101 research outputs found
The role of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery on patients who are histologically node negative after neoadjuvant chemoradiotherapy.
No full textAIM: The aim of this study is to evaluate whether adjuvant chemotherapy will affect recurrence rates, disease free and overall survival in patients with rectal adenocarcinoma who were staged with MRI node positive disease (mrN+) preoperatively and underwent neoadjuvant chemoradiotherapy with curative rectal cancer surgery and their pathological staging was negative for nodal disease (ypN0). There is no consensus on the role of adjuvant chemotherapy in these patients. METHOD: Patients who received neoadjuvant chemoradiotherapy and underwent curative rectal cancer surgery for rectal adenocarcinoma staged as [mrTxN+M0] on MRI staging and on pathological staging were found to be [ypTxN0M0] were retrospectively identified from 01/2008-12/2012 from two tertiary referral centers (Royal Marsden Hospital and Saint-Andre Hospital). RESULTS: 163 patients were recruited and after propensity matching at a ratio of 2:1 n=80 patients were divided into adjuvant (n=28) and no adjuvant treatment (n=52) respectively. A comparison of adjuvant chemotherapy vs no adjuvant therapy showed that the mean overall survival was 2.67 vs 3.60 years (p=0.42), disease free survival was 2.27 vs 3.32 years (p=0.14). CONCLUSION: This study found no significant difference in survival or disease recurrence between patients who received adjuvant chemotherapy and patients who did not. There is no clear evidence to support or dismiss the use of adjuvant chemotherapy for patients who have been node positive on pre-operative MRI and node negative on histopathological staging. Further multicenter prospective randomised trials are needed to identify the appropriate treatment regime for this group of patients
Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC)
No full text: Twenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called "classic" or "suprapubic" setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or disease-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results
Exérèse totale du mésorectum par voie transanale (TaTME) pour cancers du bas et du moyen rectum
No full text
J Psychosoc Oncol
No full textObjective: To assess colorectal cancer survivors' quality of life (QoL) and fatigue according to stoma status. Methods: In this large-scale national survey, we examined and compared QoL (SF-12) and fatigue (QLQ-C30) of colorectal cancer survivors according to stoma status and against population norms. Of the 487 colorectal cancer survivors who participated in the VICAN survey, 43 had a reversed stoma. We randomly selected 43 survivors without stoma as a comparison group. Findings: Colorectal cancer survivors had lower QoL scores compared to population norms. Fatigue affected survivors even two years after diagnosis. Participants with a reversed stoma scored lower on the physical QoL scale than participants without stoma. Conclusion: QoL and fatigue are impaired during a considerable period after cancer diagnosis and differ according to stoma status
Segmental Colectomy for Ulcerative Colitis: Is There a Place in Selected Patients without Active Colitis? An International Multicentric Retrospective Study in 72 Patients
No full textBackground and Aims: The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA]. Methods: All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo's classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed. Results: A total of: 72 UC patients underwent: sigmoidectomy [n = 28], right colectomy [n = 24], proctectomy [n = 11], or left colectomy [n = 9] for colonic cancer [n = 27], 'diverticulitis' [n = 17], colonic stenosis [n = 5], dysplasia or polyps [n = 8], and miscellaneous [n = 15]. Three patients died postoperatively and 5/69 patients [7%] developed early flare of UC within 3 months after SC. After a median followup of 40 months, 24/69 patients [35%] were reoperated after a median delay after SC of 19 months [range, 2-158 months]: 22/24 [92%] underwent total colectomy and ileorectal anastomosis [n = 9] or total coloproctectomy [TCP] [n = 13] and 2/24 [8%] an additional SC. Reasons for reoperation were: colitis [n = 14; 20%], cancer [n = 3] or dysplasia [n = 3], colonic stenosis [n = 1], and unknown reasons [n = 3]. Endoscopic score of colitis before SC was Mayo 23 in 5/5 [100%] patients with early flare vs 15/42 without early flare [36%; p = 0.0101] and in 9/12 [75%] patients with reoperation for colitis vs 11/35 without reoperation [31%; p = 0.016]. Conclusions: After segmental colectomy in UC patients, postoperative early colitis is rare [7%]. Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis
Colectomie droite par abord robotique. Recommandations formalisées d’experts sous l’égide de l’Association française de chirurgie (AFC)
No full textTwenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called “classic” or “suprapubic” setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to open laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or recurrence-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results
Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: what is the impact on postoperative outcome and oncologic results?
