Wen-Shen Lee, J. Kong, P. Carne, S. Bell, S. Warrier
Left-sided malignant colonic obstruction remains a challenging surgical problem despite recent advances. We aim to provide a concise overview of the relevant surgical options for this condition in the curative setting. A literature search of MedLine, PubMed, and Embase was performed to elucidate the latest evidence in the management of malignant left-sided colorectal obstruction, focusing on the risks and benefits of each approach and the appropriate patient selection. Primary resection and anastomosis are the intervention of choice for low-risk patients in the curative setting. Delayed resection with a bridge to surgery should be considered in unwell patients requiring medical optimization. While stenting has gained popularity, the risk of stent perforation carries a poor prognosis and must be carefully considered. Hartmann's procedure should be considered in high-risk elderly patients. Subtotal colectomy is preferred over segmental colectomy when there is extensive proximal colon damage but results in more frequent bowel actions postoperatively.
{"title":"Curative management of malignant left-sided colorectal obstruction","authors":"Wen-Shen Lee, J. Kong, P. Carne, S. Bell, S. Warrier","doi":"10.4103/WJCS.WJCS_44_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_44_18","url":null,"abstract":"Left-sided malignant colonic obstruction remains a challenging surgical problem despite recent advances. We aim to provide a concise overview of the relevant surgical options for this condition in the curative setting. A literature search of MedLine, PubMed, and Embase was performed to elucidate the latest evidence in the management of malignant left-sided colorectal obstruction, focusing on the risks and benefits of each approach and the appropriate patient selection. Primary resection and anastomosis are the intervention of choice for low-risk patients in the curative setting. Delayed resection with a bridge to surgery should be considered in unwell patients requiring medical optimization. While stenting has gained popularity, the risk of stent perforation carries a poor prognosis and must be carefully considered. Hartmann's procedure should be considered in high-risk elderly patients. Subtotal colectomy is preferred over segmental colectomy when there is extensive proximal colon damage but results in more frequent bowel actions postoperatively.","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":"70854728","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}
Ileoanal pouch reconstruction can be complicated intraoperatively by the inability for the pouch to reach the anus in a tension-free manner. Here, a case is presented where standard “mesentery lengthening” procedures did not allow the pouch to reach the anus and thus the pouch was left hanging in situ resulting in pouch lengthening over several months and a successful anastomosis at a later date.
{"title":"The hanging pouch","authors":"Daniel J Wong, Michael Q. Tran, V. Poylin","doi":"10.4103/WJCS.WJCS_9_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_9_18","url":null,"abstract":"Ileoanal pouch reconstruction can be complicated intraoperatively by the inability for the pouch to reach the anus in a tension-free manner. Here, a case is presented where standard “mesentery lengthening” procedures did not allow the pouch to reach the anus and thus the pouch was left hanging in situ resulting in pouch lengthening over several months and a successful anastomosis at a later date.","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":"45247575","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}
Perineal hernia is a rare condition most commonly described following abdominoperineal resection (APR). We report the case of a 71-year-old woman who presented with a third episode of strangulated perineal hernia mimicking perineal cellulitis following APR surgery. She underwent an emergency laparotomy, small bowel resection, and biological mesh repair. We further discuss the pros and cons of different surgical options available to surgeons when faced with this problem.
{"title":"Deadly if missed: A case of recurrent perineal hernia mimicking as perineal cellulitis following abdominoperineal resection","authors":"Himeesh Kumar, S. Ng, J. Chua, R. Chandra","doi":"10.4103/WJCS.WJCS_7_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_7_19","url":null,"abstract":"Perineal hernia is a rare condition most commonly described following abdominoperineal resection (APR). We report the case of a 71-year-old woman who presented with a third episode of strangulated perineal hernia mimicking perineal cellulitis following APR surgery. She underwent an emergency laparotomy, small bowel resection, and biological mesh repair. We further discuss the pros and cons of different surgical options available to surgeons when faced with this problem.","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":"70854933","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}
In this communication, we present a first description of right hemicolectomy in a patient with heterotaxy syndrome (HS). A 78-year-old male was admitted to the outpatient clinic with complaints of dysphagia. Diagnostic workup revealed the presence of an esophageal web. On subsequent colonoscopy, a tumoral lesion was found in the ascending colon. Computed tomography scan illustrated abdominal situs ambiguous with right-sided polysplenia, right-sided stomach, and intestinal nonrotation. Furthermore, a preduodenal portal vein, azygos continuation of the inferior vena cava, and hemiazygos continuation of the left renal vein were observed. After careful assessment of the anatomy, a right hemicolectomy with radical lymphadenectomy was performed. HS consists of a rare and complex situs anomaly, with an abnormal arrangement of the thoracic and/or abdominal organs along the left–right axis. To our knowledge, right hemicolectomy has not been described in patients with HS.
