Pooja Venkatesh, J. Ray, E. Esen, M. Grieco, M. Bernstein
Anorectal leiomyosarcoma (AL) is a rare and aggressive malignancy. Although the optimal treatment of AL is unknown, surgical resection with negative margins is the mainstay of management. We describe the case of a 72-year-old woman with metastatic rectal leiomyosarcoma, who initially presented with blood per rectum and worsening constipation. She was found to have a 7 × 7.3 cm mass prolapsing through the anal canal into the perineum without extraluminal extension or pathologic lymph nodes on MRI, with pathology consistent with sarcomatoid carcinoma. Transanal R0 resection was performed. Pathology showed a 6 cm high grade sarcoma consistent with leiomyosarcoma and negative margins. Two years post-resection, the patient was found to have a metastatic flank lesion, for which she underwent surgery. If accessible transanally, radical resection of AL is a valuable approach to treatment. Evidence regarding the best adjuvant treatment strategy is lacking and should be evaluated on a case-by-case basis. Number of similar cases published: 27 articles published with 51 cases of anorectal sarcoma based on a review published in 2019.
{"title":"Transanal resection of anorectal leiomyosarcoma","authors":"Pooja Venkatesh, J. Ray, E. Esen, M. Grieco, M. Bernstein","doi":"10.4103/wjcs.wjcs_12_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_12_21","url":null,"abstract":"Anorectal leiomyosarcoma (AL) is a rare and aggressive malignancy. Although the optimal treatment of AL is unknown, surgical resection with negative margins is the mainstay of management. We describe the case of a 72-year-old woman with metastatic rectal leiomyosarcoma, who initially presented with blood per rectum and worsening constipation. She was found to have a 7 × 7.3 cm mass prolapsing through the anal canal into the perineum without extraluminal extension or pathologic lymph nodes on MRI, with pathology consistent with sarcomatoid carcinoma. Transanal R0 resection was performed. Pathology showed a 6 cm high grade sarcoma consistent with leiomyosarcoma and negative margins. Two years post-resection, the patient was found to have a metastatic flank lesion, for which she underwent surgery. If accessible transanally, radical resection of AL is a valuable approach to treatment. Evidence regarding the best adjuvant treatment strategy is lacking and should be evaluated on a case-by-case basis. Number of similar cases published: 27 articles published with 51 cases of anorectal sarcoma based on a review published in 2019.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41258561","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}
The purpose of the review is to establish the safety and efficacy of robotic-assisted colorectal surgery (RAS) and laparoscopic colorectal surgery (LAS) for colorectal disease based on randomized controlled trial studies. The objective of this study is to evaluate two different operative interventions for short-term outcomes. The short-term outcomes include the conversion rate to open operation, intraoperative bleeding, operation time, length of hospital stay, number of lymph nodes harvested, peri-operative complications, and clear pathological resection margins. A search of MEDLINE at EBSCOhost, EMBASE, and Cochrane Library for articles from 1991 to 2020 was performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RAS and LAS. A meta-analysis was performed using the Review Manager (RevMan5.3) software. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity. Ten randomized controlled trial studies were included in the meta-analysis; 687 patients underwent RAS and 794 patients underwent LAS. The results revealed that conversion rates [relative risk (RR) =0.36, 95% confidence index (CI) =0.23–0.55, P < 0.00001], estimated blood losses [mean deviation (MD) = -15.01, 95% CI = -23.93–6.08, P = 0.0010], length of hospital stay (MD = -0.78, 95% CI = -1.11–0.46, P < 0.00001), and complications [odds ratio (OR) =1.04, 95% CI = 0.73–1.48, P = 0.97] were significantly reduced following RAS compared to that with LAS. There were no significant differences in operation time (MD = 0.61, 95% CI = -3.48–4.71, P = 0.77), number of lymph nodes harvested (MD = -0.08, 95% CI = -1.03–0.88, P = 0.87), and circumferential resection margin non-involvement (OR = 1.40, 95% CI = 0.88–2.25, P = 0.16) between the two techniques. The meta-analysis favored the robot-assisted technique. RAS is a promising technique and is a safe and effective alternative to LAS for colorectal surgery. The advantages of RAS include lower conversion rates, shorter hospital stay, and less intraoperative bleeding and complications. Further studies are required to define the effects of RAS on quality of life and long-term oncologic outcomes.
