1,721,083 research outputs found
T4N0 colon cancer has oncologic outcomes comparable to stage Iii in a specialized center
No full textBackground: National data indicate that patients with T4N0 colon carcinoma have worse oncologic outcomes than other stage II cases. Our hypothesis was that optimized surgical resection and lymph node staging in a specialized center could eliminate discrepancies in oncologic outcomes within stage II colon carcinomas. Methods: Patient characteristics and outcomes after oncologically radical colectomy for pT4N0 were compared to control groups of T1-2N1, T3N1, and T3N0 cases. Group comparisons were adjusted for age, American Society of Anesthesiologists score, tumor location, year of surgery, and duration of follow-up. Cases with at least 12 collected lymph nodes and uninvolved resection margins (R0) were analyzed separately. In addition, the T4a subgroup was compared to both T4b cases with involvement of bowel loops and with infiltration of other organs or structures. Results: T4N0 patients had worse oncologic outcomes than T1-2N1 patients and were comparable to T3N1 patients, regardless of margins status or lymph node collection. When a T4b tumor infiltrated bowel, survival and recurrence rates were similar to T4a cases, while T4b tumors involving other organs were associated with increased recurrence rate and reduced survival. Conclusions: T4N0 colon carcinoma remains associated with poor oncologic outcomes, regardless of treatment in a specialized center. The biologic aggressiveness of T4N0 colon cancers and the different oncologic outcomes according to specific organ infiltration should be taken into consideration in the choice of adjuvant therapies. © 2012 Society of Surgical Oncology
Gracilis muscle transposition for the treatment of recurrent rectovaginal and pouch-vaginal fistula: is Crohn's disease a risk factor for failure? A prospective cohort study
No full textBACKGROUND:
The surgical management of rectovaginal fistulae associated with Crohn's disease is often frustrated by poor results regardless of the different techniques. The outcomes of the gracilis muscle transposition (GMT) for the treatment of recurrent Crohn's-associated fistulae are still debated. The aim of the study is to determine whether the success rate of GMT is similar in Crohn's disease patients and in a control group.
MATERIALS AND METHODS:
All patients undergoing GMT for rectovaginal or pouch-vaginal fistula were collected from a prospectively maintained database (2005-2016). The primary study outcome was the comparison of the success rate of GMT in Crohn's disease and control group patients.
RESULTS:
Twenty-one patients with a rectovaginal fistula due to Crohn's disease (8, 38.1%) or other etiologies (13, 61.9%) were included. The groups had similar characteristics and postoperative outcomes. After a median follow-up time of 81 and 57 months (p 0.34), the success rate of GMT was 75% in patients with Crohn's disease and 68.4% in control group (p 0.6). The median time to recurrence was 3.5 months (1-12). The success rate in patients who had more than two previous attempts of repair was lower regardless of the etiology (50 vs 79.4%, p 0.1).
CONCLUSION:
GMT is associated with a high success rate, especially in Crohn's disease-related rectovaginal fistula. In consideration of the low morbidity rate and the fact that an increasing number of previous local operations might be associated with failure, the procedure should be considered as a first line of treatment for recurrent rectovaginal fistulae
Is survival reduced for patients with anal cancer requiring surgery after failure of radiation? Analysis from a population study over two decades
No full textChemoradiotherapy is the standard treatment for anal cancer. Surgery is reserved for failure of therapy, but there are limited data examining outcomes after surgery. From a prospective population-based database on radiation and surgical therapy, we compare outcomes for patients with anal cancer undergoing rectal resection after radiation with patients undergoing radiation alone. Patients undergoing surgical resection of the rectum after initial radiation (SRT) for squamous cell carcinoma of the anus, anal canal, cloacogenic zone, and overlapping lesions of the rectum and anal canal from 1983 to 2002 were identified from the Surveillance, Epidemiology and End Results database. Patient and tumor characteristics of SRT were compared with those of patients who underwent radiation alone (RT). Survival was calculated by the Kaplan-Meier test. There were 1202 patients undergoing RT and 48 patients undergoing SRT. RT and SRT had similar median age, gender, and grade of tumor. SRT had more patients with regional stage of disease (66.7 vs 42.4%, P = 0.001). Mean survival for SRT was, however, similar to RT (103 vs 96 months, P = 0.8). For patients with localized stage, survival for SRT and RT was similar (105 vs 98 months, P = 0.7). For patients with regional stage, survival for SRT and RT was similar (95 vs 83 months, P = 0.6). The presence of regional disease appears to be associated with surgical resection after radiotherapy. Mean survival for such patients is comparable to that of patients undergoing radiation alone. Because radiation is combined with chemotherapy, this suggests that salvage surgery after failure of therapy results in outcomes comparable to combination therapy alone
Is transanal total mesorectal excision a reproducible and oncologically adequate technique? A pilot study in a single center: Is transanal TME a safe procedure?
