scholarly journals Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

2011 ◽  
Vol 93 (6) ◽  
pp. 451-459 ◽  
Author(s):  
PG Vaughan-Shaw ◽  
AT King ◽  
T Cheung ◽  
NE Beck ◽  
JS Knight ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Median Duration ◽  
Enhanced Recovery ◽  
Neoadjuvant Treatment ◽  
Abdominoperineal Excision ◽  
Short Term ◽  
Invasive Approach ◽  
Enhanced Recovery Programme ◽  
Duration Of Surgery

INTRODUCTION Conventional abdominoperineal excision for low rectal cancer has a higher local recurrence and reduced survival compared to anterior resection. An extralevator abdominoperineal excision (ELAPE) may improve outcome through removal of increased tissue in the distal rectum. Experience with ELAPE is limited and no studies have reported on quality of life (QOL) following this procedure. We describe a minimally invasive approach to ELAPE within an enhanced recovery programme, and present short-term results and QOL analyses. METHODS All laparoscopic ELAPEs were included in a prospective database. Demographics, intra-operative and post-operative outcomes were evaluated. Postoperative QOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29. RESULTS Thirteen laparoscopic ELAPEs were performed over a two-year period. All were enrolled in an enhanced recovery programme. The median age was 76. The median tumour height was 20mm (range: 0–50mm) from the dentate line and all patients received neoadjuvant treatment. The median duration of surgery was 300 minutes (range: 120–488 minutes), the mean blood loss was 150ml and one procedure was converted to open surgery. There was no circumferential resection margin involvement or tumour perforation. The median duration of use of intravenous fluid, patient controlled analgesia and urinary catheterisation was 2, 2 and 2.5 days respectively and the median length of hospital stay was 7.5 days. Two patients developed perineal wound dehiscence. QOL analysis revealed high global health status (90.8), physical (91.3), emotional (98.3) and social functioning (100) scores, which compared favourably with EORTC reference values and published QOL scores following conventional abdominoperineal excision. CONCLUSIONS Laparoscopic ELAPE within an enhanced recovery setting is a feasible and safe approach with acceptable short-term outcomes and post-operative quality of life.

The influence of an enhanced recovery programme on clinical outcomes and quality of life after robotic assisted radical cystectomy

2017 ◽  
Vol 19 ◽  
pp. 75
Author(s):  
Dimitrios Moschonas ◽  
Chris Jones ◽  
Pavlos Pavlakis ◽  
Murthy Kusuma ◽  
Alison Roodhouse ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Robotic Assisted ◽  
Enhanced Recovery Programme

The influence of an Enhanced Recovery Programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer

2006 ◽  
Vol 8 (6) ◽  
pp. 506-513 ◽  
Author(s):  
P. M. King ◽  
J. M. Blazeby ◽  
P. Ewings ◽  
R. J. Longman ◽  
R. M. Kipling ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Clinical Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme

scholarly journals Short-term surgical outcomes and patient quality of life between robotic and laparoscopic extralevator abdominoperineal excision for adenocarcinoma of the rectum

2017 ◽  
Vol 99 (8) ◽  
pp. 607-613 ◽  
Author(s):  
D Kamali ◽  
A Reddy ◽  
S Imam ◽  
K Omar ◽  
A Jha ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Robotic Surgery ◽  
Learning Curve ◽  
Surgical Outcomes ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer ◽  
Short Term ◽  
Significant Difference

Introduction Some studies advocate a laparoscopic extralevator abdominoperineal excision (l-ELAPE) approach for low rectal cancer. The da Vinci™ robot (r-ELAPE) technique has potential to overcome some limitations of l-ELAPE, such as reduction of the learning curve and more precise tissue handling. It is unknown whether this approach results in improved surgical or quality of life outcomes compared with l-ELAPE. This study aimed to address this issue. Methods Consecutive patients having undergone either robotic or laparoscopic ELAPE for adenocarcinoma were studied. All operations were performed by two surgeons experienced in laparoscopic and recently introduced robotic surgery. Surgical outcomes were determined by postoperative histology and short-term complications. Quality of life was prospectively assessed using the European Organisation for Research and Treatment of Cancer QLC-CR30 and QLC-CR29 questionnaires. Results A total of 22 patients (11 r-ELAPE) with a median follow-up of 13 months (8 months robotic; 22 months laparoscopic) were studied. The groups were similarly matched for age, gender, American Society of Anesthesiologists status, preoperative chemoradiotherapy and tumour height. All had R0 resection. There was no significant difference in short-term surgical outcomes between groups. There was no significant difference in mean global health scores between the two groups (74 ± 14 r-ELAPE vs. 73 ± 10 l-ELAPE). The r-ELAPE group had a lower mean impotence score compared with the I-ELAPE group (55.5 ± 40 vs. 72.2 ± 44), although this was not statistically significant. Conclusions The newly introduced r-ELAPE was non-inferior to l-ELAPE in either patient quality of life or surgical outcomes. Robotic surgery could be particularly beneficial in the technically challenging area of low rectal cancer surgery with a shorter learning curve than laparoscopy.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

On Being Precarious

2020 ◽  
Vol 50 (1) ◽  
pp. 51-54
Author(s):  
Deirdre Flynn
Keyword(s):  
Quality Of Life ◽  
Short Term ◽  
Teaching Research ◽  
Part Time

In this essay, I reflect on my experience of part-time, fixed term, zero-hour, short-term, and unpaid contracts in academia. Precarious contracts are one of the biggest challenges facing our industry as neo-liberal values rule our institutions, impacting our teaching, research, and quality of life.

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