{"title":"Robotic versus laparoscopic low anterior resection for rectal cancer: A systematic review and meta-analysis","authors":"Aba Farid Uddin","doi":"10.4103/wjcs.wjcs_17_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_17_22","url":null,"abstract":"The purpose of the review is to establish the safety and efficacy of robotic-assisted colorectal surgery (RAS) and laparoscopic colorectal surgery (LAS) for colorectal disease based on randomized controlled trial studies. The objective of this study is to evaluate two different operative interventions for short-term outcomes. The short-term outcomes include the conversion rate to open operation, intraoperative bleeding, operation time, length of hospital stay, number of lymph nodes harvested, peri-operative complications, and clear pathological resection margins. A search of MEDLINE at EBSCOhost, EMBASE, and Cochrane Library for articles from 1991 to 2020 was performed to identify randomized controlled trial studies that compared the clinical or oncologic outcomes of RAS and LAS. A meta-analysis was performed using the Review Manager (RevMan5.3) software. The data used were mean differences and odds ratios for continuous and dichotomous variables, respectively. Fixed-effects or random-effects models were adopted according to heterogeneity. Ten randomized controlled trial studies were included in the meta-analysis; 687 patients underwent RAS and 794 patients underwent LAS. The results revealed that conversion rates [relative risk (RR) =0.36, 95% confidence index (CI) =0.23–0.55, P < 0.00001], estimated blood losses [mean deviation (MD) = -15.01, 95% CI = -23.93–6.08, P = 0.0010], length of hospital stay (MD = -0.78, 95% CI = -1.11–0.46, P < 0.00001), and complications [odds ratio (OR) =1.04, 95% CI = 0.73–1.48, P = 0.97] were significantly reduced following RAS compared to that with LAS. There were no significant differences in operation time (MD = 0.61, 95% CI = -3.48–4.71, P = 0.77), number of lymph nodes harvested (MD = -0.08, 95% CI = -1.03–0.88, P = 0.87), and circumferential resection margin non-involvement (OR = 1.40, 95% CI = 0.88–2.25, P = 0.16) between the two techniques. The meta-analysis favored the robot-assisted technique. RAS is a promising technique and is a safe and effective alternative to LAS for colorectal surgery. The advantages of RAS include lower conversion rates, shorter hospital stay, and less intraoperative bleeding and complications. Further studies are required to define the effects of RAS on quality of life and long-term oncologic outcomes.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46515740","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}
Splenic flexure volvulus is a rare cause of large bowel obstruction. Patients often present in a delayed fashion after the onset of peritonitis and require emergent surgical exploration. Here, we present a case of a subacute splenic flexure volvulus following previous low anterior resection and subsequent management.
{"title":"Subacute splenic flexure volvulus following low anterior resection","authors":"J. Chin, M. Rojas, Jan P. Kamiński, J. Estrada","doi":"10.4103/wjcs.wjcs_8_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_8_22","url":null,"abstract":"Splenic flexure volvulus is a rare cause of large bowel obstruction. Patients often present in a delayed fashion after the onset of peritonitis and require emergent surgical exploration. Here, we present a case of a subacute splenic flexure volvulus following previous low anterior resection and subsequent management.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43648208","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}
N. Gupta, E. Bellaguarda, Eileen Wafford, J. Feuerstein, V. Poylin
Background: Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23 to treat Crohn's disease. Effects on surgical complications and outcomes are not well understood. Objectives: We aimed to assess the impact of pre-operative Ustekinumab on post-operative complications in patients with Crohn's disease undergoing abdominal surgery and compare to anti-tumor necrosis factor inhibitors (Anti-TNFs). Design: Systematic review and meta-analysis. Patient and Methods: We searched Medline (Ovid), The Cochrane Library (Wiley), EMBASE (Elsevier), Web of Science (Thomson Reuters), and Scopus (Elsevier), and CINAHL Plus with Full Text (Ebsco) for studies reporting rates of post-operative complications in Ustekinumab treated patients with Crohn's disease. Main Outcome Measure: Surgical site complications (SSI) and overall infectious complications between patients exposed to Ustekinumab pre-operatively in comparison to patients exposed to anti-TNFs pre-operatively. Sample Size: 6 studies including 650 patients. Results: Four out of six studies reported data for post-operative infectious complications between Ustekinumab and anti-TNFs. Among a total of 107 patients who received Ustekinumab and 543 patients who received anti-TNFs, there was no significant difference between the two groups in terms of total infectious complications (RR 1.30, 95% CI 00.54-3.12; P = 0.55). Three studies, including 102 patients in the Ustekinumab group and 481 patients in the anti-TNF alpha group, reported surgical site infections. No significant difference was observed between the two groups (RR 0.75, 95% CI 0.36-1.58; P=0.45). Conclusion: Pre-operative Ustekinumab use was not associated with reduced post-operative complication rates as compared to anti-TNFs in patients with Crohn's disease undergoing abdominal surgery, but there was substantial heterogeneity between trials. Limitations: Data heterogeneity, incomplete data from some of the studies. Conflict of Interest: None.
