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Pelvic exenteration (PE) is a complex multivisceral surgical procedure indicated for locally advanced or recurrent pelvic malignancies. It poses significant technical challenges which account for the high risk of morbidity and mortality associated with the procedure. Developments in minimally invasive surgical (MIS) approaches and enhanced peri-operative care have facilitated improved long term outcomes. However, the optimum approach to PE remains controversial. A systematic literature search was conducted in accordance with PRISMA guidelines to identify studies comparing MIS (robotic or laparoscopic) approaches for PE versus the open approach for patients with locally advanced or recurrent pelvic malignancies. The methodological quality of the included studies was assessed systematically and a meta-analysis was conducted. 11 studies were identified, including 2009 patients, of whom 264 (13.1%) underwent MIS PE approaches. The MIS group displayed comparable R0 resections (Risk Ratio [RR] 1.02, 95% Confidence Interval [95% CI] 0.98, 1.07, p = 0.35)) and Lymph node yield (Weighted Mean Difference [WMD] 1.42, 95% CI -0.58, 3.43, p = 0.16), and although MIS had a trend towards improved towards improved survival and recurrence outcomes, this did not reach statistical significance. MIS was associated with prolonged operating times (WMD 67.93, 95% CI 4.43, 131.42, p < 0.00001) however, this correlated with less intra-operative blood loss, and a shorter length of post-operative stay (WMD -3.89, 955 CI -6.53, −1.25, p < 0.00001). Readmission rates were higher with MIS (RR 2.11, 95% CI 1.11, 4.02, p = 0.02), however, rates of pelvic abscess/sepsis were decreased (RR 0.45, 95% CI 0.21, 0.95, p = 0.04), and there was no difference in overall, major, or specific morbidity and mortality. MIS approaches are a safe and feasible option for PE, with no differences in survival or recurrence outcomes compared to the open approach. MIS also reduced the length of post-operative stay and decreased blood loss, offset by increased operating time. [ABSTRACT FROM AUTHOR]

Neoplasms of the orbit may be primary, secondary (infiltration from the adjacent structures), or metastatic (from distant structures). It can be divided into 3 histologic categories: benign, benign but locally aggressive, and malignant. Primary and secondary orbital tumors, including intra-orbital and optic nerve tumors are uncommon observations in daily medical practice. Orbital tumors represent approximately 0.1% of all tumors and approximately 18% of all orbital diseases.We report a case of a 42 year old male patient with colorectal malignancy with basal skull metastasis involving the orbital apex and involving the optic nerve causing visual loss.

