Neoadjuvant chemoradiotherapy, sepsis and neutrophil levels following radical excision of rectal cancerInternational Journal of Colorectal Disease - Tập 25 - Trang 723-729 - 2010
Aneel Bhangu, Peter Nightingale, Darren Daniels, Raju Tiramula
This study aimed to determine differences in neutrophil levels between those receiving long-course neoadjuvant chemoradiotherapy (nCXRT) and those proceeding straight to surgery (StS) for rectal cancer, and in those who developed serious septic events within 30 post-operative days within each group. Patients undergoing elective surgery between 2006 and 2008 were retrospective reviewed. Some 38 received nCXRT, and 46 proceeded StS. Statistical techniques included repeated measures analyses. There was no significant difference in serious 30-day septic rates (anastomotic leaks, pelvic abscess or generalised sepsis) between treatment groups (nCXRT, 11%; StS, 13%; p = 1.000). Neutrophil levels in the nCXRT group fell significantly and remained lower throughout treatment than those proceeding StS (p < 0.001 within groups, p < 0.001 between groups). The difference in means of the treatment groups was different for those with sepsis than for those without, and the difference in means of those with sepsis and those without is very different for the two treatment groups (p = 0.018). Chemoradiotherapy reduced neutrophil levels throughout treatment, and post-operative septic patients in this group had even lower levels. Further studies are warranted to fully assess the relationship of neutrophil levels to sepsis, using standardised definitions of sepsis.
Impact of obesity on patients undergoing surgery for rectal cancer in Australia and New ZealandInternational Journal of Colorectal Disease -
Phillip F Yang, Zhen Hao Ang, Sarit Badiani, Christophe R Berney, Matthew J. Morgan
Abstract
Purpose
Patients with obesity undergoing rectal cancer surgery may have an increased risk of developing complications, though evidence is inconclusive. The aim of this study was to determine the direct impact of obesity on postoperative outcomes using data from a large clinical registry.
Method
The Binational Colorectal Cancer Audit registry was used to identify patients who underwent rectal cancer surgery in Australia and New Zealand from 2007–2021. Primary outcomes were inpatient surgical and medical complications. Logistic regression models were developed to describe the association between body-mass index (BMI) and outcomes.
Results
Among 3,708 patients (median age 66 years [IQR 56.75–75], 65.0% male), 2.0% had a BMI < 18.5 kg/m2, 35.4% had a BMI of 18.5–24.9 kg/m2, 37.6% had a BMI of 25.0–29.9 kg/m2, 16.7% had a BMI of 30.0–34.9 kg/m2, and 8.2% had a BMI ≥ 35.0 kg/m2. Surgical complications occurred in 27.7% of patients with a BMI of 18.5–24.9 kg/m2, 26.6% of patients with a BMI of 25.0–29.9 kg/m2 (OR 0.91, 95% CI 0.76–1.10), 28.5% with a BMI of 30.0–34.9 kg/m2 (OR 0.96, 95% CI 0.76–1.21), and 33.2% with a BMI ≥ 35.0 kg/m2 (OR 1.27, 95% CI 0.94–1.71). Modelling BMI as a continuous variable confirmed a J-shaped relationship. The association between BMI and medical complications was more linear.
Conclusion
Risk of postoperative complications is increased in patients with obesity undergoing rectal cancer surgery.
