Background: Harmonic scalpel hemorrhoidectomy is associated with lesser pain postoperatively and shorter hospital stays than conventional hemorroidectomy. Objective: To compare the outcome of harmonic scalpel hemorrhoidectomy (HSH) and submucosal ligation hemorrhoidectomy (SLH) in management of Grade III and Grade IV hemorrhoids. Design: A prospective comparative study. Setting: A tertiary hospital was selected. Patients and Methods: This is a prospective randomized study that includes 120 patients with Grade III or Grade IV internal hemorrhoids who were operated in the surgical department of Menoufia University Hospital between February 2016 until December 2018. Main Outcome Measures: Demographic data, perioperative parameters, postoperative complications, and recurrence of hemorrhoids were recorded. All patients were regularly followed up after 1 month, 3 moths, 6 months, and 12 months postoperative for a year. Sample Size: One hundred and twenty patients with Grade III or Grade IV hemorrhoids were divided randomly to SLH (n = 61) and HSH (n = 59) groups. Results: Operative time was 35±12 min in Group A while 18±6 min in Group B with no significant difference between both groups regarding mean hospital stay and time to return to daily activity. Severe pain occurred in 3 cases in Group A while 9 cases in Group B with significantly higher incidence of severe pain in HSH group. The cost was highly significant in HSH group. Anal stenosis occur in 2 (3.2%) cases in Group A and 7 (11.9%) cases in Group B with significantly higher incidence of anal stenosis in HSH group. Conclusion: Both SLH and HSH were safe and effective surgical techniques for management of Grade III and Grade IV hemorrhoids. The SLH technique was associated with less incidence of severe postoperative pain, lower cost, and fewer rate of stenosis. Limitations: Prospective study design, short follow-up period, and learning curve. Conflict of Interest: None.
{"title":"Submucosal Hemorrhoidectomy versus Hemorrhoidectomy Utilizing an Energy Device in the Treatment of Grade III and IV Hemorrhoidal Disease","authors":"M. Amar, M. Nassar","doi":"10.4103/WJCS.WJCS_22_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_22_19","url":null,"abstract":"Background: Harmonic scalpel hemorrhoidectomy is associated with lesser pain postoperatively and shorter hospital stays than conventional hemorroidectomy. Objective: To compare the outcome of harmonic scalpel hemorrhoidectomy (HSH) and submucosal ligation hemorrhoidectomy (SLH) in management of Grade III and Grade IV hemorrhoids. Design: A prospective comparative study. Setting: A tertiary hospital was selected. Patients and Methods: This is a prospective randomized study that includes 120 patients with Grade III or Grade IV internal hemorrhoids who were operated in the surgical department of Menoufia University Hospital between February 2016 until December 2018. Main Outcome Measures: Demographic data, perioperative parameters, postoperative complications, and recurrence of hemorrhoids were recorded. All patients were regularly followed up after 1 month, 3 moths, 6 months, and 12 months postoperative for a year. Sample Size: One hundred and twenty patients with Grade III or Grade IV hemorrhoids were divided randomly to SLH (n = 61) and HSH (n = 59) groups. Results: Operative time was 35±12 min in Group A while 18±6 min in Group B with no significant difference between both groups regarding mean hospital stay and time to return to daily activity. Severe pain occurred in 3 cases in Group A while 9 cases in Group B with significantly higher incidence of severe pain in HSH group. The cost was highly significant in HSH group. Anal stenosis occur in 2 (3.2%) cases in Group A and 7 (11.9%) cases in Group B with significantly higher incidence of anal stenosis in HSH group. Conclusion: Both SLH and HSH were safe and effective surgical techniques for management of Grade III and Grade IV hemorrhoids. The SLH technique was associated with less incidence of severe postoperative pain, lower cost, and fewer rate of stenosis. Limitations: Prospective study design, short follow-up period, and learning curve. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48917242","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 role of intersphincteric proctectomy in low rectal cancer remains controversial. Objective: To compare the perioperative and oncologic outcomes of intersphincteric proctectomy to proctectomy with stapled coloanal anastomosis. Design: A retrospective case-matched review. Setting: A tertiary colorectal surgery unit. Patients and Methods: All intersphincteric proctectomy cases conducted by one surgeon over a 7-year period were matched for gender, race, age, and comorbidities with patients who underwent proctectomy with stapled coloanal anastomosis. Main Outcome Measures: Operative time, blood loss, postoperative complications, length of stay, margin status, lymph node harvest, and local recurrence rate. Sample Size: Thirty-four patients. Results: Group A (intersphincteric) 17 and Group B (stapled) 17 were compared. Mean age was 57.2 years (12 males and 5 females in each group). All patients received neoadjuvant chemoradiation and underwent diverting ileostomy. Estimated blood loss was higher in Group A (771 ml vs. 327 ml, P < 0.05). Similarly, operative time was longer in Group A (295 vs. 235 min, P < 0.05). No difference was noted in postoperative complication rate between Group A and B (29.4% vs. 17.6%, P = 0.688). Length of stay was similar in both groups (6.9 vs. 6.3 days, P = 0.565). There was no difference in radial or distal margin positivity (0%, both groups) or lymph node harvest. Distal margin was longer in Group B (3.7 vs. 1.6 cm, P = 0.007). During a mean follow-up of 22 months, the local recurrence rate was 0%. Conclusions: Intersphincteric proctectomy was associated with higher blood loss and longer operative time compared to stapled coloanal anastomosis. Immediate and long-term oncologic outcomes were comparable. Limitations: A single surgeon experience, retrospective study, and small number of patients. Conflict of Interest: None.
