly recommended in high risk surgery patients undergoing a major surgery which helps prevent thromboembolic episode following surgery.
{"title":"Acute Aortic Thrombosis Following Anterior Resection - A Rare Complication","authors":"Muhamad Izwan Ismail, H. Chong, Wan Khamizar Wan Khazim","doi":"10.30476/ACRR.2020.46754","DOIUrl":"https://doi.org/10.30476/ACRR.2020.46754","url":null,"abstract":"INTRODUCTION : Anterior resection is a commonly performed surgery for rectal cancer worldwide. It is associated with a wide spectrum of complications which include haemorrhage, pelvic sepsis, wound infection, anastomotic breakdown, deep vein thrombosis, peripheral nerves injury, impotence and urological dysfunction. However acute aortic thrombosis post anterior resection is a very rare complication. CASE PRESENTATION : We report a rare case of aortic thrombosis in a 67 year old gentleman following anterior resection for rectal cancer. DISCUSSION : We also discuss its possible causes as there are many postulations to the cause of this devastating complication. Prolonged surgery, abnormal blood coagulation in cancer patient, lithotomy position and the presence of peripheral vascular disease are predisposing factors contributing to this rare acute aortic thrombosis in our patient. A standard routine neurovascular examination of the extremities should be done in the postoperative period to help detect early any neurovascular complication. The use of prophylactic anticoagulant such as fondaparinux, low molecular weight heparin or low dose unfractionated heparin are strongly recommended in high risk surgery patients undergoing a major surgery which helps prevent thromboembolic episode following surgery.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"16 1","pages":"101-103"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85320409","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 : 2020-06-01DOI: 10.30476/ACRR.2020.46746
J. Cheong, A. Keshava, C. Young
IntroductionOpen abdominal surgery exposes the intestine to negative ventilation (20°C, 0-5% RH), which along with the large surface area of peritoneum has the potential to cause loss of body heat. This study examined whether the warmed, humidified CO2 (WHCO2) can reduce heat loss and reduce postoperative pain.MethodsA randomized controlled trial was performed at a tertiary colorectal unit (Concord Repatriation General Hospital, The University of Sydney, Australia). The study group received WHCO2 at a rate of 10L/min. The control group did not receive any insufflation during the operation. Patients were over 18 years of age undergoing elective open colorectal operations. Core body temperature measurement was made every 15 minutely with a trans-oesophageal probe. Postoperative pain was assessed via: (1) duration of use of patient controlled analgesia (PCA), (2) total oral morphine equivalent daily dose (oral MEDD).Results39 Patients were recruited in the study, with 20 patients receiving WHCO2. There was no difference in the core body temperature between the WHCO2 and the Control group (36.1 vs. 35.9°C, p=0.35). There was no difference in the % of the operating time where core body temperature dropped below the lower limit of normal of 35.8°C (28.4% vs 35.8%, p=0.51), or to the level of hypothermia of 35°C (7.7% vs. 13.4%, p=0.50). No difference in postoperative PCA duration, as well as MEDD, were noted between the CO2 group and control group.ConclusionWHCO2 had no effect on core body temperature during open colorectal surgery and the postoperative pain experienced.
腹腔开腹手术使肠道暴露于负通气(20°C, 0-5% RH)，这与腹膜的大表面积一起有可能导致体热损失。本研究考察了加温加湿CO2 (WHCO2)是否能减少热损失和减轻术后疼痛。方法在澳大利亚悉尼大学协和遣返总医院三级结直肠科进行随机对照试验。研究组以10L/min的速率吸入WHCO2。对照组患者术中不进行任何充气。患者均大于18岁，接受择期结肠直肠开腹手术。用经食管探头每15分钟测量一次核心体温。术后疼痛通过以下方式评估:(1)患者自控镇痛(PCA)使用时间;(2)口服吗啡总当量日剂量(口服MEDD)。结果39例患者纳入研究，其中20例患者接受了WHCO2治疗。WHCO2组与对照组的核心体温无差异(36.1°C vs 35.9°C, p=0.35)。核心体温低于正常下限35.8°C (28.4% vs 35.8%， p=0.51)或降至35°C低体温水平(7.7% vs 13.4%， p=0.50)的操作时间百分比无差异。CO2组与对照组术后PCA持续时间及MEDD均无差异。结论whco2对结直肠开腹术中核心体温及术后疼痛无明显影响。
{"title":"The effect of humidified warmed CO2 during open colorectal surgery on body temperature and postoperative pain: a randomized controlled trial.","authors":"J. Cheong, A. Keshava, C. Young","doi":"10.30476/ACRR.2020.46746","DOIUrl":"https://doi.org/10.30476/ACRR.2020.46746","url":null,"abstract":"IntroductionOpen abdominal surgery exposes the intestine to negative ventilation (20°C, 0-5% RH), which along with the large surface area of peritoneum has the potential to cause loss of body heat. This study examined whether the warmed, humidified CO2 (WHCO2) can reduce heat loss and reduce postoperative pain.MethodsA randomized controlled trial was performed at a tertiary colorectal unit (Concord Repatriation General Hospital, The University of Sydney, Australia). The study group received WHCO2 at a rate of 10L/min. The control group did not receive any insufflation during the operation. Patients were over 18 years of age undergoing elective open colorectal operations. Core body temperature measurement was made every 15 minutely with a trans-oesophageal probe. Postoperative pain was assessed via: (1) duration of use of patient controlled analgesia (PCA), (2) total oral morphine equivalent daily dose (oral MEDD).Results39 Patients were recruited in the study, with 20 patients receiving WHCO2. There was no difference in the core body temperature between the WHCO2 and the Control group (36.1 vs. 35.9°C, p=0.35). There was no difference in the % of the operating time where core body temperature dropped below the lower limit of normal of 35.8°C (28.4% vs 35.8%, p=0.51), or to the level of hypothermia of 35°C (7.7% vs. 13.4%, p=0.50). No difference in postoperative PCA duration, as well as MEDD, were noted between the CO2 group and control group.ConclusionWHCO2 had no effect on core body temperature during open colorectal surgery and the postoperative pain experienced.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"13 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81974901","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 : 2020-06-01DOI: 10.30476/ACRR.2020.46701
