Background: Rectal prolapse in children is mainly managed by conservative treatment, especially in those aged <3 years; however, intervention is indicated in cases with persistent and recurrent prolapse that is resistant to conservative treatment. Objective: To determine the efficacy of sclerotherapy using sodium tetradecyl sulphate as a sclerosant in treating rectal prolapse in children. Design: A retrospective chart review. Settings: The study was conducted in a tertiary care pediatric center in Bengaluru, Karnataka. Patients (Material) and Methods: Children aged ≥1 year with persistent rectal prolapse were included in this study, which was conducted from January 2013 to December 2021. The median follow-up period was 1 year. Main Outcome Measure: Resolution of the rectal prolapse. Sample Size: Three hundred and eighty-seven patients. Results: The success rate was 93.5% (43/46) after sclerotherapy treatment. Recurrence was noted in 6.5% of the patients who required a second dose of sclerotherapy or surgery. The median follow-up period was 8 months. There were no remarkable complications or mortality. Conclusion: Rectal sclerotherapy injection is a safe, low-cost procedure with low recurrence rate in children. Limitations: Ours was a retrospective, single-center study, and no control group was utilized. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Rectal sclerotherapy in children: An author's experience with a sclerosant","authors":"J. Aihole","doi":"10.4103/wjcs.wjcs_26_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_26_21","url":null,"abstract":"Background: Rectal prolapse in children is mainly managed by conservative treatment, especially in those aged <3 years; however, intervention is indicated in cases with persistent and recurrent prolapse that is resistant to conservative treatment. Objective: To determine the efficacy of sclerotherapy using sodium tetradecyl sulphate as a sclerosant in treating rectal prolapse in children. Design: A retrospective chart review. Settings: The study was conducted in a tertiary care pediatric center in Bengaluru, Karnataka. Patients (Material) and Methods: Children aged ≥1 year with persistent rectal prolapse were included in this study, which was conducted from January 2013 to December 2021. The median follow-up period was 1 year. Main Outcome Measure: Resolution of the rectal prolapse. Sample Size: Three hundred and eighty-seven patients. Results: The success rate was 93.5% (43/46) after sclerotherapy treatment. Recurrence was noted in 6.5% of the patients who required a second dose of sclerotherapy or surgery. The median follow-up period was 8 months. There were no remarkable complications or mortality. Conclusion: Rectal sclerotherapy injection is a safe, low-cost procedure with low recurrence rate in children. Limitations: Ours was a retrospective, single-center study, and no control group was utilized. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48310462","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}
Cristopher Varela, Adrian Terán, Sthephfania Lopez, German Millan
Short- and long-term complications of stapled hemorrhoidopexy have been extensively discussed during the popularization of the technique, with set complications remarkably decreasing with the progress of learning curves and improvements in the technique. We describe the management of a 58-year-old woman with a history of stapled hemorrhoidopexy who presented with proctalgia and recurrent tenesmus 12 months after the intervention. A 4-cm diverticulum in the lower rectum with fecal material inside was evidenced without a fistula. A transanal diverticulectomy was performed with primary repair of the rectal wall, with the postoperative disappearance of the symptoms. Iatrogenic rectal pseudodiverticul is an infrequent complication due to areas of focal weakness along the rectal wall after failing to complete resection of the mucosa at the circumference of the anastomosis or ineffective stapling of the entire circumference.
{"title":"Rectal pocket syndrome: A symptomatic rectal pseudodiverticula as a long-Term complication of failed purse-string suture during stapled hemorrhoidopexy","authors":"Cristopher Varela, Adrian Terán, Sthephfania Lopez, German Millan","doi":"10.4103/wjcs.wjcs_20_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_20_23","url":null,"abstract":"Short- and long-term complications of stapled hemorrhoidopexy have been extensively discussed during the popularization of the technique, with set complications remarkably decreasing with the progress of learning curves and improvements in the technique. We describe the management of a 58-year-old woman with a history of stapled hemorrhoidopexy who presented with proctalgia and recurrent tenesmus 12 months after the intervention. A 4-cm diverticulum in the lower rectum with fecal material inside was evidenced without a fistula. A transanal diverticulectomy was performed with primary repair of the rectal wall, with the postoperative disappearance of the symptoms. Iatrogenic rectal pseudodiverticul is an infrequent complication due to areas of focal weakness along the rectal wall after failing to complete resection of the mucosa at the circumference of the anastomosis or ineffective stapling of the entire circumference.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135913966","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}
Fetal intestinal volvulus is rare surgical condition associated with high rates of intrauterine, perinatal, and postnatal mortality. The exact incidence of this rare condition has not yet been described in the literature. This emergency surgical condition is associated with high morbidity and mortality if left unattended or unsuspected. One such rare case and its management has been discussed here.