{"title":"Right hemicolectomy in a patient with heterotaxy syndrome","authors":"M. Dewulf, R. Beckers, P. Pletinckx","doi":"10.4103/wjcs.wjcs_11_18","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_11_18","url":null,"abstract":"In this communication, we present a first description of right hemicolectomy in a patient with heterotaxy syndrome (HS). A 78-year-old male was admitted to the outpatient clinic with complaints of dysphagia. Diagnostic workup revealed the presence of an esophageal web. On subsequent colonoscopy, a tumoral lesion was found in the ascending colon. Computed tomography scan illustrated abdominal situs ambiguous with right-sided polysplenia, right-sided stomach, and intestinal nonrotation. Furthermore, a preduodenal portal vein, azygos continuation of the inferior vena cava, and hemiazygos continuation of the left renal vein were observed. After careful assessment of the anatomy, a right hemicolectomy with radical lymphadenectomy was performed. HS consists of a rare and complex situs anomaly, with an abnormal arrangement of the thoracic and/or abdominal organs along the left–right axis. To our knowledge, right hemicolectomy has not been described in patients with HS.","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":"44153061","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. Lozano-Burgos, Claudio Etcheverry-Pizarro, W. González-Arriagada, Paola Ochova-Gallardo
Leiomyoma is a soft-tissue benign tumor and its occurrence in the mesocolon is extremely rare. We present a particular case of a leiomyoma of the sigmoid mesocolon of a 58-year-old man, associated to a hemorrhagic infarction treated surgically and without recurrences after 1 year of follow-up. The macroscopic, histopathologic, and immunohistochemical features are presented and discussed. The high mast cell count associated with a low rate of cell proliferation is a sign of the benign biological behavior in this entity and may be helpful hallmarks for the differential diagnosis with other gastroenterological neoplasia.
{"title":"Leiomyoma of the sigmoid mesocolon associated to hemorrhagic infarct and high count of mast cells","authors":"C. Lozano-Burgos, Claudio Etcheverry-Pizarro, W. González-Arriagada, Paola Ochova-Gallardo","doi":"10.4103/WJCS.WJCS_8_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_8_18","url":null,"abstract":"Leiomyoma is a soft-tissue benign tumor and its occurrence in the mesocolon is extremely rare. We present a particular case of a leiomyoma of the sigmoid mesocolon of a 58-year-old man, associated to a hemorrhagic infarction treated surgically and without recurrences after 1 year of follow-up. The macroscopic, histopathologic, and immunohistochemical features are presented and discussed. The high mast cell count associated with a low rate of cell proliferation is a sign of the benign biological behavior in this entity and may be helpful hallmarks for the differential diagnosis with other gastroenterological neoplasia.","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":"43010837","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}
Mugdha Kowli, Pranav Mandovra, G. Zaveri, R. Patankar
Pilonidal sinuses commonly arise in the sacrococcygeal region. The common complications are local cellulitis, abscess formation which is related to the infectious process, and recurrence after surgery. They rarely evolve with osteomyelitis, meningitis, or malignant transformation. Coccygeal osteomyelitis as a direct complication of sacrococcygeal pilonidal sinus disease (PSD) is extremely rare with limited data. We report a case of complicated sacrococcygeal PSD with coccygeal osteomyelitis. It was managed with: wide local excision of the pilonidal sinus, coccygectomy, perineal musculature reconstruction, and defect closure by Limberg rhomboid flap.