背景:括约肌间保护切除术在低位直肠癌中的作用仍有争议。目的:比较括约肌间结肠直肠吻合术与结肠直肠吻合术围手术期及肿瘤预后。设计:回顾性病例匹配研究。单位:三级结直肠外科单位。患者和方法:所有由一名外科医生在7年内进行的括约肌间直结肠切除术的病例在性别、种族、年龄和合并症方面与行结肠吻合术直结肠切除术的患者相匹配。主要观察指标:手术时间、出血量、术后并发症、住院时间、切缘状态、淋巴结清扫、局部复发率。样本量:34例患者。结果:A组(括约肌间)17与B组(钉状)17比较。平均年龄57.2岁(每组男性12人，女性5人)。所有患者均接受新辅助放化疗并行回肠造口术。A组估计失血量较高(771 ml比327 ml, P < 0.05)。A组手术时间更长(295 min vs. 235 min, P < 0.05)。A组与B组术后并发症发生率差异无统计学意义(29.4% vs 17.6%， P = 0.688)。两组患者的住院时间相似(6.9天对6.3天，P = 0.565)。桡骨缘或远端缘阳性(两组均为0%)或淋巴结收获量无差异。B组远端切缘较长(3.7 vs. 1.6 cm, P = 0.007)。平均随访22个月，局部复发率为0%。结论:与结肠吻合术相比，括约肌间直肠吻合术出血量大，手术时间长。近期和长期肿瘤预后具有可比性。局限性:单一外科经验，回顾性研究，患者数量少。利益冲突:无。
{"title":"Case-matched comparison of intersphincteric proctectomy versus proctectomy with stapled coloanal anastomosis for low rectal cancer","authors":"L. Tabaja, Y. Akmal, Zoltan Lackberg, M. Abbas","doi":"10.4103/WJCS.WJCS_13_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_13_19","url":null,"abstract":"Background: The role of intersphincteric proctectomy in low rectal cancer remains controversial. Objective: To compare the perioperative and oncologic outcomes of intersphincteric proctectomy to proctectomy with stapled coloanal anastomosis. Design: A retrospective case-matched review. Setting: A tertiary colorectal surgery unit. Patients and Methods: All intersphincteric proctectomy cases conducted by one surgeon over a 7-year period were matched for gender, race, age, and comorbidities with patients who underwent proctectomy with stapled coloanal anastomosis. Main Outcome Measures: Operative time, blood loss, postoperative complications, length of stay, margin status, lymph node harvest, and local recurrence rate. Sample Size: Thirty-four patients. Results: Group A (intersphincteric) 17 and Group B (stapled) 17 were compared. Mean age was 57.2 years (12 males and 5 females in each group). All patients received neoadjuvant chemoradiation and underwent diverting ileostomy. Estimated blood loss was higher in Group A (771 ml vs. 327 ml, P < 0.05). Similarly, operative time was longer in Group A (295 vs. 235 min, P < 0.05). No difference was noted in postoperative complication rate between Group A and B (29.4% vs. 17.6%, P = 0.688). Length of stay was similar in both groups (6.9 vs. 6.3 days, P = 0.565). There was no difference in radial or distal margin positivity (0%, both groups) or lymph node harvest. Distal margin was longer in Group B (3.7 vs. 1.6 cm, P = 0.007). During a mean follow-up of 22 months, the local recurrence rate was 0%. Conclusions: Intersphincteric proctectomy was associated with higher blood loss and longer operative time compared to stapled coloanal anastomosis. Immediate and long-term oncologic outcomes were comparable. Limitations: A single surgeon experience, retrospective study, and small number of patients. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45515634","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: Primary rectal malignant melanoma is an exceptionally rare neoplasm associated with an extremely poor prognosis despite aggressive treatment. The described management options for localized disease are abdominoperineal resection (APR) and wide local excision (WLE) with or without radiation. Objective: To assess the surgical outcomes of the patients with anorectal melanoma. Design and Setting: Retrospective study. Patients and Methods: This retrospective study describes the experience in surgical management of 18 cases of anorectal melanoma treated surgically at our center, between 2010 and 2015. Main Outcome Measures: To assess the median survival and recurrence rates of anorectal melanoma patients who underwent surgery. Sample size: Eighteen cases. Results: This is a retrospective study of 18 cases of anorectal melanoma. APR was performed in 77.8%, wide excision (WLE) in 16.7%, and posterior exenteration in 5.6%. The median survival of patients undergoing APR was 14.66 months and median survival of patients undergoing WLE was 18 months. No significant difference in median survival was observed in the patients undergoing abdominoperineal resection (APR) or wide local excision (P = 0.168). A significant difference in median survival between the node negative group and node positive group was observed (17 months vs 13.4 months P = 0.019). The median survival of patients with stage I, II, and III cancers were 17.28 months, 16 months, and 13.4 months, respectively. A statistically significant difference in median survival was found between patients with lympho-vascular invasive and noninvasive cancer (13.37 months vs 16.7 months P = 0.029). There was no significant difference in the recurrence rate between APR and WLE groups (86% vs 66% P = 0.893).Conclusion: Anorectal melanoma is an aggressive disease which require timely diagnosis. Nodal status is an important factor that impact median survival. There is no significant difference in survival when WLE compared to APR. Node positivity and lympho-vascular invasion confer poor prognosis. Recurrence rates are identical regardless of the surgical approach. Limitations: It is a retrospective series based on case records. A major drawback of this investigation is the limited detail available for each case. Not all patients who underwent local excision received radiotherapy. Conflict of Interest: None.