Konstantinos Koukoubanis, Vasiliki Bibasi, N. Thomakos
The value of postoperative critical care in gynecologic oncology surgery is crucial for the patient’s further postoperative course. For that reason different levels of postoperative care should exist, in order to identify in an early stage the possible complications and handle them properly . Strict indications of who should be admitted or not, should be defined and surgeons as well anesthesiologists should be aware of them. On the other hand, longer stay in hospital increases the likelihood of complications such as nosocomial infections and late ambulation, increasing morbidity and mortality. Therefore, longer stay in critical care units should be avoided, by predicting if patients are able to move to the general ward and later exit from the hospital. The next step is to set strict protocols for the indications of admission and decreased hospitalization by an accepted scientific team. These protocols should be applied universally in order to achieve the best possible outcomes in patients’ postoperative course.
{"title":"The Fundamental Role of Postoperative Critical Care in Gynecologic Oncology Surgery: A Brief Report","authors":"Konstantinos Koukoubanis, Vasiliki Bibasi, N. Thomakos","doi":"10.30476/ACRR.2020.46701","DOIUrl":"https://doi.org/10.30476/ACRR.2020.46701","url":null,"abstract":"The value of postoperative critical care in gynecologic oncology surgery is crucial for the patient’s further postoperative course. For that reason different levels of postoperative care should exist, in order to identify in an early stage the possible complications and handle them properly . Strict indications of who should be admitted or not, should be defined and surgeons as well anesthesiologists should be aware of them. On the other hand, longer stay in hospital increases the likelihood of complications such as nosocomial infections and late ambulation, increasing morbidity and mortality. Therefore, longer stay in critical care units should be avoided, by predicting if patients are able to move to the general ward and later exit from the hospital. The next step is to set strict protocols for the indications of admission and decreased hospitalization by an accepted scientific team. These protocols should be applied universally in order to achieve the best possible outcomes in patients’ postoperative course.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"6 1","pages":"97-100"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80031929","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 : 2020-06-01DOI: 10.30476/ACRR.2020.46703
J. Cheong, Peter Lee, Yoon-Suk Lee, N. Ahmadi
Lateral pelvic lymph node dissection for advanced low rectal cancer has generated much discussion in the literature in last few years. Whilst it is still being debated as to whether it constitutes a locoregional disease amenable to surgery, or whether it is a distant metastases requiring neoadjuvant therapy, what is clear is that patients with enlarged lateral pelvic lymph nodes have higher rate of recurrence. In this review, we have analysed the current evidence and recommendations for lateral pelvic lymph node dissection. If advanced low rectal cancer (stage II, stage III) below peritoneal reflection, the decision to perform LPLND depends on (1) size of LPLN on MRI (>5mm) prior to neoadjuvant chemoradiotherapy and (2) non-responsive LPLN after CRT (LPLN >5mm before and after CRT). LPLN does prolong the operating time, and greater blood loss, however, is not associated with any greater morbidity. Preservation of the neurovascular structures, including the obturator nerves, hypogastric nerves, and the inferior vesical arteries must be identified and preserved. We have also described the key steps in performing lateral pelvic lymph node dissection.
{"title":"Lateral Pelvic Lymph Node Dissection for low locally advanced rectal cancer: a review","authors":"J. Cheong, Peter Lee, Yoon-Suk Lee, N. Ahmadi","doi":"10.30476/ACRR.2020.46703","DOIUrl":"https://doi.org/10.30476/ACRR.2020.46703","url":null,"abstract":"Lateral pelvic lymph node dissection for advanced low rectal cancer has generated much discussion in the literature in last few years. Whilst it is still being debated as to whether it constitutes a locoregional disease amenable to surgery, or whether it is a distant metastases requiring neoadjuvant therapy, what is clear is that patients with enlarged lateral pelvic lymph nodes have higher rate of recurrence. In this review, we have analysed the current evidence and recommendations for lateral pelvic lymph node dissection. If advanced low rectal cancer (stage II, stage III) below peritoneal reflection, the decision to perform LPLND depends on (1) size of LPLN on MRI (>5mm) prior to neoadjuvant chemoradiotherapy and (2) non-responsive LPLN after CRT (LPLN >5mm before and after CRT). LPLN does prolong the operating time, and greater blood loss, however, is not associated with any greater morbidity. Preservation of the neurovascular structures, including the obturator nerves, hypogastric nerves, and the inferior vesical arteries must be identified and preserved. We have also described the key steps in performing lateral pelvic lymph node dissection.","PeriodicalId":8370,"journal":{"name":"Annals of Colorectal Research","volume":"88 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79043528","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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