Stenting in malignant colonic obstruction—is it a real therapeutic option?International Journal of Colorectal Disease - Tập 31 - Trang 131-135 - 2015
Nir Horesh, Joseph Yosef Dux, Moshe Nadler, Alon Lang, Oded Zmora, Einat Shacham-Shmueli, Mordechai Gutman, Ron Shapiro
Malignant colonic obstruction is commonly treated surgically. Colonic stents are a therapeutic option for palliation or used as a bridge to surgery or chemotherapy. The aim of the study was to evaluate the clinical success rate of stenting as a bridge to one-step surgery, chemotherapy, or as a palliative measure. This was a retrospective observational study. The study was conducted at a university-affiliated tertiary referral center. From 2007 to 2014, 45 patients with malignant colonic obstruction were referred for stent insertion. Patients were grouped according to three pre-defined treatment goals: group 1: restorative one-step procedure without an ostomy, group 2: completion of scheduled chemotherapy before surgery, and group 3: palliation without surgical intervention. Group 1 included 11 patients. Three patients (27.3 %) met the treatment goal of one-step surgery. Eight patients (72.7 %) did not reach the primary goal due to stent insertion failure (four patients), stent-related complications (two patients), and failure to perform a one-step surgery after successful stent insertion (two patients). Group 2 included 12 patients. Chemotherapy was successfully completed prior to surgery in six patients (50 %). Six patients (50 %) did not achieve treatment goal due to stent insertion failure (two patients), stent migration (two patients), stent-related perforation (one patient), and mortality (one patient). Group 3 included 20 patients. Long-term palliation without surgical intervention was achieved in eight patients (40 %). Stent insertion failed in seven patients (35 %). Five patients (25 %) needed urgent surgery due to stent complications (three migrations and two perforations). The study was limited by its retrospective nature and small sample size. This study demonstrates only a modest success rate of colonic stents in the treatment of malignant colonic obstruction. Although colonic stenting seems to be an effective method of relieving colonic obstruction, high failure rates limits its applicability.
Risk of anastomotic leakage with two-row versus three-row manual circular staplers in colorectal anastomosis: a U.S. cohort studyInternational Journal of Colorectal Disease - Tập 38 - Trang 1-16 - 2023
Tongtong Wang, Mordechai Sadowsky, Rebekah Blakney, Paul Coplan, William Petraiuolo, Mark Soberman, Joerg Tomaszewski, Lexi Rene, Jennifer Wood
To compare the risk of anastomotic leak (AL) between Ethicon manual circular staplers (two-row) versus Medtronic EEA™ circular stapler with Tri-Staple™ technology (three-row) and between Medtronic EEA™ circular stapler with DST™ Series technology (two-row) versus Tri-Staple™ technology. A retrospective cohort study was conducted in adult patients who underwent a left-sided colorectal surgery 2019–2022 in U.S. Premier Healthcare Database to assess the risk of AL within 30 days post-index procedure. The study devices were Ethicon manual circular staplers, Medtronic EEA™ circular stapler with DST™ technology, and Medtronic EEA™ circular stapler with Tri-Staple™ technology. Across 447 hospitals, the cumulative incidences (95% confidence intervals [CI]) of AL within 30 days post-index procedure were 7.78% (6.91–8.74%) among 8337 patients in the Ethicon manual circular stapler cohort, 7.54% (6.87–8.27%) among 7928 patients in the Medtronic EEA™ circular stapler with DST™ technology cohort, and 8.19% (6.57–10.07%) among 1306 patients in the Medtronic EEA™ circular stapler with Tri-Staple™ technology cohort. Comparative analyses revealed no difference comparing Ethicon manual circular staplers with Medtronic EEA™ circular staplers with Tri-Staple™ technology (risk ratio [RR], 0.72; 95% CI, 0.52–1.01) or comparing Medtronic EEA™ circular staplers with DST™ technology to Tri-Staple™ technology (RR, 0.75; 95% CI, 0.53–1.06). In this analysis of a large cohort of patients undergoing a left-sided colorectal surgery from a U.S. hospital database, the risk of AL observed with manual two-row circular staplers was similar to that seen with three-row devices. This study affirms the safety of manual two-row circular staplers in colorectal anastomosis.
The relationship between perineal descent and denervation of the puborectalis in continent patientsInternational Journal of Colorectal Disease - Tập 1 - Trang 91-95 - 1986
D. C. C. Bartolo, A. M. Roe, N. J. McC Mortensen
It has been suggested that perineal descent causes puborectalis neuropathy. To elucidate this, perineal descent was measured on standard proctograms and prolongation of mean motor unit potential duration was used as the index of denervation of the external sphincter and puborectalis in 9 male and 18 female patients with perineal descent and obstructed defaecation. The findings were compared with 21 normal controls. There was no significant perineal descent below the pubococcygeal line at rest but both males and females had abnormal descent of the anorectal angle on straining and a similar degree of external sphincter neuropathy. Females, however, exhibited a significant degree of puborectalis denervation compared with controls (p<0.001) and with male patients (p<0.001). Thus external sphincter denervation was associated with perineal descent in both sexes whereas other causes, of which obstetric trauma is a possibility, must be implicated in the puborectalis neuropathy of the females studied.