scholarly journals Standard versus eversion-modified double-staple technique for low colorectal anastomoses after resection of rectal cancer

Surgery Today ◽  
2020 ◽  
Author(s):  
Giulio Illuminati ◽  
Rocco Pasqua ◽  
Bruno Perotti ◽  
Paolo Urciuoli ◽  
Priscilla Nardi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Rectal Stump ◽  
Postoperative Mortality ◽  
Linear Stapler ◽  
Colorectal Anastomoses ◽  
Staple Technique ◽  
Group A ◽  
Group B ◽  
Related Survival

Abstract Purpose The double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique. Methods The subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival. Results Postoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17–27) in group A and 24 (range 19–29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75). Conclusion The standard and eversion-modified double-staple techniques yield comparable results.

scholarly journals Risk of Dumping Syndrome after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Early Results of a Multicentre Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
M. Ramadan ◽  
M. Loureiro ◽  
K. Laughlan ◽  
R. Caiazzo ◽  
A. Iannelli ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Anastomosis Group ◽  
Dumping Syndrome ◽  
Linear Stapler ◽  
Gastrojejunal Anastomosis ◽  
Early Results ◽  
B 41 ◽  
Group A ◽  
Important Field ◽  
Group B

Background. Bariatric surgery is an important field of surgery. An important complication of bariatric surgery is dumping syndrome (DS).Aims. To evaluate the incidence of DS in patients undergoing bariatric surgery.Methods. 541 patients included from 5 nutrition and bariatric centers in France underwent either LSG or LRYGB. They were evaluated at 1 month (M1) and 6 months (M6) postoperatively by an interview and completion of a dumping syndrome questionnaire.Results. 268 patients underwent LSG (Group A) and 273 underwent LRYGB. From the LRYGB patients 229 had mechanical gastrojejunoanal anastomosis with 30 mm linear stapler (Group B) and 44 had manual (hand sewn) 15 mm gastrojejunal anastomosis (Group C). Overall incidence of DS was 8.5% at M1 and M6. In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B, 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6. Group C experienced one case (2.27%) of DS at M1 and none (0%) at M6.Conclusions. Patients undergoing LRYGB, especially with larger gastrojejunal anastomosis, are more prone to developing DS following surgery than patients undergoing LSG or LRYGB with calibrated manual anastomosis.

scholarly journals Effect of Arterial Hypertension on Postoperative Mortality and Morbidity after Off-pump CABG Surgery

2017 ◽  
Vol 10 (1) ◽  
pp. 13-16
Author(s):  
Asraful Hoque ◽  
Shahriar Moinuddin
Keyword(s):  
Coronary Artery ◽  
Arterial Hypertension ◽  
Postoperative Mortality ◽  
P Value ◽  
Hypertensive Patients ◽  
Mortality And Morbidity ◽  
Off Pump ◽  
Group A ◽  
Pump Cabg ◽  
Group B

Background: Arterial hypertension is one of the leading modifiable risk factor in coronary artery disease patients who underwent coronary artery bypass grafting (CABG) with the major impact on clinical outcome in these patients. This study was done to evaluate the effect of arterial hypertension on postoperative mortality and morbidity after off-pump CABG.Methods: 200 patients with mean age of 52 ± 6 years, (182 male/18 female) undergoing off pump CABG were divided equally into two groups, 100 patients with hypertension (Group A) and 100 patients without hypertension (Group B). Postoperative mortality and morbidities (Wound infection, AMI, TIA, Stroke) up to 6 months were recorded in the 2 groups.Results: In comparison with the normotensive patients, hypertensive patients had a higher mortality rate (Group A 10% and Group B 2%, p value-<0.05) and increased frequency of myocardial infarction (Group A 12 % and Group B 3%, p value - <0.05). There was also increased rate of infection in hypertensive patients (Group A 13 % and Group B 4%, p value - <0.05). We found that hypertensive patients developed post-operative cerebrovascular complications like TIA (Group A 8 % and Group B 1%, p value - <0.05) and stroke (Group A 11 % and Group B 2%, p value - <0.05) more frequently than normotensive patients. Post-operative ventilator support and duration of hospital stay were almost similar in both groups.Conclusions: Among CABG patients, those with a history of hypertension have an increased frequency of post-operative complications and increased mortality.Cardiovasc. j. 2017; 10(1): 13-16

CLO19-049: Central Lymph Node Dissection in the Clinically Node-Negative (cN0) Papillary Thyroid Carcinoma: Is it Necessary?