背景:原发性直肠恶性黑色素瘤是一种非常罕见的肿瘤，尽管积极治疗，但预后极差。所描述的局部疾病的治疗选择是腹部会阴切除(APR)和广泛局部切除(WLE)，有或没有放疗。目的:探讨肛肠黑色素瘤的手术治疗效果。设计与设定:回顾性研究。患者和方法:本回顾性研究描述了2010年至2015年在我中心手术治疗的18例肛管直肠黑色素瘤的手术治疗经验。主要结局指标:评估肛管直肠黑色素瘤手术患者的中位生存率和复发率。样本量:18例。结果:对18例肛管直肠黑色素瘤进行回顾性研究。APR占77.8%，宽切除(WLE)占16.7%，后路切除占5.6%。APR患者的中位生存期为14.66个月，WLE患者的中位生存期为18个月。腹会阴切除术(APR)和广泛局部切除术患者的中位生存期无显著差异(P = 0.168)。淋巴结阴性组和淋巴结阳性组的中位生存期有显著差异(17个月vs 13.4个月P = 0.019)。I期、II期和III期癌症患者的中位生存期分别为17.28个月、16个月和13.4个月。淋巴血管浸润性癌与非浸润性癌患者的中位生存期差异有统计学意义(13.37个月vs 16.7个月P = 0.029)。APR组与WLE组复发率差异无统计学意义(86% vs 66% P = 0.893)。结论:肛肠黑色素瘤是一种侵袭性疾病，需要及时诊断。淋巴结状态是影响中位生存期的重要因素。与apr相比，WLE的生存率无显著差异。淋巴结阳性和淋巴血管浸润导致预后不良。无论采用何种手术方式，复发率都是相同的。局限性:这是一个基于病例记录的回顾性系列研究。这种调查的一个主要缺点是每个案件的细节有限。并非所有接受局部切除的患者都接受了放疗。利益冲突:无。
{"title":"Anorectal melanoma surgical management: A tertiary cancer centre analysis","authors":"R. Arjunan, C. Ramach, P. Jonnada, U. Karjol","doi":"10.4103/WJCS.WJCS_17_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_17_19","url":null,"abstract":"Background: Primary rectal malignant melanoma is an exceptionally rare neoplasm associated with an extremely poor prognosis despite aggressive treatment. The described management options for localized disease are abdominoperineal resection (APR) and wide local excision (WLE) with or without radiation. Objective: To assess the surgical outcomes of the patients with anorectal melanoma. Design and Setting: Retrospective study. Patients and Methods: This retrospective study describes the experience in surgical management of 18 cases of anorectal melanoma treated surgically at our center, between 2010 and 2015. Main Outcome Measures: To assess the median survival and recurrence rates of anorectal melanoma patients who underwent surgery. Sample size: Eighteen cases. Results: This is a retrospective study of 18 cases of anorectal melanoma. APR was performed in 77.8%, wide excision (WLE) in 16.7%, and posterior exenteration in 5.6%. The median survival of patients undergoing APR was 14.66 months and median survival of patients undergoing WLE was 18 months. No significant difference in median survival was observed in the patients undergoing abdominoperineal resection (APR) or wide local excision (P = 0.168). A significant difference in median survival between the node negative group and node positive group was observed (17 months vs 13.4 months P = 0.019). The median survival of patients with stage I, II, and III cancers were 17.28 months, 16 months, and 13.4 months, respectively. A statistically significant difference in median survival was found between patients with lympho-vascular invasive and noninvasive cancer (13.37 months vs 16.7 months P = 0.029). There was no significant difference in the recurrence rate between APR and WLE groups (86% vs 66% P = 0.893).Conclusion: Anorectal melanoma is an aggressive disease which require timely diagnosis. Nodal status is an important factor that impact median survival. There is no significant difference in survival when WLE compared to APR. Node positivity and lympho-vascular invasion confer poor prognosis. Recurrence rates are identical regardless of the surgical approach. Limitations: It is a retrospective series based on case records. A major drawback of this investigation is the limited detail available for each case. Not all patients who underwent local excision received radiotherapy. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70854176","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}
Joseph C. H. Kong, Glen R Guerra, A. Lee, S. Warrier, A. Lynch, A. Heriot