Background: Implementation of screening modalities has led to a decreased incidence of colorectal malignancies. Unfortunately, overall incidence has remained unchanged as cases have increased in patients below the suggested screening age. Therefore, we evaluated characteristics and oncological outcomes of malignancies in patients ≤40 years of age. Methods: Single-center retrospective analysis of prospectively collected data of malignancies in patients ≤40 years evaluated in our institution between 2010 and 2016. Basic descriptors for demographic, clinical, histologic, and genetic data were collected. Disease-free survival (DFS) and 5-year overall survival (OS) were compared for patients between 30-40 years and <30 years. Results: Fifty-six patients ≤40 years were identified, 44 of whom (96.5%) had adenocarcinomas. Most common malignancy location was the rectum (64.3%). Despite aggressive tumor characteristics such as moderate/poor differentiation (88.6%), lymphovascular invasion (26.8%), perineural invasion (21.4%), and advanced tumor stage T3/T4 (60.7%), OS rate was 94.6%. Both age groups had similar oncologic characteristics. There was a trend toward worse OS (2/11 and 1/45, P =.06) but not for DFS (7/11 and 15/43, P =.18) in patients <30 years of age compared to 30-40 years. There were no differences in OS (3/44 vs 0/88, P =.44) or DFS (17/42 vs 3/8, P =.80) between sporadic vs non-sporadic malignancies, respectively. Conclusions: Patients ≤40 years of age with malignancy have advanced tumor stages and aggressive tumor characteristics at diagnosis. Although there is higher OS risk for patients <30 compared to those aged 30-40 years, no differences were found for DFS between these two groups. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the third most common cancer worldwide. The colorectal cancer has varied presentation and often patients present in late stages of disease. Pre-operative carcinoembryonic antigen (CEA) levels are indicative of tumor stage and thus are predictive of prognosis. However, the importance of post-operative CEA value is seldom discussed and utility of this clinically relevant parameter needs to be established to predict survival of subjects after surgical resection of tumor. Aims and Objectives: This study aims to understand the colorectal malignancy in a group of population and evaluate its complexity, clinical presentations, modalities of treatment, and its complications. Furthermore, we aimed to access predictive utility of post-operative CEA levels for forecasting the long-term outcome in the patient. Materials and Methods: All subjects with diagnosed cases of colorectal malignancy were included in the study. The subjects presenting complaints were clinically examined and the observations were noted. Colonoscopy and histopathological investigations were scheduled, and based on CT findings, further management was planned. Carcinoembryonic antigen levels were assessed in pre-operative and post-operative serum sample. Follow-up was done at regular intervals. CEA levels in subjects with different outcome were compared retrospectively. Results: The most common age group of subjects with colorectal malignancies was 51–60 years. Bleeding per rectum was the most common symptom and the most common sign was per rectal palpable mass. Laparoscopic surgery had less hospital stay, less blood loss, and lower rate of wound site infection. The pre-operative CEA levels were found to be matched; however, post-operative CEA levels were found to be significantly elevated in non-survivor subjects compared to those who survived. Conclusion: Patients with high post-operative CEA values should be closely followed up for relapse and dealt with more caution to reduce the mortality.

Arterioenteric fistulas (AEF) are rare and devastating complications of colorectal/pelvic malignancies. These fistulas can be seen following neoadjuvant or adjuvant therapy but are exceptionally rare de novo. The reported incidence of AEF is less than 1% and iliac artery-enteric fistulas make up less than.1% of all AEF. Here we present a patient in hemorrhagic shock secondary to an advanced colorectal malignancy without adjuvant therapies with local invasion of the right external iliac artery. Following initial resuscitation and hemorrhage control with coil embolization, definitive control with ligation and excision of the involved artery, end colostomy, and ureteral stent placement was achieved. It is important to consider malignancy as the source of lower gastrointestinal bleeds, especially in elderly patients without current colonoscopy studies. The management of this unfortunate diagnosis often involves a multidisciplinary approach with early and frequent goals of care discussions. [ABSTRACT FROM AUTHOR]

Background Approximately 9,000 patients undergo ileostomy formation each year in England. This includes those formed in both the elective and emergency settings. Recent studies have indicated a stoma-related complication rate of up to 83%.The aim of the current study was to ascertain the most common indications for ileostomy formation and to determine whether there were differences in the complication rates depending on whether the surgery occurred in the emergency or elective setting. Methods The study was a retrospective audit conducted at the University Hospitals of Leicester. Inclusion criteria were patients who underwent ileostomy formation between January 1 and December 31, 2023. Results The study cohort comprised 97 patients. Eleven of 44 (25.0%) patients in the emergency cohort had stoma-related complications, with their main reasons being high output stomas and bowel obstruction, which is higher compared to the elective patient cohort which had a complication rate of 5/53 (9.4%), with their main reasons being parastomal hernias and stoma prolapse. Ileostomies formed as a result of colorectal malignancy also led to a higher complication rate. Conclusion Our study suggests that ileostomies formed in the emergency setting as well as those formed due to colorectal malignancies had a higher rate of stoma-related complications. Stoma-related complications continue to be a common presentation to the emergency department., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Review Board of the University Hospitals of Leicester NHS Trust issued approval 12921. This study was a retrospective audit conducted at the University Hospitals of Leicester, United Kingdom. The Institutional Review Board of the University Hospitals of Leicester NHS Trust granted approval for this audit with the number #12921. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Wu et al.)