{"title":"Rare complication of a common disease: Coccygeal osteomyelitis following Pilonidal sinus","authors":"Mugdha Kowli, Pranav Mandovra, G. Zaveri, R. Patankar","doi":"10.4103/WJCS.WJCS_10_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_10_18","url":null,"abstract":"Pilonidal sinuses commonly arise in the sacrococcygeal region. The common complications are local cellulitis, abscess formation which is related to the infectious process, and recurrence after surgery. They rarely evolve with osteomyelitis, meningitis, or malignant transformation. Coccygeal osteomyelitis as a direct complication of sacrococcygeal pilonidal sinus disease (PSD) is extremely rare with limited data. We report a case of complicated sacrococcygeal PSD with coccygeal osteomyelitis. It was managed with: wide local excision of the pilonidal sinus, coccygectomy, perineal musculature reconstruction, and defect closure by Limberg rhomboid flap.","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":"46713415","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}
Almost from the time of initial description of Crohn's disease 85 years ago, it has been known that surgical resection is not curative. The disease invariably recurs. Over this period of time, numerous strategies have been proposed in an attempt to reduce the recurrence rate, or delay the development of recurrent disease. The purpose of this review is to examine a number of strategies and to evaluate their effectiveness. It also aims to look at what might lie ahead in the future. This review consists of an English language literature search to identify previous studies that have proposed various surgical strategies to reduce the recurrence rate following surgery for Crohn's disease. A number of surgical strategies have been proposed including widening the resection margins, changing the type of anastomosis, use of laparoscopy, and most recently, resecting wide mesenteric margins. To date, none of these strategies has proven to be effective in reducing recurrence rates. Although a surgical strategy to reduce recurrence in Crohn's disease has not been identified, there are currently investigators looking at other possibilities that may be shown to be effective in the future.
{"title":"Surgical strategies to reduce recurrence in Crohn's disease","authors":"C. Austin, R. Steinhagen","doi":"10.4103/WJCS.WJCS_1_17","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_1_17","url":null,"abstract":"Almost from the time of initial description of Crohn's disease 85 years ago, it has been known that surgical resection is not curative. The disease invariably recurs. Over this period of time, numerous strategies have been proposed in an attempt to reduce the recurrence rate, or delay the development of recurrent disease. The purpose of this review is to examine a number of strategies and to evaluate their effectiveness. It also aims to look at what might lie ahead in the future. This review consists of an English language literature search to identify previous studies that have proposed various surgical strategies to reduce the recurrence rate following surgery for Crohn's disease. A number of surgical strategies have been proposed including widening the resection margins, changing the type of anastomosis, use of laparoscopy, and most recently, resecting wide mesenteric margins. To date, none of these strategies has proven to be effective in reducing recurrence rates. Although a surgical strategy to reduce recurrence in Crohn's disease has not been identified, there are currently investigators looking at other possibilities that may be shown to be effective in the future.","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":"46758788","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: There has been considerable interest worldwide in the application of a robotic operating platform in the practice of colorectal surgery. Objective: The aim of this study was to evaluate the current uptake of robotic colorectal surgery in Australia and New Zealand. Design: Survey data were obtained from the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) registry of all specialist colorectal surgeons in Australia and New Zealand. Setting: Specialist colorectal surgeons responded to the survey through e-mail contact via an official e-mail from the CSSANZ. Materials and Methods: A questionnaire was distributed to members of the CSSANZ regarding their current robotic surgical practice. Main Outcome Measures: Volume of and nature of robotic surgery being currently undertaken in Australia and New Zealand, with an emphasis on seeking to understand the surgeon and patient factors that would promote robotic practice and also any factors or barriers in the implementation of robotic colorectal surgery being performed. Sample Size: The sample size was 77. Results: Seventy-seven replies were received from a total of 227 surveys. The response rate is similar to other comparable surveys published when the laparoscopic colorectal era was introduced. Most surgeons performed minimally invasive (laparoscopic) surgery; however, only 29% performed any robotic surgery and 50% of these performed < 5 cases in the preceding 12 months. Low rectal cancer and rectopexy surgeries were the most frequently performed robotic operations. About 48% of surgeons believed that the robotic platform offers specific patient benefits, and 75% believed that it offers specific benefits to the surgeon. The main reason for consultants not performing robotic procedures was largely related to cost, with training also cited as a barrier. Conclusion: Robotic colorectal surgery is being performed by 29% of colorectal consultants in Australasia, although only a minority of these surgeons have a substantial volume. In the future, a substantial reduction in costs is envisaged, as more companies enter the robotic surgery marketplace and competition drives reduction in costs. This in many ways mirrors the introduction of laparoscopy and we believe as cost comes down, training pathways need to be established to train the next generation of colorectal surgeons robotically. Limitations: Our study is limited by inherent limitations of survey data and the response rate.