Background: There is a great interest in predicting the pathological complete response (pCR) to facilitate patient selection for a “watch and wait” protocol, sparing locally advanced rectal cancer patients from surgical related morbidity and mortality. However, there is a high risk of tumor regrowth with the current assessment of clinical complete response, highlighting the need for a better predictive marker of pCR. Objective: The aim of this study was to assess the short- and long-term outcomes according to tumor response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Design: Retrospective analysis of a prospectively maintained bi-national database. Settings: Multicenter bi-national database. Patients and Methods: This was a retrospective study of a prospectively maintained bi-national colorectal cancer audit database. Inclusion criteria were T3-4 and/or N1-2 rectal cancer patients receiving long course chemoradiotherapy followed by surgery. The primary outcome measure was pathological tumor response. Main Outcome Measures: The primary outcome measure was rate of pathological response and associated local and distant recurrence. Sample Size: There were 929 consecutive locally advanced rectal cancer patients identified within the database. Results: A total of 929 patients were included, with a pCR rate of 29.6% (275 patients). Non-responding tumors had a higher circumferential resection margin positive rate of 20% (33 of 165 patients) compared to partial responding tumors of 5.1% (24 of 475 patients). Local recurrence rates in accordance to tumor regression grade (pCR, partial and no response) were 2.2%, 4.4%, and 4.7% (P = 0.254) respectively, with distant recurrence rates of 2.9%, 4.1%, and 8.1% (P = 0.03) respectively. Independent predictors of pCR were early stage disease on pre-treatment imaging (OR 2.12 95% CI 1.24–3.63, P = 0.005), a rural setting (OR 3.15 [95%] CI 1.63–6.06, P < 0.001) and private insurance (OR 2.06 [95%] CI 1.45–2.93, P < 0.001), with an inverse association to metastatic disease (OR 0.22 [95%] CI 0.1-0.5, P < 0.001). Conclusions: Early-stage tumors had the greatest likelihood of attaining a pCR with a lower risk of local and distant recurrence than partial or non-responding tumors. Limitations: This study is limited by the retrospective nature of the analysis and the lack of data auditing to ensure accuracy of data is maintained. Conflict of Interest: None.
背景:人们对预测病理完全缓解(pCR)非常感兴趣，以方便患者选择“观察和等待”方案，使局部晚期直肠癌患者免于手术相关的发病率和死亡率。然而，目前对临床完全缓解的评估存在较高的肿瘤再生风险，因此需要更好的pCR预测标志物。目的:本研究的目的是根据肿瘤反应评估局部晚期直肠癌新辅助放化疗后的短期和长期结果。设计:对前瞻性维护的两国数据库进行回顾性分析。设置:多中心双国家数据库。患者和方法:这是一项前瞻性维护的两国结直肠癌审计数据库的回顾性研究。纳入标准为T3-4和/或N1-2直肠癌患者接受长期放化疗后手术。主要结局指标为病理性肿瘤反应。主要观察指标:主要观察指标为病理反应率及相关的局部和远处复发率。样本量:在数据库中确定了929例连续的局部晚期直肠癌患者。结果:共纳入929例患者，pCR率为29.6%(275例)。无应答肿瘤的周切缘阳性率为20%(165例患者中的33例)，而部分应答肿瘤的阳性率为5.1%(475例患者中的24例)。根据肿瘤消退分级(pCR、部分缓解和无缓解)，局部复发率分别为2.2%、4.4%和4.7% (P = 0.254)，远处复发率分别为2.9%、4.1%和8.1% (P = 0.03)。pCR的独立预测因子为治疗前影像的早期疾病(OR 2.12 95% CI 1.24-3.63, P = 0.005)、农村环境(OR 3.15 [95%] CI 1.63-6.06, P < 0.001)和私人保险(OR 2.06 [95%] CI 1.45-2.93, P < 0.001)，与转移性疾病呈负相关(OR 0.22 [95%] CI 0.1-0.5, P < 0.001)。结论:与部分或无反应肿瘤相比，早期肿瘤获得pCR的可能性最大，局部和远处复发的风险较低。局限性:本研究受限于分析的回顾性性质和缺乏数据审计以确保数据的准确性。利益冲突:无。
{"title":"Long-term outcomes of locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A bi-national colorectal cancer audit study","authors":"Joseph C. H. Kong, Glen R Guerra, A. Lee, S. Warrier, A. Lynch, A. Heriot","doi":"10.4103/WJCS.WJCS_16_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_16_19","url":null,"abstract":"Background: There is a great interest in predicting the pathological complete response (pCR) to facilitate patient selection for a “watch and wait” protocol, sparing locally advanced rectal cancer patients from surgical related morbidity and mortality. However, there is a high risk of tumor regrowth with the current assessment of clinical complete response, highlighting the need for a better predictive marker of pCR. Objective: The aim