2019 ◽  
Vol 17 (3.5) ◽  
pp. CLO19-049
Author(s):  
Girish M. Suresh ◽  
C. Ramachandra ◽  
Ravi Arjunan ◽  
Rajshekar Halkud
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Postoperative Complication ◽  
Central Compartment ◽  
Central Neck ◽  
Papillary Thyroid ◽  
Node Dissection ◽  
Group A ◽  
Group B

Background: Surgery is the treatment of choice in papillary thyroid cancer (PTC), which is the most common thyroid malignancy and frequently has metastases in the central compartment lymph nodes (CLN). There is debate among surgeons whether removing normal-appearing lymph nodes in the central neck (prophylactic lymph node dissection) is better than removing only the abnormal-appearing lymph nodes. Herein, we review the potential utility of central compartment lymph nodal dissection (CLND) on surgical outcome and disease-free follow-up of PTC and 5-year survival of patients operated on at our center. Methods: A total of 246 patients from February 2009 to March 2012 who were treated for PTC in our Kidwai Cancer Institution was analyzed retrospectively. 135 patients who underwent total thyroidectomy and CLND were assigned to Group A, which was compared with 111 patients who received total thyroidectomy, without CLND, who were assigned to Group B by evaluation of postoperative complications (recurrent laryngeal nerve damage, hoarseness, hypocalcemia, and hemorrhage rates) and recurrence at the time of Iodine131 treatment and subsequently at 60 months follow-up. Results: In the present study, Mean DFS and OS did not differ in both groups. Male gender and age more than 45 years had statistically significant DFS but without any impact on OS. There was a significant postoperative complication in group A compared to group B (P≤.001), with a very minimal recurrence in the central neck. 4 patients (3.6%) had recurrences in CLN. Conclusion: Considering the significant postoperative complication, which outweighs benefit, we conclude that for cN0 PTC, routine CLND is not necessary.

scholarly journals Relevance of Regional Lymph Node Invasion in Radical Hepatectomy and Lymphadenectomy for Alveolar Echinococcosis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Xianwei Yang ◽  
Tao Wang ◽  
Shu Shen ◽  
Wentao Wang
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Alveolar Echinococcosis ◽  
Regional Lymph Node ◽  
Regional Lymph Nodes ◽  
Node Number ◽  
Lymph Node Enlargement ◽  
Group A ◽  
Group B ◽  
Node Diameter

Abstract Background Hepatic Alveolar echinococcosis (AE) is also known as worm cancer, parasitic cancer, and it often invades the regional lymph nodes of the liver. The present study was to investigate the clinical value of radical hepatectomy and lymphadenectomy in AE patients. Methods Our study enrolled consecutive AE patients who underwent radical hepatectomy with removal the regional lymph nodes between January 2009 and April 2019. Patients with inflammatory lymph node enlargement was included in group A, and patients with AE lymph node invasion were included in group B. The clinical characteristics, survival and recurrence rates were compared.Results A total of 103 patients were enrolled group A, and 24 in group B. Preoperative computed tomography showed that the lymph node positivity rate in group B was 70.8% while that in group A was 43.7% (p=0.017). The lymph node diameter was 1.8±0.9 cm in group A vs 2.5±1.1 cm in group B (p=0.004), and the lymph node number (p=0.035) and lymph node location (p=0.001). A total of 10 patients (7.9%) had recurrent lesions, and 6 patients (4.7%) died (P>0.05). Conclusions lymph node diameter, number, and distance from the liver were important characteristics for describing lymph node invasion. There was no difference in the long-term efficacy of lymphadenectomy between patients with lymph node enlargement and those with invasion.

scholarly journals Analysis of surgical treatment of duodenal ulcers with multiple combined complications