背景：Ustekinumab是一种靶向白细胞介素12和23的单克隆抗体，用于治疗克罗恩病。对手术并发症和结果的影响尚不清楚。目的：我们旨在评估术前Ustekinumab对克罗恩病腹部手术患者术后并发症的影响，并与抗肿瘤坏死因子抑制剂（anti-TNF）进行比较。设计：系统综述和荟萃分析。患者和方法：我们搜索了Medline（Ovid）、The Cochrane Library（Wiley）、EMBASE（Elsevier）、Web of Science（Thomson Reuters）和Scopus（Elseville）以及CINAHL Plus with Full Text（Ebsco），以了解报告Ustekinumab治疗克罗恩病患者术后并发症发生率的研究。主要结果指标：术前接触Ustekinumab的患者与术前接触抗TNFs的患者之间的手术部位并发症（SSI）和总体感染并发症。样本量：6项研究，包括650名患者。结果：六分之四的研究报告了Ustekinumab和抗TNFs术后感染并发症的数据。在总共107名接受Ustekinumab治疗的患者和543名接受抗TNF-α治疗的患者中，两组在总感染并发症方面没有显著差异（RR 1.30，95%CI 00.54-3.12；P=0.55）。三项研究报告了手术部位感染，包括Ustekinu单抗组的102名患者和抗TNF-a组的481名患者。两组之间没有观察到显著差异（RR 0.75，95%CI 0.36-1.58；P=0.45）。结论：在接受腹部手术的克罗恩病患者中，与抗TNFs相比，术前使用Ustekinumab与降低术后并发症率无关，但试验之间存在显著的异质性。局限性：数据异质性，一些研究的数据不完整。利益冲突：无。
{"title":"Post-operative outcomes in patients undergoing abdominal surgery for Crohn's disease treated with pre-operative Ustekinumab: A systematic review and meta-analysis","authors":"N. Gupta, E. Bellaguarda, Eileen Wafford, J. Feuerstein, V. Poylin","doi":"10.4103/wjcs.wjcs_29_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_29_22","url":null,"abstract":"Background: Ustekinumab is a monoclonal antibody targeting interleukins 12 and 23 to treat Crohn's disease. Effects on surgical complications and outcomes are not well understood. Objectives: We aimed to assess the impact of pre-operative Ustekinumab on post-operative complications in patients with Crohn's disease undergoing abdominal surgery and compare to anti-tumor necrosis factor inhibitors (Anti-TNFs). Design: Systematic review and meta-analysis. Patient and Methods: We searched Medline (Ovid), The Cochrane Library (Wiley), EMBASE (Elsevier), Web of Science (Thomson Reuters), and Scopus (Elsevier), and CINAHL Plus with Full Text (Ebsco) for studies reporting rates of post-operative complications in Ustekinumab treated patients with Crohn's disease. Main Outcome Measure: Surgical site complications (SSI) and overall infectious complications between patients exposed to Ustekinumab pre-operatively in comparison to patients exposed to anti-TNFs pre-operatively. Sample Size: 6 studies including 650 patients. Results: Four out of six studies reported data for post-operative infectious complications between Ustekinumab and anti-TNFs. Among a total of 107 patients who received Ustekinumab and 543 patients who received anti-TNFs, there was no significant difference between the two groups in terms of total infectious complications (RR 1.30, 95% CI 00.54-3.12; P = 0.55). Three studies, including 102 patients in the Ustekinumab group and 481 patients in the anti-TNF alpha group, reported surgical site infections. No significant difference was observed between the two groups (RR 0.75, 95% CI 0.36-1.58; P=0.45). Conclusion: Pre-operative Ustekinumab use was not associated with reduced post-operative complication rates as compared to anti-TNFs in patients with Crohn's disease undergoing abdominal surgery, but there was substantial heterogeneity between trials. Limitations: Data heterogeneity, incomplete data from some of the studies. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47803462","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}
A. Kattepur, S. Nadipanna, H. Deepak, T. Suresh, Srinivasan Doraiswamy, D. Aswathappa
Synchronous tumors of gall bladder and colon cancer are rare, and the underlying genetic, environmental, and immunological factors could play a role in the development of such tumors. Till date, only a few cases of synchronous gall bladder and colonic malignancies have been reported. A 60-year-old lady presented with sub-acute onset of colicky pain in the abdomen and vomiting. Imaging showed the presence of thickening in the ileocecal junction along with a thickened gall bladder. A provisional diagnosis of gall bladder tumour with ileocecal tuberculosis or a synchronous colonic malignancy was made. Laparotomy revealed synchronous tumors in the gall bladder and caecum. Radical cholecystectomy with radical right hemicolectomy was performed. The final histopathology report confirmed the presence of two independent malignancies. A tailored treatment approach for both sites based on clinical findings and anticipated outcomes must be considered. Further immunohistochemical studies must be conducted to confirm the presence of dual malignancies. Metastases from one site to the other should be ruled out.