Background: Colorectal cancer is the third most common cancer worldwide. The colorectal cancer has varied presentation and often patients present in late stages of disease. Pre-operative carcinoembryonic antigen (CEA) levels are indicative of tumor stage and thus are predictive of prognosis. However, the importance of post-operative CEA value is seldom discussed and utility of this clinically relevant parameter needs to be established to predict survival of subjects after surgical resection of tumor. Aims and Objectives: This study aims to understand the colorectal malignancy in a group of population and evaluate its complexity, clinical presentations, modalities of treatment, and its complications. Furthermore, we aimed to access predictive utility of post-operative CEA levels for forecasting the long-term outcome in the patient. Materials and Methods: All subjects with diagnosed cases of colorectal malignancy were included in the study. The subjects presenting complaints were clinically examined and the observations were noted. Colonoscopy and histopathological investigations were scheduled, and based on CT findings, further management was planned. Carcinoembryonic antigen levels were assessed in pre-operative and post-operative serum sample. Follow-up was done at regular intervals. CEA levels in subjects with different outcome were compared retrospectively. Results: The most common age group of subjects with colorectal malignancies was 51–60 years. Bleeding per rectum was the most common symptom and the most common sign was per rectal palpable mass. Laparoscopic surgery had less hospital stay, less blood loss, and lower rate of wound site infection. The pre-operative CEA levels were found to be matched; however, post-operative CEA levels were found to be significantly elevated in non-survivor subjects compared to those who survived. Conclusion: Patients with high post-operative CEA values should be closely followed up for relapse and dealt with more caution to reduce the mortality. [ABSTRACT FROM AUTHOR]

Streptococcus gallolyticus (SG) – among other bacterial infections – is associated with colorectal malignancy and adenoma. It is reported that patients with SG bacteraemia have a concomitant colorectal tumour in 25–80% of cases. We present a case of a patient with complications of this septicaemia associated with a rectal adenocarcinoma, as an example of this important radiological and clinical correlation. Teaching Point: Always screen for primary colorectal malignancy in a patient with malignancy-associated bacterial infection.

Streptococcus gallolyticus (SG) - among other bacterial infections - is associated with colorectal malignancy and adenoma. It is reported that patients with SG bacteraemia have a concomitant colorectal tumour in 25-80% of cases. We present a case of a patient with complications of this septicaemia associated with a rectal adenocarcinoma, as an example of this important radiological and clinical correlation. Teaching Point: Always screen for primary colorectal malignancy in a patient with malignancyassociated bacterial infection. [ABSTRACT FROM AUTHOR]

Background: In the West, piecemeal endoscopic resection remains the primary treatment for large colon polyps (LCP), as most recurrences are believed to be benign and resectable with follow-up endoscopy. However, invasive malignancy at the site of prior piecemeal endoscopic mucosal resection has been reported in the Asian literature. This study aims to identify the incidence of and the risk factors for local recurrence with malignancy after endoscopic resection of LCP with high-grade dysplasia (HGD).Methods: In this retrospective cohort study, we identified patients undergoing complete endoscopic resection of LCPs (≥ 20 mm) with HGD at the Cleveland Clinic between January 2000 and December 2016. Demographic, endoscopic, and pathologic data were collected. All subsequent endoscopic and pathology reports were reviewed to identify recurrence. The cumulative incidence of malignancy at the polypectomy site was determined and univariate analysis was performed to assess risk factors.Results: A total of 254 LCPs with HGD were resected in 229 patients. Mean polyp size was 29.2 mm. There were 138 lesions resected in piecemeal fashion and 116 en-bloc. After a median follow-up of 28.7 months for the entire cohort, local recurrence with malignancy was diagnosed in six cases. Median time to malignancy diagnosis was 28.5 months. All malignant cases occurred after piecemeal resection and none after en-bloc resection (HR 11.4; 95% CI 0.48-273).Conclusion: Malignancy after endoscopic resection of LCPs with HGD is uncommon and may be associated with piecemeal resection. When possible, en-bloc resection should be the goal for the management of LCPs. [ABSTRACT FROM AUTHOR]