{"title":"Current status of robotic colorectal surgery in Australasia: A questionnaire survey of consultant members of the colorectal surgical society of Australia and New Zealand","authors":"K. Buxey, F. Lam, G. Newstead","doi":"10.4103/WJCS.WJCS_38_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_38_18","url":null,"abstract":"Background: There has been considerable interest worldwide in the application of a robotic operating platform in the practice of colorectal surgery. Objective: The aim of this study was to evaluate the current uptake of robotic colorectal surgery in Australia and New Zealand. Design: Survey data were obtained from the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) registry of all specialist colorectal surgeons in Australia and New Zealand. Setting: Specialist colorectal surgeons responded to the survey through e-mail contact via an official e-mail from the CSSANZ. Materials and Methods: A questionnaire was distributed to members of the CSSANZ regarding their current robotic surgical practice. Main Outcome Measures: Volume of and nature of robotic surgery being currently undertaken in Australia and New Zealand, with an emphasis on seeking to understand the surgeon and patient factors that would promote robotic practice and also any factors or barriers in the implementation of robotic colorectal surgery being performed. Sample Size: The sample size was 77. Results: Seventy-seven replies were received from a total of 227 surveys. The response rate is similar to other comparable surveys published when the laparoscopic colorectal era was introduced. Most surgeons performed minimally invasive (laparoscopic) surgery; however, only 29% performed any robotic surgery and 50% of these performed < 5 cases in the preceding 12 months. Low rectal cancer and rectopexy surgeries were the most frequently performed robotic operations. About 48% of surgeons believed that the robotic platform offers specific patient benefits, and 75% believed that it offers specific benefits to the surgeon. The main reason for consultants not performing robotic procedures was largely related to cost, with training also cited as a barrier. Conclusion: Robotic colorectal surgery is being performed by 29% of colorectal consultants in Australasia, although only a minority of these surgeons have a substantial volume. In the future, a substantial reduction in costs is envisaged, as more companies enter the robotic surgery marketplace and competition drives reduction in costs. This in many ways mirrors the introduction of laparoscopy and we believe as cost comes down, training pathways need to be established to train the next generation of colorectal surgeons robotically. Limitations: Our study is limited by inherent limitations of survey data and the response rate.","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":"70854469","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}
G. Simpson, T. Marks, S. Blacker, C. Magee, Jeremy Wilson
Background: The psoas major muscle accurately represents overall skeletal muscle mass. The skeletal muscle mass volume is related to outcomes in multiple surgical procedures including colorectal cancer. However, neoadjuvant chemoradiotherapy for rectal cancer may adversely affect muscle mass. Objective: Assess the effect of neoadjuvant chemoradiotherapy on muscle mass in rectal cancer patients as well as on outcomes. Design: Retrospective study. Setting: A large UK District General Hospital. Patients and Methods: Analysis of all rectal cancer patients between 2014 and 2017. Psoas major was measured at the L3 level using pre- and post-neoadjuvant chemoradiotherapy images. Psoas major to L3 cross-sectional area (PML3) was calculated for each patient. Main Outcome Measures: 30-day and 90-day mortality, inpatient stay, and postoperative complications. Sample Size: One hundred and twenty-one rectal cancer patients. Results: Median age was 72 years (IQR: 64–78 years). Male:Female ratio was 82:39. 