{"title":"A rare case of antenatal volvulus and its management","authors":"J. Aihole","doi":"10.4103/wjcs.wjcs_17_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_17_23","url":null,"abstract":"Fetal intestinal volvulus is rare surgical condition associated with high rates of intrauterine, perinatal, and postnatal mortality. The exact incidence of this rare condition has not yet been described in the literature. This emergency surgical condition is associated with high morbidity and mortality if left unattended or unsuspected. One such rare case and its management has been discussed here.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49586478","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}
Background: The natural progression and life expectancy of patients following a diagnosis of treatable colorectal cancer who receive only symptomatic treatment, nonoperative palliative therapy, or noncurative surgical interventions are relatively unknown. Objectives: The objective of this retrospective study was to examine the survival of patients following a diagnosis of primary nonmetastatic colorectal cancer who did not undergo major surgery for the purpose of curative treatment. Design: A retrospective observational study. Study Settings: Department of Colorectal Surgery, King's College Hospital, London. Patient and Methods: A retrospective study of patients with stages I–III colorectal cancer who had not undergone noncurative surgery, palliative chemotherapy, or radiotherapy between 2012 and 2019 was conducted. Multivariate and univariate analyses were used to evaluate the prognostic factors associated with overall survival (OS). Main Outcome Measure: OS. Sample Size: A total of 78 patients. Results: A total of 78 patients were enrolled in this study. The median survival rate was 296 days or 9.7 months, and the mean survival rate was 385 days (15–1894 days). The 1- and 2-year OS rates were 37.2% and 3.8%, respectively. Univariate analysis revealed that three parameters were statistically significant for OS with a significant correlation with performance status (PS) (P = 0.004), tumor stage (pT) (P = 0.030), and lymph node metastasis (pN) (P = 0.001). Multivariate analysis revealed that pN2 (hazard ratio: 2.19, 95% confidence index: -1.1–4.4) and PS 3 and 4 (hazard ratio: 0.525, 95% confidence index: 0.3–1.0, P = 0.026) were prognostic factors associated with OS. Conclusion: Operable colorectal cancer patients without surgical resection have an OS rate of <1 year; a higher T and N stage is associated with adverse prognosis. Limitations: Our study is limited by its retrospective nature and small sample size. In addition, patients underwent various palliative interventions based on their unique clinical, pathological, and social needs. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Survival and prognostic factors predicting outcomes of patients with primary non-Metastatic colorectal cancer who have not had curative intervention","authors":"AsadA Toor, Mariam Rizk, Simone Cremona, JosephW Nunoo-Mensah","doi":"10.4103/wjcs.wjcs_21_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_21_23","url":null,"abstract":"Background: The natural progression and life expectancy of patients following a diagnosis of treatable colorectal cancer who receive only symptomatic treatment, nonoperative palliative therapy, or noncurative surgical interventions are relatively unknown. Objectives: The objective of this retrospective study was to examine the survival of patients following a diagnosis of primary nonmetastatic colorectal cancer who did not undergo major surgery for the purpose of curative treatment. Design: A retrospective observational study. Study Settings: Department of Colorectal Surgery, King's College Hospital, London. Patient and Methods: A retrospective study of patients with stages I–III colorectal cancer who had not undergone noncurative surgery, palliative chemotherapy, or radiotherapy between 2012 and 2019 was conducted. Multivariate and univariate analyses were used to evaluate the prognostic factors associated with overall survival (OS). Main Outcome Measure: OS. Sample Size: A total of 78 patients. Results: A total of 78 patients were enrolled in this study. The median survival rate was 296 days or 9.7 months, and the mean survival rate was 385 days (15–1894 days). The 1- and 2-year OS rates were 37.2% and 3.8%, respectively. Univariate analysis revealed that three parameters were statistically significant for OS with a significant