2021 ◽  
pp. 10-12
Author(s):  
Pavlo Ivanchev ◽  
Maxim Bilyachenko ◽  
Anton Kurbanov ◽  
Oleksii Lissov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Mortality ◽  
Bleeding Complications ◽  
Duodenal Ulcers ◽  
The Third ◽  
Number Of Patients ◽  
Group A ◽  
Analysis Of Results ◽  
Surgical Tactics ◽  
Group B

The aim of the research. Analysis of results and development of surgical tactics for the treatment of DU with multiple combined complications. Materials and methods. The results of the analysis of surgical treatment of duodenal ulcers with multiple combined complications (3 and 4 combined complications) for 3 periods are presented: 1st (1983–1995) (group A) – 77 patients, 2nd (2000–2007) years (group B) – 30 patients and 3rd (2008–2020) (group C) – 46 patients. Results. 153 patients (100 %) underwent surgery for complicated duodenal ulcer (DU), of which 130 patients (84.9 %) had a combination of three complications and 23 (15.1 %) had four complications. Bleeding complications were noted in 139 of 153 patients, accounting for 90.8 %, and ulcer perforation in 69 patients, accounting for 45.1 % of all other complications. Based on the obtained data of the analysis, there is a steady tendency to increase the proportion of organ-preserving operations (OPO) by 1.5 times (from 50.7 % to 76.2 %), reducing the number of gastrectomy (GR) by 3 times (from 14.5 % to 4.8 %) and palliative operations (PAL) 3.3 times (from 15.8 % to 4.8 %) with a relatively stable number of performed organ-saving operations (OSO): in group A – 17 (24.6 %) interventions, in group B – 4 (21.1 %), group C – 6 (14.3 %). Conclusions. The use of modern measures of endoscopic hemostasis allowed to operate on patients in the delayed period, and their share from the second period to the third increased 2.8 times. The number of patients who underwent emergency surgery with perforation of the ulcer as one of the complications decreased in the third period compared to the second by 2.6 times, due to the widespread use of PPIs in the conservative treatment of DU. According to the results of the analysis it became known that the chosen active-individualized tactics and developed algorithms for choosing the type of surgery allowed to achieve a stable level of postoperative mortality at 8.3 %.

The efficacy of neoadjuvant treatment in locally advanced rectal cancer with dMMR.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 615-615 ◽  
Author(s):  
Yanhong Deng ◽  
Jianwei Zhang
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Group A ◽  
Tumor Downstaging ◽  
Group B ◽  
Group D

615 Background: The incidence of Mismatch repair gene deficiency (dMMR) was about 15% in colorectal cancer, but mostly in right side colon cancer, while in locally advanced rectal cancer, it is very rare. As is known, adjuvant chemotherapy with 5FU alone was not recommended in stage II colon cancer with dMMR or MSI. However, in locally advanced rectal cancer with dMMR or MSI, the efficacy of neoadjuvant treatment with 5FU was not yet known. Methods: We enrolled patients with locally advanced rectal cancer from three prospective clinical trials, including the FOWARC study (N = 309), the mFOLFOXIRI neoadjuvant chemotherapy trial (N = 106) and the total neoadjuvant treatment with FOLFOX and radiotherapy (N = 129). From the 544 patients, 35 (6.4%) patients were dMMR, 133 patients with unknown status of MMR. Among the 35 patients, 10 patients received 5FU concurrent with radiotherapy (group A), nine patients underwent FOLFOX concurrent with radiation (group B), and 12 patients received FOLFOX neoadjuvant chemotherapy alone (group C). Another four patients underwent mFOLFOXIRI neoadjuvant chemotherapy alone (group D), including one patient with nivolumab as neoadjuvant treatment after chemotherapy. Results: Totally, 4 (11.4%) patients achieved pathologic complete response, and 13 (37%) patients had tumor downstaging to ypT0-2N0M0 (stage 0-I). In group A, the pCR rate was 10% (1/10), the tumor downstaging rate was 20% (2/10); In group B, the pCR rate was 33.3% (3/9), the tumor downstaging rate was 55.6% (5/9); In group C, the tumor downstaging rate was 41.7% (5/12). In group D, only one patient achieved pCR, and it is the one who received nivolumab as neoadjuvant treatment. Conclusions: The efficacy of neoadjuvant in locally advanced rectal cancer seemed not affected by the MMR status. But further study was needed.