No full textObjectives: The aim of the study was to compare the postoperative and oncologic outcomes of laparoscopic versus open surgery for gastric gastrointestinal stromal tumors (gGISTs). Background: The feasibility of the laparoscopic approach for gGIST resection has been demonstrated; however, its impact on outcomes, particularly its oncologic safety for tumors greater than 5cm, remains unknown. Methods: Among 1413 patients treated for a GIST in 61 European centers between 2001 and 2013, patients who underwent primary resection for a gGIST smaller than 20cm (N=666), by either laparoscopy (group L, n=282) or open surgery (group O, n=384), were compared. Multivariable analyses and propensity score matching were used to compensate for differences in baseline characteristics. Results: In-hospital mortality and morbidity rates in groups L and O were 0.4% versus 2.1% (P=0.086) and 11.3% vs 19.5% (P=0.004), respectively. Laparoscopic resection was independently protective against in-hospital morbidity (odds ratio 0.54, P=0.014). The rate of R0 resection was 95.7% in group L and 92.7% in group O (P=0.103). After 1:1 propensity score matching (n=224), the groups were comparable according to age, sex, tumor location and size, mitotic index, American Society of Anesthesiology score, and the extent of surgical resection. After adjustment for BMI, overall morbidity (10.3% vs 19.6%; P=0.005), surgical morbidity (4.9% vs 9.8%; P=0.048), and medical morbidity (6.2% vs 13.4%; P=0.01) were significantly lower in group L. Five-year recurrence-free survival was significantly better in group L (91.7% vs 85.2%; P=0.011). In tumors greater than 5cm, in-hospital morbidity and 5-year recurrence-free survival were similar between the groups (P=0.255 and P=0.423, respectively). Conclusions: Laparoscopic resection for gGISTs is associated with favorable short-term outcomes without compromising oncologic results
The 2017 European Society of Coloproctology (ESCP) international snapshot audit of left colon, sigmoid and rectal resections – study protocol
No full textBackground: Left hemicolectomy, sigmoid, and rectal resections are commonly performed colorectal operations. There is significant variability in the techniques utilised to undertake these operationsat patient, surgeon and unit level. Aim: To explore differences in patients, techniques and outcomes across an international cohort to identify areas of practice variability resulting in apparent differences in outcome warranting further study. Endpoints: A three-stage data collection strategy collecting patient demographics, operative details and outcome markers. Several outcomes measures will be used including mortality, surgical morbidity (including anastomotic leak) and length of hospital stay. Methods: A two-month prospective audit to be performed across Europe in early 2017, co-ordinated by the European Society of Coloproctology. The main audit will be preceded by a one-week, five centre pilot. Sites will be asked to pre-register for the audit and obtain appropriate regional or national approvals. During the study period all eligible operations will be recorded contemporaneously and followed-up through to 30 days. The audit will be performed using a standardised pre-determined protocol and a secure online database. In the first ESCP conducted audit in 2015, 38 countries registered 3208 patients undergoing right hemi-colectomy, while in the second audit 2441 patients undergoing stoma closure were recruited from 48 countries. It is expected that equivalent numbers will be obtained in this audit. The report of this audit will be prepared in accordance with guidelines set by the STROBE (strengthening the reporting of observational studies in epidemiology) statement for observational studies. Discussion: This multicentre, pan-European audit will be delivered by colorectal surgeons and trainees in an organised and homogenous manner. The data obtained about areas of variability in provision or practice, and how this may impact upon outcomes, will serve to improve overall patient care as well as being hypothesis generating and inform areas needing future prospective study
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