of this study was to assess the short- and long-term outcomes according to tumor response after neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Design: Retrospective analysis of a prospectively maintained bi-national database. Settings: Multicenter bi-national database. Patients and Methods: This was a retrospective study of a prospectively maintained bi-national colorectal cancer audit database. Inclusion criteria were T3-4 and/or N1-2 rectal cancer patients receiving long course chemoradiotherapy followed by surgery. The primary outcome measure was pathological tumor response. Main Outcome Measures: The primary outcome measure was rate of pathological response and associated local and distant recurrence. Sample Size: There were 929 consecutive locally advanced rectal cancer patients identified within the database. Results: A total of 929 patients were included, with a pCR rate of 29.6% (275 patients). Non-responding tumors had a higher circumferential resection margin positive rate of 20% (33 of 165 patients) compared to partial responding tumors of 5.1% (24 of 475 patients). Local recurrence rates in accordance to tumor regression grade (pCR, partial and no response) were 2.2%, 4.4%, and 4.7% (P = 0.254) respectively, with distant recurrence rates of 2.9%, 4.1%, and 8.1% (P = 0.03) respectively. Independent predictors of pCR were early stage disease on pre-treatment imaging (OR 2.12 95% CI 1.24–3.63, P = 0.005), a rural setting (OR 3.15 [95%] CI 1.63–6.06, P < 0.001) and private insurance (OR 2.06 [95%] CI 1.45–2.93, P < 0.001), with an inverse association to metastatic disease (OR 0.22 [95%] CI 0.1-0.5, P < 0.001). Conclusions: Early-stage tumors had the greatest likelihood of attaining a pCR with a lower risk of local and distant recurrence than partial or non-responding tumors. Limitations: This study is limited by the retrospective nature of the analysis and the lack of data auditing to ensure accuracy of data is maintained. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70854080","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}
C. Hall, R. Roberts, T. Merriman, A. Pal, T. Eglinton, C. Wakeman, F. Frizelle
Background: Carcinoembryonic antigen (CEA) is a glycoprotein that can be elevated in a number of benign and malignant conditions. In colorectal cancer, it is used as a prognostic marker and to detect recurrence. However, it lacks specificity and may become elevated in individuals without a history of cancer or other identifiable cause leading to costly and invasive investigation. Objective: The aim of this study was to assess whether genetic polymorphisms in the liver enzyme CYP2C9 could explain high CEA levels in otherwise normal individuals. Design: This is a case-control study. Setting: Individuals were genotyped for the poor metabolizer (PM) alleles CYP2C9*2 and CYP2C9*3 using predesigned TaqMan single nucleotide polymorphisms assays. Patients and Methods: Nineteen individuals with previously clinically unexplained elevated CEA and 567 healthy Caucasian controls were included. Main Outcome Measures: Chi-square analysis was used to test for association of CYP2C9 genotype with plasma CEA concentration. Sample Size: Nineteen individuals with previously clinically unexplained elevated CEA and 567 healthy Caucasian controls were included. Results: Fifteen of the 19 individuals with previously high CEA had elevated plasma CEA (>3.0μg/L) on re-testing. The frequency of CYP2C9 PM alleles in these 15 patients was not significantly higher than the frequency in controls. Conclusion: CEA concentrations do not appear to be influenced by CYP2C9 genotype, so this cannot be used to explain elevated CEA in the absence of an obvious clinical cause. Limitation: Small sample size.