{"title":"A sordid tale of bile and bowel: A case report","authors":"A. Kattepur, S. Nadipanna, H. Deepak, T. Suresh, Srinivasan Doraiswamy, D. Aswathappa","doi":"10.4103/wjcs.wjcs_24_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_24_22","url":null,"abstract":"Synchronous tumors of gall bladder and colon cancer are rare, and the underlying genetic, environmental, and immunological factors could play a role in the development of such tumors. Till date, only a few cases of synchronous gall bladder and colonic malignancies have been reported. A 60-year-old lady presented with sub-acute onset of colicky pain in the abdomen and vomiting. Imaging showed the presence of thickening in the ileocecal junction along with a thickened gall bladder. A provisional diagnosis of gall bladder tumour with ileocecal tuberculosis or a synchronous colonic malignancy was made. Laparotomy revealed synchronous tumors in the gall bladder and caecum. Radical cholecystectomy with radical right hemicolectomy was performed. The final histopathology report confirmed the presence of two independent malignancies. A tailored treatment approach for both sites based on clinical findings and anticipated outcomes must be considered. Further immunohistochemical studies must be conducted to confirm the presence of dual malignancies. Metastases from one site to the other should be ruled out.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43904918","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: During the COVID-19 pandemic, routine maintenance including endoscopies were postponed for patients with Inflammatory Bowel Disease (IBD). The effects of delaying endoscopies on IBD outcomes are currently unknown. Objectives: This study aimed to evaluate effects of delayed endoscopies on IBD patients. Design: Retrospective study. Patient and Methods: review of all IBD patients scheduled for routine endoscopy at Northwestern Memorial Hospital March 13, 2020 through May 31, 2020, during which all endoscopies were canceled due to COVID-19. Patients were divided between rescheduled on-time after delayed. Patient outcomes one year after cancellation were examined. Main Outcome Measure: hospital and emergency room admissions, surgery, and medication changes. Sample Size: 250 patients. Results: 100 patients were included in the delayed group and 150 in the on-time group, with mean ages of 47.5 and 42.8 years respectively. 59.2% had Crohn's disease (CD), 39.2% had Ulcerative Colitis (UC) and 1.2% had indeterminate colitis. Both groups had similar severity scores during the delay and 1 year post-endoscopy. There was no difference in the number of emergency room or hospital admissions during the delay or at one-year post-endoscopy. One-year post-endoscopy there were significantly more hospitalizations in the on-time group (n=14, 9.3%) compared to the delayed group (n=3, 3%), P=0.03. There were more IBD related surgeries in the on-time group (16) compared to the delayed group (4), P=0.03. Conclusion: Patients with delayed endoscopies due to COVID-19 did not experience worse outcomes compared to patients with on-time endoscopies. There was a higher number of admissions and operations in the on-time group despite similar severity scores. Limitations: Retrospective analysis, only short and intermediate term follow up. Conflict of Interest: None.