No full textPurpose: An oncologically effective total mesorectal excision (TME) still represents a technical challenge, especially in the presence of a low rectal cancer and anatomical restraints such as obesity or narrow pelvis. Recently, few reports have shown that transanal TME was feasible and associated with good outcomes. Nevertheless, a widespread employment of the technique has yet to happen due to the doubts about the reproducibility of the results outside a tertiary specialized center. Methods: Between February 2014 and June 2015, patients with low rectal cancer underwent a transanal TME with laparoscopic assistance. The end points included the oncologic adequacy of the mesorectal excision and the perioperative outcomes. Results: Eleven patients (9 male, median age 70.5 years) with proven low rectal cancer were enrolled in the study. The median distance of the tumor from the anal verge was 5 cm (2–7). Four patients (36.4 %) received preoperative chemoradiation. The median operative time was 360 min (275–445). Postoperative morbidity (36.4 %) included one (9.1 %) anastomotic leak requiring a reoperation. The median length of hospital stay was 8 days (3–28). The median distance from the circumferential and distal resection margins were, respectively, 5 (1–20) and 10 (5–20) mm, and the mean number of harvested lymph nodes was 21.7 (11–50). All cases had a complete or nearly complete mesorectal plane of surgery. Conclusions: Although technically challenging, the initial results suggest that transanal TME could be a feasible, oncologically safe, and reproducible operation. However, more robust studies are required to assess the short- and long-term outcomes
Emergency Surgery in Obese Patients
No full textObesity is considered an important risk factor for the development of gastrointestinal
disorders [1], likely through alterations of gastrointestinal motility. Even though
gastroesophageal reflux disease is the condition mainly studied at present, the prevalence
of other upper gastrointestinal symptoms has also increased.
Upper gastrointestinal tract perforations occur as a result of various causes. The
majority of the perforations that we see today in the esophagus are iatrogenic (about
60%), but they could be spontaneous (Boerhaave’s syndrome), traumatic or due to
other causes. Perforation of a peptic, gastric or duodenal, ulcer is now less frequent
because of the availability of adequate medical therapy. Peptic ulcer disease represented
1% of the discharge diagnosis of patients with a body mass index
(BMI) > 25 kg/m2 admitted to the Surgical Unit of Christchurch Hospital, New
Zealand in a 26-month study period [2], and a surgical intervention for perforated
viscus accounted for 4.4% of patients with a BMI > 30 kg/m2 operated on at a US
community teaching hospital in 1 year [3].
They represent a surgical emergency and the timing of the intervention is very
important. Just one day of delay increases mortality significantly.