{"title":"CYP2C9 polymorphism is not associated with elevated carcinoembryonic antigen levels","authors":"C. Hall, R. Roberts, T. Merriman, A. Pal, T. Eglinton, C. Wakeman, F. Frizelle","doi":"10.4103/WJCS.WJCS_39_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_39_18","url":null,"abstract":"Background: Carcinoembryonic antigen (CEA) is a glycoprotein that can be elevated in a number of benign and malignant conditions. In colorectal cancer, it is used as a prognostic marker and to detect recurrence. However, it lacks specificity and may become elevated in individuals without a history of cancer or other identifiable cause leading to costly and invasive investigation. Objective: The aim of this study was to assess whether genetic polymorphisms in the liver enzyme CYP2C9 could explain high CEA levels in otherwise normal individuals. Design: This is a case-control study. Setting: Individuals were genotyped for the poor metabolizer (PM) alleles CYP2C9*2 and CYP2C9*3 using predesigned TaqMan single nucleotide polymorphisms assays. Patients and Methods: Nineteen individuals with previously clinically unexplained elevated CEA and 567 healthy Caucasian controls were included. Main Outcome Measures: Chi-square analysis was used to test for association of CYP2C9 genotype with plasma CEA concentration. Sample Size: Nineteen individuals with previously clinically unexplained elevated CEA and 567 healthy Caucasian controls were included. Results: Fifteen of the 19 individuals with previously high CEA had elevated plasma CEA (>3.0μg/L) on re-testing. The frequency of CYP2C9 PM alleles in these 15 patients was not significantly higher than the frequency in controls. Conclusion: CEA concentrations do not appear to be influenced by CYP2C9 genotype, so this cannot be used to explain elevated CEA in the absence of an obvious clinical cause. Limitation: Small sample size.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43526759","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}
Anne K. Mongiu, Rowza T. Rumma, Amy K. Wise, Russell W. Farmer
Background: As the percentage of the population that is elderly increases, colorectal operations performed in this age group are becoming more common. This study examined the use of the American Society of Anesthesiologists (ASA) Classification System (class) as a predictor of 30-day morbidity and mortality in patients ≥90 years old. Objective: The objective of this study was to evaluate the use of ASA classification in elderly patients undergoing colorectal surgery to determine whether it is an accurate predictor of perioperative risk. Design and Setting: This was a retrospective database review. Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all colectomies, coloproctectomies, and proctectomies performed from 2005 to 2009. Demographic and perioperative information including class and 30-day outcomes were assessed. A multiple logistic regression model was used to calculate the odds of 30-day morbidity and mortality correlated with age, class procedure type (open vs. minimally invasive), and do not resuscitate (DNR) status. Main Outcome Measures: 30-day mortality and 30-day morbidity. Sample Size: The sample size included 73,974 patients. Results: A total of 73,974 patients were identified including 1276 patients ≥90 years old. Across all patients, multiple logistic regression demonstrated higher odds of 30-day mortality with increase in class (P < 0.001, odds ratio [OR] 5.62), age (P < 0.001, OR 1.04), DNR status (P < 0.001, OR 3.01), and open procedures (P < 0.001, OR 2.60). Subgroup analysis of patients with class ≤3 showed increase in 30-day mortality with increased age (P < 0.001, OR 1.05), class (P < 0.001, OR 3.87), DNR status (P < 0.001, OR 5.05), and open procedures (P < 0.001, OR 2.39). For patients ≥90 with class ≤3, class was no longer correlated with 30-day mortality (P = 0.251) or morbidity (P = 0.236). Conclusions: In colorectal surgery patients, class is a validated predictor of morbidity and mortality. For the most elderly patients, class indicative of preoperative status of less than a constant threat to life (≤3) increasing class does not correlate with increased morbidity or mortality. Ongoing work is needed to define predictors of risk in these patients. Limitations: This is a retrospective study derived on data retrieved from a national database; we are limited to the preselected variables collected and the potential for missed or omitted patients.
{"title":"Age versus American society of anesthesiologists – Examining 30-day mortality and morbidity in elderly patients undergoing colectomy from the American college of surgeons national surgical quality improvement program","authors":"Anne K. Mongiu, Rowza T. Rumma, Amy K. Wise, Russell W. Farmer","doi":"10.4103/WJCS.WJCS_1_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_1_19","url":null,"abstract":"Background: As the percentage of the population that is elderly increases, colorectal operations performed in this age group are becoming more common. This study examined the use of the American Society of Anesthesiologists (ASA) Classification System (class) as a predictor of 30-day morbidity and mortality in patients ≥90 years old. Objective: The objective of this study was to evaluate the use of ASA classification in elderly patients undergoing colorectal surgery to determine whether it is an accurate predictor of perioperative risk. Design and Setting: This was a retrospective database review. Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all colectomies, coloproctectomies, and proctectomies performed from 2005 to 2009. Demographic and perioperative information including class and 30-day outcomes were assessed. A multiple logistic regression model was used to calculate the odds of 30-day morbidity and mortality correlated with age, class procedure type (open vs. minimally invasive), and do not resuscitate (DNR) status. Main Outcome Measures: 30-day mortality and 30-day morbidity. Sample Size: The sample size included 73,974 patients. Results: A total of 73,974 patients were identified including 1276 patients ≥90 years old. Across all patients, multiple logistic regression demonstrated higher odds of 30-day mortality with increase in class (P < 0.001, odds ratio [OR] 5.62), age (P < 0.001, OR 1.04), DNR status (P < 0.001, OR 3.01), and open procedures (P < 0.001, OR 2.60). Subgroup analysis of patients with class ≤3 showed increase in 30-day mortality with increased age (P < 0.001, OR 1.05), class (P < 0.001, OR 3.87), DNR status (P < 0.001, OR 5.05), and open procedures (P < 0.001, OR 2.39). For patients ≥90 with class ≤3, class was no longer correlated with 30-day mortality (P = 0.251) or morbidity (P = 0.236). Conclusions: In colorectal surgery patients, class is a validated predictor of morbidity and mortality. For the most elderly patients, class indicative of preoperative status of less than a constant threat to life (≤3) increasing class does not correlate with increased morbidity or mortality. Ongoing work is needed to define predictors of risk in these patients. Limitations: This is a retrospective study derived on data retrieved from a national database; we are limited to the preselected variables collected and the potential for missed or omitted patients.