{"title":"Consequences of delayed endoscopies on the IBD population during the COVID-19 pandemic","authors":"K. Young, V. Poylin","doi":"10.4103/wjcs.wjcs_28_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_28_22","url":null,"abstract":"Background: During the COVID-19 pandemic, routine maintenance including endoscopies were postponed for patients with Inflammatory Bowel Disease (IBD). The effects of delaying endoscopies on IBD outcomes are currently unknown. Objectives: This study aimed to evaluate effects of delayed endoscopies on IBD patients. Design: Retrospective study. Patient and Methods: review of all IBD patients scheduled for routine endoscopy at Northwestern Memorial Hospital March 13, 2020 through May 31, 2020, during which all endoscopies were canceled due to COVID-19. Patients were divided between rescheduled on-time after delayed. Patient outcomes one year after cancellation were examined. Main Outcome Measure: hospital and emergency room admissions, surgery, and medication changes. Sample Size: 250 patients. Results: 100 patients were included in the delayed group and 150 in the on-time group, with mean ages of 47.5 and 42.8 years respectively. 59.2% had Crohn's disease (CD), 39.2% had Ulcerative Colitis (UC) and 1.2% had indeterminate colitis. Both groups had similar severity scores during the delay and 1 year post-endoscopy. There was no difference in the number of emergency room or hospital admissions during the delay or at one-year post-endoscopy. One-year post-endoscopy there were significantly more hospitalizations in the on-time group (n=14, 9.3%) compared to the delayed group (n=3, 3%), P=0.03. There were more IBD related surgeries in the on-time group (16) compared to the delayed group (4), P=0.03. Conclusion: Patients with delayed endoscopies due to COVID-19 did not experience worse outcomes compared to patients with on-time endoscopies. There was a higher number of admissions and operations in the on-time group despite similar severity scores. Limitations: Retrospective analysis, only short and intermediate term follow up. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41385267","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}
We present the case of a 53-year-old man with newly diagnosed stage III rectal cancer who was found to have an incidental large pelvic schwannoma on staging imaging. Open enucleation and resection of the 11-cm schwannoma was performed to facilitate our oncologic resection, allowing for a single-stage procedure. Number of similar cases published: three.
{"title":"Incidental large pelvic schwannoma found on rectal cancer staging","authors":"J. Chin, M. Rojas, Jan P. Kamiński, J. Estrada","doi":"10.4103/wjcs.wjcs_7_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_7_22","url":null,"abstract":"We present the case of a 53-year-old man with newly diagnosed stage III rectal cancer who was found to have an incidental large pelvic schwannoma on staging imaging. Open enucleation and resection of the 11-cm schwannoma was performed to facilitate our oncologic resection, allowing for a single-stage procedure. Number of similar cases published: three.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45935408","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}
M. Fujioka, K. Fukui, Kentaro Yoshino, M. Idemitsu
Fournier's gangrene (FG) can be treated with prompt surgical debridement. Stoma revision has also been performed to prevent fecal contamination. However, recent advances in stool and wound management have reduced the need for colostomy. We report four cases of severe FG with an exposed rectum and discuss the conditions under which colostomy is indispensable. All four peoples developed FG, and an emergency debridement was performed, resulting in exposure of the rectum. Two peoples with perirectal infectious inflammation extending to the anterior rectum underwent colostomy because the inflammation had reached the retroperitoneum, but the other two, where the inflammation was confined to the dorsal-lateral rectum, were treated successfully without colostomy. We believe that colostomy can be avoided by using suitable wound management devices, except in severe cases where soft tissue infection and necrosis extend to the peritoneum and retroperitoneum and there is concern about rectal ischemia. Number of similar cases published: 0.
