TP1.2.6Functional Outcomes of Organ Preservation Strategies - Local Excision Procedures and 'Watchful-Waiting' In Management of Low Rectal Cancers - A Systematic Review

Objective To evaluate functional outcomes and quality of life (QOL) associated with `wait-and-watch’ (WW) strategy and local-excision (LE) of rectal tumours after neo-adjuvant therapy, in comparison to the standard practice of total-mesorectal-excision (TME) for locally-advanced-rectal-cancers. Data Sources Medline, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, and retrospective studies with propensity-score-matched analyses analysing outcomes of WW and LE procedures for rectal cancer. Data Extraction and Synthesis Risk of bias assessments and data extraction were carried out independently by two reviewers. A narrative synthesis of data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The outcomes of interest were those of faecal-incontinence (FI), bowel and rectal-evacuatory function, sexual-function, stoma-free-survival, and quality-of-life scores, which were assessed in comparison to those associated with radical surgeries. Results 7 studies reported functional outcomes. Faecal-incontinence, bowel, and rectal-evacuatory-function assessed by various scoring systems were found to be least affected among patients on WW strategy, followed by those undergoing local excision and most in patients undergoing TME. These reflected on the quality of life assessments (FIQOL and FACT-C questionnaires). Sexual dysfunction was not higher among patients who underwent LE compared to TME. Advantage of stoma-free-survival with organ preservation strategies was realised for up to 2 years after treatment. Conclusions Organ-preservation strategies appear to have a favourable functional outcome compared to the gold standard of TME for up to 2 years after the commencement of treatment. Further research is warranted to provide stronger levels of evidence regarding the same.

Functional outcomes and quality of life in patients after rectocele repair

Background: Rectocele is a herniation of rectal wall that can cause evacuatory disorders. Despite the variety of surgical methods for rectocele repair the procedure does not always alleviate symptoms. Aim of study: To evaluate the long-term outcome and quality of life after rectocele repair. Materials and Methods: From 2007 to 2011 forty one women were underwent surgery for symptomatic rectocele. The patients age ranged from 24 to 64 (48,95?9,09) years old. Reinforcement of rectovaginal septum with mesh implant was performed in 22 (53.7%) patients and transanal repair by circular stapler (STARR)-19 (46.3%). Median follow-up time was 36 moths (6-60). Results: Most of patients - 29 (70,7%) reported about improvement of rectal evacuatory function after surgery. Another 12 (29,3%) women did not experience of symptomatic improvement and even experienced a deterioration of the symptoms. Quality of life was correlated with surgical outcomes. The results of surgery didn?t depend of procedure. The factors influenced on functional outcomes were revealed: age of patients, duration of constipations and number of parity. Substantial improvement of the rectal evacuatory function which was registered in patients at one year after surgery over time turned to the worse and 43,9% of patients pointed the recurrence of symptoms. Conclusion: Long term follow-up show a decrease of success rate to 43,9% of patient treated.

Indices of psychic status in the people with regular and irregular rhythm of the intestine

The level of neuropsychic adaptation and regularity of the circadian rhythm of the evacuatory function of the intestine were investigated in the working people. The people were divided - according to the psychic state - into 4 main groups: I - practically healthy people - 22 %, prenosologic condition - 22 %, III - pre-pathologic condition - 27 %, IV - pathology condition - 29 %. The people with the irregular rhythm of the intestine demonstrate worsening of the psychic state from 2 to 6 times more frequently than in the people with a regular rhythm of the intestine.

Comparative X-Ray study of galantamine and tacrine on the evacuatory function of rat gastrointestinal tract

A The acetylcholinesterase inhibitors galantamine and tacrine are used to treat Alzheimer’s disease. However, these compounds also affect the gastrointestinal (GI) tract. Here, we compared and analyzed both the effects of galantamine-and tacrine on the evacuatory kinetics of the GI tract in rats. Rats were untreated (n=15) or treated with galantamine (one daily dose of 1 mg/kg per os for 21 days; n=17) or tacrine (one daily dose of 0.5 mg/kg per os for 21 days; n=13) and evacuatory kinetics were assessed using radiological methods. Galantamine initially slowed and then accelerated evacuation, which is characteristic of the majority of cholinesterase inhibitors and is a result of the endogenous acetylcholine accumulated in the GI tissues. In the tacrine-treated rats the contrast medium was kept in the stomach and cecum and its evacuation time was reliably increased. These results indicate that when administered for 20 days, galantamine and tacrine have different effects on motor and evacuatory function in the GI tract of rats, because at certain levels of the tract the tacrine-action is dominated by specific non-cholinergic and non-anticholinesterase mechanisms.

Febrile responsiveness of vagotomized rats is suppressed even in the absence of malnutrition

The repeatedly observed attenuation of fever in vagotomized rats has been accepted as evidence of an essential role of vagal afferents in the transduction of pyrogenic signals from the periphery to the brain. If, however, the general condition of a vagotomized animal is poor (the usual case) and accompanied by malnutrition and body mass loss (common complications of vagotomy), the febrile responsiveness can be suppressed not because of the lack of vagal afferentation, but rather secondarily to a malnutrition-associated thermogenic incompetence. In the present study, we addressed this dilemma. Male Wistar rats were subjected to subdiaphragmatic vagotomy (or sham surgery) and, 24 days later, catheterized in the jugular vein. Postsurgically, the rats were closely watched and fed highly palatable food. Their febrile responsiveness [colonic (Tc) and tail skin (Tsk) temperature responses] to Escherichia coli lipopolysaccharide (LPS: 1 microgram/kg i.v.) was tested on day 27 postvagotomy. To verify the completeness of vagotomy, each rat was food deprived for 24 h and then euthanized; its stomach's evacuatory function was assessed by weighing the organ. One month postsurgery, both food consumption and body mass of the vagotomized rats (33 +/- 2 g/day and 313 +/- 4 g, respectively) were similar to the control values (30 +/- 1 g/day and 315 +/- 8 g). In the sham rats, LPS induced a monophasic Tc rise of 0.5 +/- 0.3 degree C at 70 min postinjection (peak), preceded by a fall in Tsk. Neither this Tsk fall (tail skin vasoconstriction) nor the resultant fever occurred in the vagotomized rats; at 70 min, Tc change was -0.1 +/-0.1 degree C. The gastric mass (4.1 +/- 0.5 g in the vagotomized vs. 1.8 +/- 0.1 g in sham rats) indicated the effectiveness of vagotomy. In sum, although the vagotomy-associated malnutrition was successfully prevented with special perioperative care, the vagotomized animals still did not respond to LPS with fever. Malnutrition is, therefore, unlikely to constitute the main reason of the febrile irresponsiveness of vagotomized rats.