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42557307","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: Colorectal cancer (CRC) is the second most common cancer in Australia. Improvements in patient outcomes after resections for CRC have been reported in an Australian metropolitan hospital, but significant outcome variability exists between health systems and institutions. Objective: This study sought to determine whether changes in the management of CRC have translated into improved survival after surgery in an Australian regional hospital. Design: This is a retrospective study of a prospectively maintained database. Setting: This study was conducted in an Australian regional hospital. Patients and Methods: All patients who underwent surgery for CRC at our institution between January 2002 and December 2014 were studied. Demographic information, comorbidities, types of surgery performed, and tumor staging were recorded. Patients were followed up for life whenever possible. Survival analysis was done using the Kaplan–Meier method, and comparisons made using the Cox proportional-hazards method. Chi-squared test was used to compare categorical data and look at trends as appropriate. P ≤ 0.05 was considered statistically significant. Statistical analysis was done using Medcalc® (Mariakerke, Belgium) software. Main Outcome Measures: Primary outcome measures the survival trends for CRC patients in regional center, Victoria. Secondary outcomes measure the short-term results, including perioperative mortality and anastomotic leak rate. Sample Size: A total of 1079 patients who underwent surgery for CRC over 13 years were studied. Results: There were 744 colon cancer and 335 rectal cancer patients. The number of operations per year increased over time (P = 0.037). The median age was 72 years (range, 23–98) and this did not change over time (P = 0.67). There was also no temporal change in tumor stage distribution (P = 0.21) or in the proportion of emergency cases (P = 0.75), but the proportion of patients with severe comorbidities increased (P = 0.015). The perioperative mortality rate was 4.5%. The median survival after surgery by stage was 123 months (Stage I), 141 months (Stage II), 76 months (Stage III), and 17 months (Stage IV tumors). Over the study period, there were improvements in both perioperative mortality (P = 0.028) and long-term survival (P = 0.0025). Conclusion: Both short- and long-term survivals after surgery for CRC have improved in our institution. Limitation: Although a large regional cohort was analyzed, the study still has its own limitation, in that it is a retrospective single institute study.
{"title":"Trends in survival after colorectal cancer surgery in an Australian regional hospital","authors":"S. Ng, D. Stupart, D. Watters","doi":"10.4103/WJCS.WJCS_5_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_5_19","url":null,"abstract":"Background: Colorectal cancer (CRC) is the second most common cancer in Australia. Improvements in patient outcomes after resections for CRC have been reported in an Australian metropolitan hospital, but significant outcome variability exists between health systems and institutions. Objective: This study sought to determine whether changes in the management of CRC have translated into improved survival after surgery in an Australian regional hospital. Design: This is a retrospective study of a prospectively maintained database. Setting: This study was conducted in an Australian regional hospital. Patients and Methods: All patients who underwent surgery for CRC at our institution between January 2002 and December 2014 were studied. Demographic information, comorbidities, types of surgery performed, and tumor staging were recorded. Patients were followed up for life whenever possible. Survival analysis was done using the Kaplan–Meier method, and comparisons made using the Cox proportional-hazards method. Chi-squared test was used to compare categorical data and look at trends as appropriate. P ≤ 0.05 was considered statistically significant. Statistical analysis was done using Medcalc® (Mariakerke, Belgium) software. Main Outcome Measures: Primary outcome measures the survival trends for CRC patients in regional center, Victoria. Secondary outcomes measure the short-term results, including perioperative mortality and anastomotic leak rate. Sample Size: A total of 1079 patients who underwent surgery for CRC over 13 years were studied. Results: There were 744 colon cancer and 335 rectal cancer patients. The number of operations per year increased over time (P = 0.037). The median age was 72 years (range, 23–98) and this did not change over time (P = 0.67). There was also no temporal change in tumor stage distribution (P = 0.21) or in the proportion of emergency cases (P = 0.75), but the proportion of patients with severe comorbidities increased (P = 0.015). The perioperative mortality rate was 4.5%. The median survival after surgery by stage was 123 months (Stage I), 141 months (Stage II), 76 months (Stage III), and 17 months (Stage IV tumors). Over the study period, there were improvements in both perioperative mortality (P = 0.028) and long-term survival (P = 0.0025). Conclusion: Both short- and long-term survivals after surgery for CRC have improved in our institution. Limitation: Although a large regional cohort was analyzed, the study still has its own limitation, in that it is a retrospective single institute study.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48880454","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}
Mixed adenoneuroendocrine carcinoma (MANEC) of the intestinal tract, is relatively rare and with a poor prognosis. The majority of literature to date has documented the rare occurrence of this tumor within the colon or rectum, but not within the anal canal or verge. We report our case of a female patient identified with a MANEC tumor of the perianal skin extending into the anal canal.