30-day mortality was 0%, and 90-day mortality was 0.83%. Sixty-one patients underwent neoadjuvant chemoradiotherapy (50.4%). Thirty-one patients underwent abdominoperineal excision of the rectum (APER) (25.6%), 1 underwent proctocolectomy (0.83%), 1 underwent completion proctectomy (0.83%), and 88 patients underwent anterior resection (72.7%). Significant muscle loss occurred during neoadjuvant therapy (median loss: 25.9%, IQR: 12.6–36.8%) (P < 0.0001). No correlation was observed between PML3 and inpatient stay. Patients with PML3 in the lowest quartile had a chest infection rate of 11.1% and a complication rate of 37.1% rather than 6.2% and 26.8%, respectively, for those in the upper quartiles. Anastomotic leak rate in the PML3 lowest quartile was 23.5% compared to 11.4% in patients in the upper quartiles. Conclusion: Patients who received neoadjuvant chemoradiotherapy had a significant reduction in muscle mass. Muscle mass loss can be overcome with a prehabilitation program that may reduce muscle loss and improve outcomes. Limitations: Due to a low event-rate of anastomotic leak, it is difficult to show statistical significance with a patient cohort of this size. Conflict of Interest: None.
{"title":"The influence of neoadjuvant chemoradiotherapy on muscle mass in patients with rectal cancer","authors":"G. Simpson, T. Marks, S. Blacker, C. Magee, Jeremy Wilson","doi":"10.4103/WJCS.WJCS_12_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_12_19","url":null,"abstract":"Background: The psoas major muscle accurately represents overall skeletal muscle mass. The skeletal muscle mass volume is related to outcomes in multiple surgical procedures including colorectal cancer. However, neoadjuvant chemoradiotherapy for rectal cancer may adversely affect muscle mass. Objective: Assess the effect of neoadjuvant chemoradiotherapy on muscle mass in rectal cancer patients as well as on outcomes. Design: Retrospective study. Setting: A large UK District General Hospital. Patients and Methods: Analysis of all rectal cancer patients between 2014 and 2017. Psoas major was measured at the L3 level using pre- and post-neoadjuvant chemoradiotherapy images. Psoas major to L3 cross-sectional area (PML3) was calculated for each patient. Main Outcome Measures: 30-day and 90-day mortality, inpatient stay, and postoperative complications. Sample Size: One hundred and twenty-one rectal cancer patients. Results: Median age was 72 years (IQR: 64–78 years). Male:Female ratio was 82:39. 30-day mortality was 0%, and 90-day mortality was 0.83%. Sixty-one patients underwent neoadjuvant chemoradiotherapy (50.4%). Thirty-one patients underwent abdominoperineal excision of the rectum (APER) (25.6%), 1 underwent proctocolectomy (0.83%), 1 underwent completion proctectomy (0.83%), and 88 patients underwent anterior resection (72.7%). Significant muscle loss occurred during neoadjuvant therapy (median loss: 25.9%, IQR: 12.6–36.8%) (P < 0.0001). No correlation was observed between PML3 and inpatient stay. Patients with PML3 in the lowest quartile had a chest infection rate of 11.1% and a complication rate of 37.1% rather than 6.2% and 26.8%, respectively, for those in the upper quartiles. Anastomotic leak rate in the PML3 lowest quartile was 23.5% compared to 11.4% in patients in the upper quartiles. Conclusion: Patients who received neoadjuvant chemoradiotherapy had a significant reduction in muscle mass. Muscle mass loss can be overcome with a prehabilitation program that may reduce muscle loss and improve outcomes. Limitations: Due to a low event-rate of anastomotic leak, it is difficult to show statistical significance with a patient cohort of this size. Conflict of Interest: None.","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":"70854059","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: Surveillance colonoscopy is routinely offered to patients who have undergone curative resections for colorectal cancer (CRC). The purpose of this study is to investigate the early detection of metachronous tumors or anastomotic recurrences. Few studies have investigated the utility of surveillance scopes in the elderly population. Objective: To investigate the incidence of metachronous cancer or anastomotic recurrence in patients over the age of 80 years who underwent resection of CRC with curative intent. Design: This is a retrospective study of a prospectively maintained database. Setting: University Hospital Geelong. Patients and Methods: All patients ≥80 years of age who underwent resection of CRC with curative intent at University Hospital Geelong between January 2002 and December 