correlation with performance status (PS) (P = 0.004), tumor stage (pT) (P = 0.030), and lymph node metastasis (pN) (P = 0.001). Multivariate analysis revealed that pN2 (hazard ratio: 2.19, 95% confidence index: -1.1–4.4) and PS 3 and 4 (hazard ratio: 0.525, 95% confidence index: 0.3–1.0, P = 0.026) were prognostic factors associated with OS. Conclusion: Operable colorectal cancer patients without surgical resection have an OS rate of <1 year; a higher T and N stage is associated with adverse prognosis. Limitations: Our study is limited by its retrospective nature and small sample size. In addition, patients underwent various palliative interventions based on their unique clinical, pathological, and social needs. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135914568","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}
Ryan Ward, Carlos Cabalag, Matthew Ng, Fidel Touma
De Garengeot hernia is a rare type of femoral hernia in which the appendix is contained within the hernial sac. Due to its rarity, there is limited evidence regarding its optimal surgical approach. Twenty-five reports of repair using the laparoscopic transabdominal preperitoneal (TAPP) technique have been identified; however, there is a lack of consensus pertaining to preoperative diagnosis and whether concurrent appendicectomy is performed. In addition, there is debate over the use of a covering mesh. A 34-year-old woman presented with a 5-week history of pain in the right groin. On examination, an irreducible, tender mass was identified in the groin. A computed tomography scan illustrated a right femoral hernia containing the appendix, demonstrating features of acute uncomplicated appendicitis. The patient underwent laparoscopic TAPP repair with mesh plus appendicectomy and made an uncomplicated recovery. Here, we present laparoscopic TAPP repair with mesh plus appendicectomy as a safe and feasible surgical method for managing De Garengeot hernia with concurrent uncomplicated appendicitis.
{"title":"Laparoscopic transabdominal preperitoneal repair of de garengeot hernia: A case report","authors":"Ryan Ward, Carlos Cabalag, Matthew Ng, Fidel Touma","doi":"10.4103/wjcs.wjcs_23_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_23_23","url":null,"abstract":"De Garengeot hernia is a rare type of femoral hernia in which the appendix is contained within the hernial sac. Due to its rarity, there is limited evidence regarding its optimal surgical approach. Twenty-five reports of repair using the laparoscopic transabdominal preperitoneal (TAPP) technique have been identified; however, there is a lack of consensus pertaining to preoperative diagnosis and whether concurrent appendicectomy is performed. In addition, there is debate over the use of a covering mesh. A 34-year-old woman presented with a 5-week history of pain in the right groin. On examination, an irreducible, tender mass was identified in the groin. A computed tomography scan illustrated a right femoral hernia containing the appendix, demonstrating features of acute uncomplicated appendicitis. The patient underwent laparoscopic TAPP repair with mesh plus appendicectomy and made an uncomplicated recovery. Here, we present laparoscopic TAPP repair with mesh plus appendicectomy as a safe and feasible surgical method for managing De Garengeot hernia with concurrent uncomplicated appendicitis.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135914578","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}
Natural orifice specimen extraction is a surgical technique that is defined as the removal of a surgical specimen from a natural orifice with intracorporeal anastomosis. Natural orifice specimen extraction is defined by the site of extraction and has been performed via the vagina, anal canal, rectum, colon, and mouth. The primary benefit of this technique is reduced trauma at the access point due to avoidance of mini laparotomy, used to facilitate specimen extraction in conventional laparoscopy. This technique has been associated with less postoperative pain, lower analgesic requirement, faster return of bowel function, and fewer incisional hernias, as well as an improved cosmetic result. Use of the robotic platform allows for deep pelvic dissection, which is challenging to impossible with laparoscopic instruments. Here, we report a case of recurrent diverticulitis in the setting of complex abdominal surgical history managed by robotic-assisted laparoscopic sigmoidectomy with transrectal specimen extraction.