Patterns of adjuvant therapy use and survival outcomes in patients with rectal cancer not receiving neoadjuvant therapy in an Australian cohort.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 675-675
Author(s):  
Kate Jessica Wilkinson ◽  
Sharlyn Kang ◽  
Stephanie Hui-Su Lim ◽  
Cheok Soon Lee ◽  
Ray Asghari ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Surgical Resection ◽  
Real World ◽  
Survival Benefit ◽  
Cancer Specific Survival ◽  
Group A ◽  
Group B

675 Background: Consensus international guidelines recommend the use of neoadjuvant chemo-radiotherapy in patients with stage II-III rectal cancer. Despite this, due to factors including inaccurate/under-staging, patient co-morbidities and acute presentations, a proportion will undergo up-front surgical resection. The survival benefit of adjuvant therapy is unclear in this real world, non-trial population. Methods: A retrospective analysis of patients presenting with stage II-III rectal adenocarcinoma in South Western Sydney and Illawarra Shoalhaven Health Districts, Australia, between 2006 to 2015 was performed. Data was extracted from electronic health records, with institutional ethics approval. Treatment modalities, clinicopathological, recurrence and survival data were analyzed. The primary endpoint was overall survival (OS) by treatment modality. Results: 549 patients were identified, of which 295 (54%) underwent up-front surgical resection without neoadjuvant therapy. Of this cohort, 137 (46%) had no adjuvant therapy (Group A), 103 (35%) had adjuvant chemotherapy alone (Group B), and 55 (19%) had adjuvant radiotherapy +/- chemotherapy (Group C). Receipt of any adjuvant treatment was significantly associated with improved OS (5 year OS 56 vs. 79%, HR 0.44, 95% CI 0.3 – 0.6, p < 0.0001) and recurrence free survival (5 yr RFS 25% vs. 47%, HR 0.66, 95% CI 0.5 – 0.9, p=0.01), but not cancer specific survival (5yr CSS 75 vs. 80%, HR 0.78, 95% CI 0.5 – 1.3, p = 0.30). Group B had improved OS compared to Group A (5 yr OS 56% vs. 80%, HR 0.35, 95% CI 0.22 – 0.55, p < 0.0001). There was a trend to improved OS in Group C vs. Group A (5yr OS 56.0% vs. 69.2%, HR 0.79 95% CI 0.6 – 1.01, p = 0.052). The improved OS in Group B versus Group A remained significant in multivariate analysis (HR 0.41, 95% CI 0.22 – 0.77, p = 0.005). Conclusions: Adjuvant chemotherapy improved OS in this real world cohort, and there was a trend to a benefit with adjuvant chemo-radiotherapy. However, the lack of difference in cancer specific survival suggests that this benefit may be partly driven by patient selection bias. Further exploratory analyses to identify sub-groups deriving a cancer specific survival benefit are required.

Effect of Continuing Nursing on Self-Care Ability and Nursing Satisfaction of Patients with Rectal Cancer Undergoing Colostomy

2021 ◽  
Vol 7 (5) ◽  
pp. 2513-2521
Author(s):  
Wenlong Sheng ◽  
Jimei An
Keyword(s):  
Mental Health ◽  
Rectal Cancer ◽  
Nursing Care ◽  
Life Quality ◽  
Self Care ◽  
Care Group ◽  
Nursing Satisfaction ◽  
Group A ◽  
Group B