2014 were studied. Demographic information, comorbidities (Charlson score), types of surgery, postoperative complications (Clavien–Dindo), tumor staging, and details regarding postoperative colonoscopies were recorded. Patients were followed up for life whenever possible. The mean length of hospital stay and follow-up were determined. Survival analysis was done using the Kaplan–Meier method. The incidence of metachronous and locally recurrent CRC was calculated. Main Outcome Measures: Incidence of metachronous or locally recurrent CRC. Sample Size: One hundred and eighty-three patients. Results: Ninety-nine patients (54%) were female and 147 (80%) had elective resections. Seventy-one (39%) patients had moderate-to-severe comorbidities (Charlson Comorbidity Index ≥3). There were 139 patients who had had colon cancer and 44 with rectal cancer who had been resected with curative intent. Stages I, II, and III cancers comprised 16%, 47%, and 37%, respectively. The mean length of hospital stay was 13.3 days. The mean duration of follow-up was 3.43 years. Median survival after surgery by stage was 93 months (Stage I), 92 months (Stage II), and 72 months (Stage III). A total of 26 surveillance colonoscopies were performed on 24 patients. After a total of 627.21 patient-years of follow up, one metachronous CRC was detected, but no local recurrences were observed. Conclusion: It is extremely uncommon to detect clinically significant metachronous tumors in patients aged over 80. Limitation: Small cohort size. Conflict of Interest: None.
{"title":"Is colonoscopic surveillance necessary after curative resection of colorectal cancer in elderly patients?","authors":"S. Ng, J. Kong, D. Stupart, D. Watters","doi":"10.4103/WJCS.WJCS_8_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_8_19","url":null,"abstract":"Background: Surveillance colonoscopy is routinely offered to patients who have undergone curative resections for colorectal cancer (CRC). The purpose of this study is to investigate the early detection of metachronous tumors or anastomotic recurrences. Few studies have investigated the utility of surveillance scopes in the elderly population. Objective: To investigate the incidence of metachronous cancer or anastomotic recurrence in patients over the age of 80 years who underwent resection of CRC with curative intent. Design: This is a retrospective study of a prospectively maintained database. Setting: University Hospital Geelong. Patients and Methods: All patients ≥80 years of age who underwent resection of CRC with curative intent at University Hospital Geelong between January 2002 and December 2014 were studied. Demographic information, comorbidities (Charlson score), types of surgery, postoperative complications (Clavien–Dindo), tumor staging, and details regarding postoperative colonoscopies were recorded. Patients were followed up for life whenever possible. The mean length of hospital stay and follow-up were determined. Survival analysis was done using the Kaplan–Meier method. The incidence of metachronous and locally recurrent CRC was calculated. Main Outcome Measures: Incidence of metachronous or locally recurrent CRC. Sample Size: One hundred and eighty-three patients. Results: Ninety-nine patients (54%) were female and 147 (80%) had elective resections. Seventy-one (39%) patients had moderate-to-severe comorbidities (Charlson Comorbidity Index ≥3). There were 139 patients who had had colon cancer and 44 with rectal cancer who had been resected with curative intent. Stages I, II, and III cancers comprised 16%, 47%, and 37%, respectively. The mean length of hospital stay was 13.3 days. The mean duration of follow-up was 3.43 years. Median survival after surgery by stage was 93 months (Stage I), 92 months (Stage II), and 72 months (Stage III). A total of 26 surveillance colonoscopies were performed on 24 patients. After a total of 627.21 patient-years of follow up, one metachronous CRC was detected, but no local recurrences were observed. Conclusion: It is extremely uncommon to detect clinically significant metachronous tumors in patients aged over 80. Limitation: Small cohort size. Conflict of Interest: None.","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":"70854939","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：