Since a detailed discussion of upper gastrointestinal perforations is beyond the
scope of this chapter, attention has been directed to examining the peculiar characteristics
of this topic in the obese population
Outcomes of pelvic exenteration for recurrent and primary locally advanced rectal cancer
No full textBackground Pelvic exenteration is the only radical treatment for locally advanced (ARC) or recurrent (RRC) rectal cancers. The long-term results of the procedure are variably reported in the literature, with recent series suggesting similar survival between ARC and RRC. The study aimed to analyze and compare the long-term survival and perioperative outcomes of patients undergoing pelvic exenteration for ARC and RRC in a tertiary center. Materials and methods This was a retrospective analysis of prospectively collected data. Comparison of variables was performed using Chi-square, Fisher's exact or Wilcoxon rank sum test as appropriate. The Kaplan Meier method was used to analyze the disease-free survival (DFS) and the log-rank test to compare the two groups. Results Since 2002, 46 patients underwent pelvic exenteration for ARC (28, 60.9%) and RRC (18, 39.1%). The groups had comparable characteristics, perioperative results, including postoperative complications, and rate of adjuvant chemotherapy. A R0 resection was obtained in 71.4% and 55.6% (p 0.41) and a T4 stage was diagnosed in 75% and 94.4% (p 0.22) of ARC and RRC patients, respectively. After a median follow-up time of 32.5 and 56.6 months (p 0.01), the 5-year DFS was significantly lower in the RRC group (23.6 vs 46.2%, p 0.006), even after exclusion of R1 cases (30 vs 54.5%, p 0.044). Conclusion The long-term disease free survival of patients undergoing pelvic exenteration is significantly worse when the procedure is performed for RRC, regardless of the tumor involvement of the resection margins
Gender of the patient may influence perioperative and long-term complications after restorative proctocolectomy
No full textAim Gender-related differences in preoperative characteristics and early and long-term outcome for patients undergoing ileal pouch anal anastomosis (IPAA) have not previously been well studied. Method All male and female patients undergoing IPAA at a single centre between 1983 and 2008 were compared for perioperative variables and long-term outcome. Statistical tests were used as appropriate. A multivariate analysis was performed to evaluate the effects of gender on pouch failure. Results Female patients (n=1495) were younger than male patients (n=1912) (P<0.001). Surgery type and pouch configuration were similar, although male gender was associated with a higher use of ileostomy (P<0.001) and a higher incidence of 30-day anastomotic separation (P=0.001). During a median follow up of 9.9 (female) and 9.3 (male) years, female patients were more likely to develop bowel obstruction (20.8 vs 16.7%, P=0.02) and pouch-related fistula (10.9 vs 7.6%, P=0.001). Women had a higher number of daily bowel movements than men (P=0.001), and more frequently had urgency (P=0.001), daily seepage (P=0.01) and pad use (P<0.001). A higher percentage of female patients reported dietary (P<0.001) and work (P=0.022) restrictions and lower mental component of the Short-Form 36 quality of life score (P=0.018). On multivariate analysis of perioperative variables, female gender was associated with pouch failure (P=0.05). Conclusion The gender of the patient seems to be associated with specific differences in preoperative variables and postoperative outcomes for patients undergoing IPAA. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland
Rectovaginal fistula: Risk factors for failure after graciloplasty—A bicentric retrospective European study of 61 patients
No full textBACKGROUND: Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF) after failure of previous local treatments. The aim of this study was to assess risk factors for GP failure performed for RVF.METHODS: Retrospective study based on a prospective database of GP, coming from two expert centers.RESULTS: 61 patients undergoing a first GP for RVF (n=51) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n=10), with a mean age of 42 years (range, 24-72) were analyzed. After a mean follow-up of 56 ± 48 months (range, 1-183), failure of GP (considered as persistent stoma and/or clinical RVF) was noted in 24/61 patients (39%). Failure rate was 43% (13/30) in case of Crohn's disease, 38% (3/8) in case of ileal-vaginal fistula after IPAA for ulcerative colitis, 30% in case of obstetrical RVF (3/10), 33% in case of post radiotherapy RVF (1/3), and 40% for other causes (4/10) (NS). Two risk factors for failure of GP were found on univariate analysis: 1) absence of postoperative antibiotic prophylaxis (PAP): only 3/24 (13%) patients with failure of GP received PAP versus 18/37 (49%) patients with success of GP (p=0.0053); 2) postoperative perineal infection: 11/23 (48%) with failure of GP failure developed postoperative perineal infection versus only 4/37 (10%) patients with success of GP (p=0.0021).CONCLUSIONS: Failure of Graciloplasty for rectovaginal fistula is observed in approximately 40% of the patients whatever the aetiology of the fistula. Reduced failure rate was associated with systematic postoperative antibiotic prophylaxis