To determine the effect of continuing nursing on self-care ability and nursing satisfaction of patients undergoing resection of rectal cancer (RC), a total of 130 patients undergoing resection of RC who were diagnosed and treated in our hospital from April 2018 to May 2019 were enrolled. Among them, 62 patients nursed under the routine nursing mode for advanced RC were assigned to Group A, and other 68 patients nursed under continuing nursing mode based on the routine nursing for patients undergoing resection of RC were assigned to Group B. The two groups were compared in mental health, emotional state, life quality, and self-care ability before and after nursing care during hospitalization and after 2 months of follow-up visit, and they were also compared in nursing satisfaction, status on discharge, and complications. After nursing care. Group B got notably lower scores of self-rating anxiety scale (SAS) ans self-rating depression scale (SDS) than Group A (both P<0.001), and showed much better compliance than Group A (P<0.001). The quality of life scale (QOL-C30) scores in physical health, mental health, material life, and social function of Group B were all notably higher than those of Group A (all P<0.001). Additionally, after nursing care. Group B got notably higher scores of self-care ability than Group A (all P<0.001), and showed notably higher nursing satisfaction than Group A (P<0.05). Group B experienced shorter hospitalization than Group A, but there was no significant difference between them during the periods of 10 d-15 d, 16 d-21 d and 22 d-3 Od (all P>0.05). Moreover, after nursing care, the incidence of complications in Group B was notably lower than that in Group A (P<0.05). Continuing nursing can provide better results of improving the emotion and life quality of patients undergoing resection of RC based on routine nursing, and it can reduce the occurrence of postoperative complications on such patients to a certain extent.

scholarly journals A New Laparoscopic Surgical Procedure to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Seiji Ohigashi ◽  
Takashi Taketa ◽  
Kazuki Sudo ◽  
Hironori Shiozaki ◽  
Hisashi Onodera
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Rectal Stump ◽  
Linear Stapler ◽  
Laparoscopic Technique ◽  
Mesorectal Excision ◽  
Laparoscopic Surgical Procedure ◽  
Mesenteric Vessels ◽  
Endoscopic Linear Stapler ◽  
Anal Side

Objective. Mesorectal excision corresponding to the location of a tumor, termed tumor-specific mesorectal excision (TSME), is commonly performed for resection of upper rectal cancer. We devised a new laparoscopic procedure for sufficient TSME with rectal transection followed by mesorectal excision.Operative Technique. After mobilization of the sigmoid colon and ligation of inferior mesenteric vessels, we dissected the mesorectum along the layer of the planned total mesorectal excision. The rectal wall was carefully separated from the mesorectum at the appropriate anal side from the tumor. After the rectum was isolated and transected using an endoscopic linear stapler, the rectal stump drew immediately toward the anal side, enabling the mesorectum to be identified clearly. In this way, sufficient TSME can be performed easily and accurately. This technique has been successfully conducted on 19 patients.Conclusion. This laparoscopic technique is a feasible and reliable procedure for achieving sufficient TSME.

scholarly journals Fibrinogen and Albumin Score Changes during Preoperative Treatment Can Predict Prognosis in Patients with Locally Advanced Rectal Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Meng-Jun Tang ◽  
Shu-Bo Ding ◽  
Wang-Yuan Hu
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Preoperative Treatment ◽  
Prognostic Parameters ◽  
Group A ◽  
Group B

Background. Fibrinogen (Fib) and albumin (Alb) levels are indicators of systemic inflammatory responses. Elevated Fib and decreased Alb levels are considered negative prognostic factors in different types of cancer. Here, we explored the prognostic value of changes in pre- and post- neoadjuvant chemoradiotherapy (NCRT) plasma fibrinogen and serum albumin (FA) scores in patients with locally advanced rectal cancer (LARC). Methods. A total of 106 patients with LARC who underwent NCRT followed by surgical resection at Jinhua Municipal Central Hospital between 2011 and 2015 were analyzed. In addition, plasma Fib and serum Alb levels before and after NCRT were collected. FA scores were calculated based on the Fib and Alb levels dichotomized by clinical reference values. Patients were classified into two groups based on the changes in FA scores during NCRT: in group A, FA scores decreased or remained unchanged (n=84), and in group B, FA scores increased (n=22). Changes in FA scores were compared with patient outcomes. Results. Increased FA scores were associated with worse disease-free survival (DFS) and overall survival (OS) in patients with LARC. The occurrence of systemic failure was higher in group B than in group A (40.9% vs. 19%, P=0.032). In multivariate analysis, changes in FA scores, pretreatment carcinoembryonic antigen (CEA) levels, and pathologic differentiation were independent prognostic parameters for DFS and changes in FA scores and pretreatment CEA levels were independent prognostic parameters for OS. Conclusions. Increased FA score after NCRT was an independent negative prognostic factor for DFS and OS in patients with NCRT-treated LARC.

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