{"title":"Robotic-Assisted laparoscopic sigmoidectomy with transrectal specimen extraction for recurrent diverticulitis","authors":"Carolyn Judge, Gordon G. Wisbach","doi":"10.4103/wjcs.wjcs_11_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_11_22","url":null,"abstract":"Natural orifice specimen extraction is a surgical technique that is defined as the removal of a surgical specimen from a natural orifice with intracorporeal anastomosis. Natural orifice specimen extraction is defined by the site of extraction and has been performed via the vagina, anal canal, rectum, colon, and mouth. The primary benefit of this technique is reduced trauma at the access point due to avoidance of mini laparotomy, used to facilitate specimen extraction in conventional laparoscopy. This technique has been associated with less postoperative pain, lower analgesic requirement, faster return of bowel function, and fewer incisional hernias, as well as an improved cosmetic result. Use of the robotic platform allows for deep pelvic dissection, which is challenging to impossible with laparoscopic instruments. Here, we report a case of recurrent diverticulitis in the setting of complex abdominal surgical history managed by robotic-assisted laparoscopic sigmoidectomy with transrectal specimen extraction.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44333302","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}
B. Behboudi, S. Ahmadi-Tafti, Mostafa Heidari, M. Fazeli, A. Kazemeini, A. Keshvari, A. Heirani-Tabasi, Mohammad Poursalehian, A. Notash, M. Keramati
Background: Distinguishing predictors of local recurrence after surgery is important following curative resection of rectal cancer. Objectives: This study aimed to evaluate the correlation between perineural and lymphovascular invasion with local recurrence after curative resection of rectal cancer. Design: Prospective Cohort Study. Patient and Methods: Patients with stages II and III rectal cancer operated on between January 2011 and December 2015 were included. Data including demographic information and pathologic characteristics of the primary tumor, including perineural and lymphovascular features, were collected. The patients were followed-up for at least 5 years for any evidence of tumor recurrence. Main Outcome Measure: Perineural invasion (PNI) and Lymphovascular invasion (LVI). Sample Size: 202 patients (including 77 women and 125 men). Results: PNI and LVI were found in the histologic features of the tumors of 34 (16.8%) and 56 (27.7%) patients, respectively. 85.3% of the patients with PNI and 67.9% with LVI had developed recurrence within 5 years after curative surgery. Twenty-four patients had concurrent PNI and LVI, which showed a recurrence rate of 87.5%. Conclusion: This study found a significant correlation between tumor recurrence and PNI or LVI in male patients with stage II or III rectal cancer. In addition, a significant relationship was found between PNI and tumor recurrence in female patients; however, there was no significant correlation between LVI and tumor recurrence in these patients. Limitations: Limited sample size. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Perineural and lymphovascular invasion as histologic predictors of a 5-year local recurrence after curative resection of stages II and III rectal cancer","authors":"B. Behboudi, S. Ahmadi-Tafti, Mostafa Heidari, M. Fazeli, A. Kazemeini, A. Keshvari, A. Heirani-Tabasi, Mohammad Poursalehian, A. Notash, M. Keramati","doi":"10.4103/wjcs.wjcs_20_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_20_22","url":null,"abstract":"Background: Distinguishing predictors of local recurrence after surgery is important following curative resection of rectal cancer. Objectives: This study aimed to evaluate the correlation between perineural and lymphovascular invasion with local recurrence after curative resection of rectal cancer. Design: Prospective Cohort Study. Patient and Methods: Patients with stages II and III rectal cancer operated on between January 2011 and December 2015 were included. Data including demographic information and pathologic characteristics of the primary tumor, including perineural and lymphovascular features, were collected. The patients were followed-up for at least 5 years for any evidence of tumor recurrence. Main Outcome Measure: Perineural invasion (PNI) and Lymphovascular invasion (LVI). Sample Size: 202 patients (including 77 women and 125 men). Results: PNI and LVI were found in the histologic features of the tumors of 34 (16.8%) and 56 (27.7%) patients, respectively. 85.3% of the patients with PNI and 67.9% with LVI had developed recurrence within 5 years after curative surgery. Twenty-four patients had concurrent PNI and LVI, which showed a recurrence rate of 87.5%. Conclusion: This study found a significant correlation between tumor recurrence and PNI or LVI in male patients with stage II or III rectal cancer. In addition, a significant relationship was found between PNI and tumor recurrence in female patients; however, there was no significant correlation between LVI and tumor recurrence in these patients. Limitations: Limited sample size. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43896989","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}