Laparoscopic colorectal resection for cancer: Effects of conversion on long-term oncologic outcomes
No full textBackground: The effects of conversion to open surgery during laparoscopic resection for colorectal cancer on longterm oncologic outcomes still are unclear. Methods: All 450 laparoscopic colorectal resections for cancer performed at a single center between 1994 and 2008 and included in a prospectively maintained database were considered. Patients who required conversion to open surgery (CONV) were matched 1:2 with laparoscopically completed cases (LAP) and 1:5 with open surgery cases (OPEN) for age, American Society of Anesthesiologists (ASA) score, year of surgery, tumor location, and tumor stage. Fisher's exact, chi-square, and Wilcoxon tests were used as appropriate. Kaplan-Meier curves were compared to analyze survival. Results: In this study, 31 CONV cases were independently compared with 62 LAP and 155 OPEN cases. Compared with the LAP and OPEN patients, the CONV patients were characterized by a numerically higher rate of preoperative comorbidity (61.3% vs LAP, 51.6; P = 0.4 and OPEN, 48.4%; P = 0.2), male gender (77.4% vs LAP, 59.7%; P = 0.09 and OPEN, 58.1%; P = 0.05), and a significantly higher mean body mass index (29.6 vs LAP, 26.8; P = 0.012 and OPEN, 28.8; P = 0.3). The pathologic tumor stage, location, and chemotherapy and radiotherapy rates were comparable among the groups. After a median follow-up period of 4.1, 4.2, and 4.6 years, the 5-year disease-free survival rate was significantly lower for the CONV patients (40.2%) than for the LAP (70.7%, P = 0.01) or the OPEN (63.3%, P = 0.04) patients. However, the 5-year cancer-specific survival rates were similar among the CONV (94.4%), LAP (86.1%, P = 0.36), and OPEN (84.9%, P = 0.14) patients. Conclusions: Conversion to open surgery does not affect oncologic outcomes, although CONV patients have increased comorbidity rates affecting long-term mortality. © Springer Science+Business Media, LLC 2012
Long-term outcomes after local excision and radical surgery for anal melanoma: Data from a population database
No full textPURPOSE: Anal melanoma is rare and associated with a poor outcome. Previous studies that have reported outcomes after surgical treatment are limited by both small number of participants and treatment at single centers only. This study evaluates survival of patients undergoing surgery for anal melanoma from a prospective, population-based database. METHODS: Characteristics and survival of patients undergoing rectal resection or local excision for anal melanoma of the anus, anal canal, and overlapping region of the rectum from 1982 to 2002 were obtained from the Surveillance, Epidemiology and End Results database and compared. RESULTS: A total of 160 patients were included in the study. Details of previous surgical procedures were available for 109 of the study patients: 60 (55%) underwent local excision and 49 (45%) rectal resection. Patients who underwent local excision were significantly older (73.5 vs 65.1 years, P <.001), whereas those who had undergone rectal resection had a greater proportion of regional disease (73.5% vs 16.7%, P <.001). The median survival of the 2 groups was similar (rectal resection vs local excision: 17 vs 28 months, P =.3). Rectal resection and local excision were associated with similar survival for patients in both regional (P =.6) and localized (P =.95) stages. Outcomes for patients who were appropriately pathologically staged after rectal resection depended on localized vs regional stage (5-year survival: 43.1% vs 12.5%, P =.17). Survival for patients in localized and regional stages who underwent rectal resection was similar to that for patients with corresponding clinical stage who underwent local excision. CONCLUSION: Survival of patients with anal melanoma is similar after local excision or rectal resection irrespective of whether patients have localized or regional stage of disease. © The ASCRS 2010
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