{"title":"Mixed adenoneuroendocrine tumor of the perianal skin","authors":"D. Mullins, Robert Lewis","doi":"10.4103/WJCS.WJCS_10_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_10_19","url":null,"abstract":"Mixed adenoneuroendocrine carcinoma (MANEC) of the intestinal tract, is relatively rare and with a poor prognosis. The majority of literature to date has documented the rare occurrence of this tumor within the colon or rectum, but not within the anal canal or verge. We report our case of a female patient identified with a MANEC tumor of the perianal skin extending into the anal canal.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47058025","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}
C. Brennan, G. McFarlane, L. Robertson, Morag Douglas
{"title":"Lecicarbon a suppositories: An acceptable bowel preparation for flexible sigmoidoscopy?","authors":"C. Brennan, G. McFarlane, L. Robertson, Morag Douglas","doi":"10.4103/wjcs.wjcs_4_19","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_4_19","url":null,"abstract":"","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70854377","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}
Ashley M Tameron, A. Murphy, L. Hussain, David Y. Lee, H. Guend
Background: Colonic volvulus is a rare cause of bowel obstruction with an incidence of 2%–10%. Cecal volvulus accounts for 10%–40% of cases, with a mean age of 53 years. There is a paucity of literature reporting how older patients with cecal volvulus fair relative to their younger counterparts. Objective: The goal of our study is to evaluate the outcomes after surgical resection in patients ≥50 years old with cecal volvulus. Design: The design of the study was to collect the National Surgical Quality Improvement Program (NSQIP) data and analyze primary outcomes. Settings: These data were collected from NSQIP database focusing on patients with cecal volvulus. Materials and Methods: We utilized the NSQIP database. We identified volvulus by ICD-9 code 560.2. We selected patients with cecal volvulus who underwent surgical resection by specifying the CPT codes for open and laparoscopic right hemicolectomy. Main Outcome Measures: The primary outcomes were mortality and major and minor postoperative complications. Student's t-test was used to compare continuous variables. Chi-square and Fisher's exact tests were used to compare categorical variables. Sample Size: Analyzing the NSQIP database from 2010 to 2015, 1220 patients were identified. Results: 21.8% of patients were <50 years old and 78.2% were ≥50 years old. Patients aged ≥50 years had higher rates of comorbid conditions. There was no significant difference in mortality between the two groups or major and minor complications. Patients aged ≥50 years had a longer length of total hospital stay, i.e., days from operation to discharge. Conclusion: Cecal volvulus is an uncommon reason for bowel obstruction with unclear outcomes in elderly patients in the literature. Our study demonstrates no differences in outcomes after surgical intervention for cecal volvulus. Limitations: Limitations of this study include large database collection and selection bias. As we specifically included right hemicolectomy, this excludes patients who underwent nonresection intervention.
{"title":"Outcomes in cecal volvulus: Does age affect outcomes in patients who undergo surgery?","authors":"Ashley M Tameron, A. Murphy, L. Hussain, David Y. Lee, H. Guend","doi":"10.4103/WJCS.WJCS_40_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_40_18","url":null,"abstract":"Background: Colonic volvulus is a rare cause of bowel obstruction with an incidence of 2%–10%. Cecal volvulus accounts for 10%–40% of cases, with a mean age of 53 years. There is a paucity of literature reporting how older patients with cecal volvulus fair relative to their younger counterparts. Objective: The goal of our study is to evaluate the outcomes after surgical resection in patients ≥50 years old with cecal volvulus. Design: The design of the study was to collect the National Surgical Quality Improvement Program (NSQIP) data and analyze primary outcomes. Settings: These data were collected from NSQIP database focusing on patients with cecal volvulus. Materials and Methods: We utilized the NSQIP database. We identified volvulus by ICD-9 code 560.2. We selected patients with cecal volvulus who underwent surgical resection by specifying the CPT codes for open and laparoscopic right hemicolectomy. Main Outcome Measures: The primary outcomes were mortality and major and minor postoperative complications. Student's t-test was used to compare continuous variables. Chi-square and Fisher's exact tests were used to compare categorical variables. Sample Size: Analyzing the NSQIP database from 2010 to 2015, 1220 patients were identified. Results: 21.8% of patients were <50 years old and 78.2% were ≥50 years old. Patients aged ≥50 years had higher rates of comorbid conditions. There was no significant difference in mortality between the two groups or major and minor complications. Patients aged ≥50 years had a longer length of total hospital stay, i.e., days from operation to discharge. Conclusion: Cecal volvulus is an uncommon reason for bowel obstruction with unclear outcomes in elderly patients in the literature. Our study demonstrates no differences in outcomes after surgical intervention for cecal volvulus. Limitations: Limitations of this study include large database collection and selection bias. As we specifically included right hemicolectomy, this excludes patients who underwent nonresection intervention.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41791704","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：