Background: Studies have been conducted to investigate more practical and useful parameters in determining the prognosis of patients with colorectal cancer (CRC), and some suggest that the lymph node ratio (LNR) may be useful in doing so, especially in patients with inadequate lymph node dissection. Objectives: We aimed to evaluate the effect of LNR (number of metastatic lymph nodes/number of total lymph nodes excised) on disease-free survival and overall survival rates in CRC. Design: A single-center retrospective cohort study. Setting: Tertiary care hospital. Patients and Methods: The clinical and pathological features of the patients were analyzed by dividing them into groups according to tumor localization; tumor, node, metastasis staging; and LNR. The Kaplan–Meier method and the log-rank test were used for survival analysis. Sample Size: A total of 479 patients with CRC who were operated on between September 1991 and December 2011 were included in this study. The LNR of 439 patients could be calculated, and analyses were according to these patient groups. Main Outcome Measures: The primary objective of this study was to determine the effect of LNR on disease-free survival and overall survival in CRC. Results: A total of 121 right-sided colon cancers, 202 left-sided colon cancers, and 156 rectal cancers were analyzed. The age of the patients ranged from 20 to 93 years, and the mean age was 66.8 (13.5) years. The cumulative 5-year survival rate was 48.5% in our patients with CRC. When analyzing the tumor, node, metastasis stages of the groups according to their LNRs, the results showed that as the rate of lymph node metastasis increases, so does the tumor stage parameter (P < 0.001). The overall survival and disease-free survival rates significantly decreased as LNR increased (P < 0.001). Conclusion: This study showed that LNR correlates well with the disease-free and overall survival rates. A higher LNR could indicate the aggressiveness of the tumor; therefore, LNR may be a predictor of the poor prognosis of CRC. Limitations: Some patients could not be followed-up and we could not evaluate complications because not all patients had data on postoperative complications. As a result, our study results may have been affected. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Prognostic Role of the Lymph Node Ratio in Colorectal Cancer: A Retrospective Study","authors":"S. Derici, Muhammer Ergenç, İ. Sücüllü, M. Akın","doi":"10.4103/wjcs.wjcs_7_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_7_23","url":null,"abstract":"Background: Studies have been conducted to investigate more practical and useful parameters in determining the prognosis of patients with colorectal cancer (CRC), and some suggest that the lymph node ratio (LNR) may be useful in doing so, especially in patients with inadequate lymph node dissection. Objectives: We aimed to evaluate the effect of LNR (number of metastatic lymph nodes/number of total lymph nodes excised) on disease-free survival and overall survival rates in CRC. Design: A single-center retrospective cohort study. Setting: Tertiary care hospital. Patients and Methods: The clinical and pathological features of the patients were analyzed by dividing them into groups according to tumor localization; tumor, node, metastasis staging; and LNR. The Kaplan–Meier method and the log-rank test were used for survival analysis. Sample Size: A total of 479 patients with CRC who were operated on between September 1991 and December 2011 were included in this study. The LNR of 439 patients could be calculated, and analyses were according to these patient groups. Main Outcome Measures: The primary objective of this study was to determine the effect of LNR on disease-free survival and overall survival in CRC. Results: A total of 121 right-sided colon cancers, 202 left-sided colon cancers, and 156 rectal cancers were analyzed. The age of the patients ranged from 20 to 93 years, and the mean age was 66.8 (13.5) years. The cumulative 5-year survival rate was 48.5% in our patients with CRC. When analyzing the tumor, node, metastasis stages of the groups according to their LNRs, the results showed that as the rate of lymph node metastasis increases, so does the tumor stage parameter (P < 0.001). The overall survival and disease-free survival rates significantly decreased as LNR increased (P < 0.001). Conclusion: This study showed that LNR correlates well with the disease-free and overall survival rates. A higher LNR could indicate the aggressiveness of the tumor; therefore, LNR may be a predictor of the poor prognosis of CRC. Limitations: Some patients could not be followed-up and we could not evaluate complications because not all patients had data on postoperative complications. As a result, our study results may have been affected. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48477445","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}