{"title":"Colostomy for Fournier's gangrene with rectum exposure","authors":"M. Fujioka, K. Fukui, Kentaro Yoshino, M. Idemitsu","doi":"10.4103/wjcs.wjcs_4_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_4_23","url":null,"abstract":"Fournier's gangrene (FG) can be treated with prompt surgical debridement. Stoma revision has also been performed to prevent fecal contamination. However, recent advances in stool and wound management have reduced the need for colostomy. We report four cases of severe FG with an exposed rectum and discuss the conditions under which colostomy is indispensable. All four peoples developed FG, and an emergency debridement was performed, resulting in exposure of the rectum. Two peoples with perirectal infectious inflammation extending to the anterior rectum underwent colostomy because the inflammation had reached the retroperitoneum, but the other two, where the inflammation was confined to the dorsal-lateral rectum, were treated successfully without colostomy. We believe that colostomy can be avoided by using suitable wound management devices, except in severe cases where soft tissue infection and necrosis extend to the peritoneum and retroperitoneum and there is concern about rectal ischemia. Number of similar cases published: 0.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47071644","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}
Jose L. Cataneo, H. Meidl, G. Joshi, Michael Zhang, Luke Willand, R. Lutfi, F. Quinteros
Background: Obesity has been linked to the development of colorectal cancer and increase in morbidity. However, the impact body mass index (BMI) has on surgical staging through nodal harvest is not entirely understood. Objective: To identify the association between BMI and nodal harvest during elective colon cancer surgeries Design: Retrospective cohort review from 2015 to 2019. Setting: The National Surgical Quality Improvement Program-targeted colectomy database. Materials and Methods: The cohort was selected based on the codes corresponding to elective colectomies for colon cancer. BMI was grouped into the five clinically relevant categories and dichotomized. Nodal harvest was dichotomized into <12 and ≥12 lymph nodes. Univariate and multivariate regression analysis. Sample Size: A total of 35,039 patients. Main Outcomes Measures: The main outcome was adequate lymph node harvest for each BMI group. Secondary outcomes included analysis in laterality of tumors, approach, extent of resection, and identification of risk factors for adequate harvest. Results: The median BMI was 29.02 kg/m2 (interquartile range = 24.37–32.44) with a median of 22 (15–27) lymph nodes harvested. The BMI groups with the highest adequate lymph nodes harvested were those ≤25 with 93.7% compared to 92.8% in BMI >25 (P = 0.002). Right colon cancers had a higher rate of achieving adequate harvest than left colon cancers (94.8% vs. 90.8%, respectively; P < 0.001). Right tumors had a higher rate of adequate harvest in the ≤25 group, this frequency decreases as BMI increases and is the opposite for left tumors (P < 0.001). Inadequate harvest was higher for the open approach (9.82%) than that for laparoscopic (6.12%) or robotic (6.6%) procedures (P ≤ 0.001). BMI of ≤25 was associated with a 13% increase in the likelihood of an adequate nodal harvest (odds ratio = 1.13, 95% confidence index = 1.02–1.26). Conclusion: This study found that lower BMI was associated with a higher probability of achieving adequate nodal harvest. This can increase awareness about the risk of incomplete harvest in overweight and obese patients. Limitations: Large sample size bias, selection bias, and lack of details in specific variables due to the type of database.
{"title":"The association between body mass index and lymph node harvest after elective colon cancer resections","authors":"Jose L. Cataneo, H. Meidl, G. Joshi, Michael Zhang, Luke Willand, R. Lutfi, F. Quinteros","doi":"10.4103/wjcs.wjcs_15_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_15_22","url":null,"abstract":"Background: Obesity has been linked to the development of colorectal cancer and increase in morbidity. However, the impact body mass index (BMI) has on surgical staging through nodal harvest is not entirely understood. Objective: To identify the association between BMI and nodal harvest during elective colon cancer surgeries Design: Retrospective cohort review from 2015 to 2019. Setting: The National Surgical Quality Improvement Program-targeted colectomy database. Materials and Methods: The cohort was selected based on the codes corresponding to elective colectomies for colon cancer. BMI was grouped into the five clinically relevant categories and dichotomized. Nodal harvest was dichotomized into <12 and ≥12 lymph nodes. Univariate and multivariate regression analysis. Sample Size: A total of 35,039 patients. Main Outcomes Measures: The main outcome was adequate lymph node harvest for each BMI group. Secondary outcomes included analysis in laterality of tumors, approach, extent of resection, and identification of risk factors for adequate harvest. Results: The median BMI was 29.02 kg/m2 (interquartile range = 24.37–32.44) with a