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Objective: To assess the incidence of synchronous colorectal liver metastasis in patients referred to a tertiary referral center in Sri Lanka and to evaluate the differences in the clinicopathological features of patients with and without synchronous metastasis., Methods: Records of 438 patients were retrospectively analyzed. Patients were classified into metastatic group (n = 34, 8%) and non metastastatic group (n = 404, 92%). In the two groups macroscopic features compared were: tumor size (2 cm, 2-5 cm, and >5 cm), site of primary tumor and side of liver involved. Carcinoembryonic antigen (CEA) levels were recorded. At microscopy, tumor differentiation, invasion and nodal status were evaluated., Results: The rectum was the primary site of the tumor in a majority (60%) of patients. There was no difference in the distribution of the primary site and size of the tumor, pathological stage, lymphatic infiltration and the degree of tumor differentiation in two groups (p > 0.05). Patients with metastasis had higher levels of CEA, higher frequency of vascular infiltration and N3 nodes involved (p < 0.05)., Conclusion: The incidence of synchronous colorectal liver metastasis seems to be lower in our patients. Association of higher CEA level, advanced nodal stage and presence of vascular invasion needs to be further assessed with risk of developing metachronous liver metastasis.

Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.

Introduction: Fecal incontinence (FI) impairs quality of life. We performed an audit of biofeedback (BFB) in management of patients with FI., Methods: Fifty patients (median [range] age 30 [4-77] years; 28 men) who received BFB for median (range) of 15 weeks (4-28), either postoperatively (n=39), or as the sole treatment (n=11) were evaluated. Cleveland continence score (0-good, 20-poor), anorectal manometry parameters, and patient satisfaction (assessed by Fecal Incontinence Quality of Life Scale [FIQLS]) were evaluated at baseline and after the BFB therapy in all patients., Results: Continence scores improved after intervention. In the surgery + BFB group, mean (SD) continence scores baseline vs. postsurgery + BFB (post-treatment) were 18.2 (3.9) vs. 6 (5.9; p< 0.01). In the BFB alone group, scores were similar at baseline 11.7 (5.9) and 6.1 (5.2) post BFB (p=0.08). Maximum resting anal pressure (MRP) improved from preoperative 12.6 (9.8) mmHg to: vs. 21.1 (11.9) mmHg post-treatment (p< 0.01). In patients who received BFB alone, MRP did not change significantly (pre vs post BFB 22.9 (11.7) mmHg vs. 29.6 (12.1) mmHg [p=0.08]). Maximal squeeze pressure improved significantly (preoperative vs. post-treatment: 46.3 (41.2) mmHg vs. 78.3 (33.9) mmHg [p< 0.01]; pre vs. post BFB alone: 72.4 (34.8) mmHg vs. 114.5 (43.1) mmHg [p< 0.01]). In 29 patients (19 surgery + BFB; 10 BFB alone), maximal tolerable volume in saline continence improved from baseline 47.9 (27.4) mL to 152.6 (87) mL after surgery + BFB (p< 0.01); pre vs. post BFB: 98 mL (95.9) vs. 205 (134.3) p< 0.02]. There was significant improvement in all parameters of FIQLS in both groups: lifestyle (p< 0.02), coping/behavior (p< 0.02), depression/self perception (p< 0.02) and embarrassment (p< 0.02)., Conclusion: BFB therapy with or without surgical reconstruction of the damaged anal sphincter improves maximum squeeze pressure, saline retention capacity, quality of life and is a useful first line treatment for fecal incontinence.