Background: Recent advances in minimally invasive surgery (MIS) have improved outcomes in colon cancer treatment. However, the use of MIS in pT4 colon cancer is controversial. Existing literature on lymph node retrieval in MIS compared to that in open surgery is inconsistent. Previous studies using the National Cancer Database from 2010 to 2014 and 2010 to 2016 found that MIS was associated with higher odds of adequate lymph node resection. Objectives: Using data from more recent years, this study seeks to compare lymph node resection between MIS and open surgery in pT4 colon cancer. Design and Setting: This retrospective cohort study was conducted using the National Cancer Database. Patients and Methods: Patients undergoing MIS or open surgery with lymph node harvest for pT4 colon cancer were included in this study. A trend analysis of surgical approach (MIS versus open and robotic versus laparoscopic) from 2010 to 2017 and a logistic regression model including multiple tumor characteristics and demographic variables for procedures between 2015 and 2017 were performed. Main Outcome Measures: The main outcome evaluated was the adequacy of lymph node retrieval. Sample Size: A total of 27319 patients were included. Results: This study showed a trend towards MIS and robotic surgery for pT4 colon cancer. In addition, it found that MIS for pT4 tumors have higher odds of achieving an adequate lymph node harvest than open surgery in recent years (2015–2017). The demographic factors associated with inadequate lymph node harvest include race and location of the facility (rural versus metro cities). Conclusions: The findings of this study suggest that colorectal surgery has shifted towards MIS, and specifically, robotic surgery for pT4 tumors. This approach has an oncological advantage of adequate lymph node harvest compared to open surgery. Limitations: Despite its advantages, this retrospective database study has inherent biases, such as confounding bias, selection bias, and coding errors in the database, as well as limited data available for analysis. Conflict of interest: The authors have no conflict of interest to declare.
{"title":"Trends of minimally invasive surgery and adequate lymph node harvest in pT4 colon adenocarcinoma: A national cancer database analysis","authors":"Felipe Pacheco, Sarah Harris-Gendron","doi":"10.4103/wjcs.wjcs_8_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_8_23","url":null,"abstract":"Background: Recent advances in minimally invasive surgery (MIS) have improved outcomes in colon cancer treatment. However, the use of MIS in pT4 colon cancer is controversial. Existing literature on lymph node retrieval in MIS compared to that in open surgery is inconsistent. Previous studies using the National Cancer Database from 2010 to 2014 and 2010 to 2016 found that MIS was associated with higher odds of adequate lymph node resection. Objectives: Using data from more recent years, this study seeks to compare lymph node resection between MIS and open surgery in pT4 colon cancer. Design and Setting: This retrospective cohort study was conducted using the National Cancer Database. Patients and Methods: Patients undergoing MIS or open surgery with lymph node harvest for pT4 colon cancer were included in this study. A trend analysis of surgical approach (MIS versus open and robotic versus laparoscopic) from 2010 to 2017 and a logistic regression model including multiple tumor characteristics and demographic variables for procedures between 2015 and 2017 were performed. Main Outcome Measures: The main outcome evaluated was the adequacy of lymph node retrieval. Sample Size: A total of 27319 patients were included. Results: This study showed a trend towards MIS and robotic surgery for pT4 colon cancer. In addition, it found that MIS for pT4 tumors have higher odds of achieving an adequate lymph node harvest than open surgery in recent years (2015–2017). The demographic factors associated with inadequate lymph node harvest include race and location of the facility (rural versus metro cities). Conclusions: The findings of this study suggest that colorectal surgery has shifted towards MIS, and specifically, robotic surgery for pT4 tumors. This approach has an oncological advantage of adequate lymph node harvest compared to open surgery. Limitations: Despite its advantages, this retrospective database study has inherent biases, such as confounding bias, selection bias, and coding errors in the database, as well as limited data available for analysis. Conflict of interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49596844","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}
Maranda K. Pahlkotter, John Snyder, Jesse A. Gygi, W. Sause, HTae Kim