median of 22 (15–27) lymph nodes harvested. The BMI groups with the highest adequate lymph nodes harvested were those ≤25 with 93.7% compared to 92.8% in BMI >25 (P = 0.002). Right colon cancers had a higher rate of achieving adequate harvest than left colon cancers (94.8% vs. 90.8%, respectively; P < 0.001). Right tumors had a higher rate of adequate harvest in the ≤25 group, this frequency decreases as BMI increases and is the opposite for left tumors (P < 0.001). Inadequate harvest was higher for the open approach (9.82%) than that for laparoscopic (6.12%) or robotic (6.6%) procedures (P ≤ 0.001). BMI of ≤25 was associated with a 13% increase in the likelihood of an adequate nodal harvest (odds ratio = 1.13, 95% confidence index = 1.02–1.26). Conclusion: This study found that lower BMI was associated with a higher probability of achieving adequate nodal harvest. This can increase awareness about the risk of incomplete harvest in overweight and obese patients. Limitations: Large sample size bias, selection bias, and lack of details in specific variables due to the type of database.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44485822","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: Rectal prolapse surgery aims to correct the condition, improve continence, and prevent constipation. Current treatments have issues, but the author developed TRRPCS, an innovative approach to effectively address rectal prolapse and associated functional issues. Design: Observational prospective study. Objective: To explore effectiveness and long term outcomes of TRRPCS (Trans-anal Rectal Resection of Prolapse by Circular Stapler). Settings: Single centre. Patients and Methods: All subjects underwent Transanal Rectal Resection by Circular stapler for prolapse. Patients have been followed for two years and telephonic follow-up was planned for five years. Main Outcome Measures: Pre and postoperative ODS scores and Wexner fecal incontinence score were obtained to evaluate symptomatic outcomes. Improvement in Longo's ODS score system, Wexner fecal incontinence score and subjective overall satisfaction of patients were used for evaluation. Sample Size: 91. Results: In a study of 91 patients (aged 41-60), TRRCS procedure had a median surgery time of 40 minutes and a median hospital stay of 24 hours. Normal activities resumed within 5 days. Complications included pain, burning, urgency, bleeding, and loose motions. Significant improvement was observed in Longo and Wexner scores. 78.85% of patients were highly satisfied. One patient experienced mucosal prolapse, treated successfully. No other recurrences were reported during a follow-up of up to seven years. Conclusion: TRRPCS: Safe, minimally invasive daycare procedure improves incontinence, corrects constipation without sexual dysfunction. Low recurrence rate (1.1%) with long-term follow-up. Limitations: Single institution, Non comparative data. Conflict of Interest: No conflict of interest declared.
{"title":"Transanal rectal resection by circular stapler for rectal prolapse: A prospective cohort study","authors":"A. Porwal, P. Gandhi, D. Kulkarni","doi":"10.4103/wjcs.wjcs_23_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_23_21","url":null,"abstract":"Background: Rectal prolapse surgery aims to correct the condition, improve continence, and prevent constipation. Current treatments have issues, but the author developed TRRPCS, an innovative approach to effectively address rectal prolapse and associated functional issues. Design: Observational prospective study. Objective: To explore effectiveness and long term outcomes of TRRPCS (Trans-anal Rectal Resection of Prolapse by Circular Stapler). Settings: Single centre. Patients and Methods: All subjects underwent Transanal Rectal Resection by Circular stapler for prolapse. Patients have been followed for two years and telephonic follow-up was planned for five years. Main Outcome Measures: Pre and postoperative ODS scores and Wexner fecal incontinence score were obtained to evaluate symptomatic outcomes. Improvement in Longo's ODS score system, Wexner fecal incontinence score and subjective overall satisfaction of patients were used for evaluation. Sample Size: 91. Results: In a study of 91 patients (aged 41-60), TRRCS procedure had a median surgery time of 40 minutes and a median hospital stay of 24 hours. Normal activities resumed within 5 days. Complications included pain, burning, urgency, bleeding, and loose motions. Significant improvement was observed in Longo and Wexner scores. 78.85% of patients were highly satisfied. One patient experienced mucosal prolapse, treated successfully. No other recurrences were reported during a follow-up of up to seven years. Conclusion: TRRPCS: Safe, minimally invasive daycare procedure improves incontinence, corrects constipation without sexual dysfunction. Low recurrence rate (1.1%) with long-term follow-up. Limitations: Single institution, Non comparative data. Conflict of Interest: No conflict of interest declared.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42014809","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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