Background: Approximately 1 in 23 people will be diagnosed with colorectal cancer, resulting in nearly 50,000 cancer related deaths per year in the United States. An effective surgical resection plays an integral role in the success or failure of these patients' oncologic treatment. Objective: This study was designed to focus on lymph node sampling and survival of patients undergoing resections for colon cancer to determine if additional training leads to better outcomes. Design: This is a retrospective review from 2006–2017. Patients who presented through the emergency room were considered elective if their surgery was performed >72 hours after admission. One-hundred and thirty-five surgeons were included, and 13 were colorectal trained. We excluded patients with metachronous or synchronous tumors. Analysis was performed using the Wilcoxon rank sum test. Settings: Twenty-three hospitals within a single healthcare system. Patients: Final analysis included patients undergoing a primary, elective resection for colon cancer. Sample Size: We focused at 2335 patients. Main Outcome Measure: Survival after resection and number of lymph nodes sampled. Results: Among the patients, 2657 met the inclusion criteria, with only 322 resections being considered nonelective. In the elective population of 2335 patients, 536 underwent resection by a colorectal specialty trained surgeon. The survival probability was greater for patients who underwent resection by colorectal surgeons than those for patients who underwent resection by non-colorectal surgeons (p = 9e-05). Lymph node sampling in elective resections by colorectal surgeons was significantly higher (p = < 2e-16), with the mean being 23.8 vs 19.1, respectively. Conclusion: Colorectal trained surgeons have significantly better outcomes than non-specialty trained surgeons considering the overall survival rates and number of lymph nodes sampled for elective resections. Limitations: There was insufficient evidence to conclude that any difference existed in the outcomes when considering the non-elective patient population given the low numbers of these resections being performed by colorectal surgeons. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Does Fellowship Matter? A Comparison of Overall Survival and Lymph Node Sampling in Colon Cancer Resections amongst Colorectal Fellowship Trained Surgeons vs. Non-Colorectal Specialty Trained Surgeons","authors":"Maranda K. Pahlkotter, John Snyder, Jesse A. Gygi, W. Sause, HTae Kim","doi":"10.4103/wjcs.wjcs_15_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_15_21","url":null,"abstract":"Background: Approximately 1 in 23 people will be diagnosed with colorectal cancer, resulting in nearly 50,000 cancer related deaths per year in the United States. An effective surgical resection plays an integral role in the success or failure of these patients' oncologic treatment. Objective: This study was designed to focus on lymph node sampling and survival of patients undergoing resections for colon cancer to determine if additional training leads to better outcomes. Design: This is a retrospective review from 2006–2017. Patients who presented through the emergency room were considered elective if their surgery was performed >72 hours after admission. One-hundred and thirty-five surgeons were included, and 13 were colorectal trained. We excluded patients with metachronous or synchronous tumors. Analysis was performed using the Wilcoxon rank sum test. Settings: Twenty-three hospitals within a single healthcare system. Patients: Final analysis included patients undergoing a primary, elective resection for colon cancer. Sample Size: We focused at 2335 patients. Main Outcome Measure: Survival after resection and number of lymph nodes sampled. Results: Among the patients, 2657 met the inclusion criteria, with only 322 resections being considered nonelective. In the elective population of 2335 patients, 536 underwent resection by a colorectal specialty trained surgeon. The survival probability was greater for patients who underwent resection by colorectal surgeons than those for patients who underwent resection by non-colorectal surgeons (p = 9e-05). Lymph node sampling in elective resections by colorectal surgeons was significantly higher (p = < 2e-16), with the mean being 23.8 vs 19.1, respectively. Conclusion: Colorectal trained surgeons have significantly better outcomes than non-specialty trained surgeons considering the overall survival rates and number of lymph nodes sampled for elective resections. Limitations: There was insufficient evidence to conclude that any difference existed in the outcomes when considering the non-elective patient population given the low numbers of these resections being performed by colorectal surgeons. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48104678","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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