Background: The management of patients presenting with malignant small bowel obstruction is a challenging paradigm. The aim of this systematic review was to examine different management strategies in these complex patients. The primary outcomes evaluated were the type of intervention, 30‐day morbidity and mortality and overall survival rates. Methods: A systematic literature review of EMBase, Medline, PubMed and the Cochrane Library was performed using Preferred Reporting Items for Systematic reviews and Meta‐Analyses for studies reporting on conservative and operative management of malignant small bowel obstruction. Results: Fifteen studies (n = 882 patients) reporting on outcomes for malignant small bowel obstruction were analysed. Outcomes measured were primarily survival and relief of obstructive symptoms. The median age ranged from 52 to 66 years. The most common cause of malignant small bowel obstruction was gynaecological in nature (56%), followed by colorectal (19%). Four hundred and eighty‐six patients underwent primary surgical management and the remaining 396 patients were assigned to non‐surgical intervention. Median overall survival in the operative studies ranged from 2.5 to 7.4 months compared with 0.9 to 1.9 months (P < 0.05). The 30‐day mortality ranged from 13% to 28% in those who underwent surgical interventions versus 2% to 61% in the non‐surgical group (P = 0.09). No significant difference in median survival in gastrointestinal (GI) and gynaecological malignancies was observed (4.3 versus 5.0 months, P = 0.12). Morbidity ranged from 21% to 85% in the surgical group and 12% to 29% in the percutaneous groups (P < 0.05). Conclusion: Surgical intervention in malignant small bowel obstruction is associated with significant morbidity, although it may improve survival in selected patients with gynaecological and colorectal malignancy. It is imperative that realistic goals and expectations are discussed with patients preoperatively. [ABSTRACT FROM AUTHOR]

There is a known relationship between Clostridium septicum bacteremia and colorectal malignancies. C. septicum is a gram-positive, anaerobic, spore-forming bacterium that can survive the acidic colorectal tumor microenvironment, where it is thought to enter the blood by tumor-mediated epithelial tissue damage. While in circulation, C. septicum can release exotoxins which may lead to life-threatening sepsis. The patient in this case presented with a mild fever, abdominal pain, and left hand weakness. Imaging of the head and abdomen revealed a right frontal lucency and wall thickening of the ascending colon. Two colonic adenocarcinomas were found and removed via an exploratory laparotomy and right hemicolectomy. The blood culture was positive for C. septicum. Brain MRI confirmed a right frontal mass concerning for metastasis. Here, we discuss the relationship between colonic cancers and Clostridium septicum bacteremia.

INTRODUCTION: The burden of colorectal carcinoma (CRC), once considered rare in Africa, may be changing with the disease being increasingly diagnosed and there is a suggestion that age and race influence tumour behaviour. To describe the clinicopathological spectrum of CRC among the different population groups and age groups in a South African setting. METHODS: analysis of prospectively collected data from an on-going colorectal cancer database, including demographics, clinical presentation, site, staging and grading on all patients enrolled over an 18-year period. RESULTS: a total of 2232 patients with CRC were accrued over the study period (Africans, 798; Indians, 890; Coloureds, 104; and Whites, 440). Mean age was 57.7 (SD 14.4) but varied considerably by race (p = 0.001) and Africans were significantly younger. Young adults (aged =40 years) totalled 305 and older patients (aged 40 years) totalled 1927. The proportion of young patients (40 years old) was 28%, 7%, 9% and 3% among Africans, Indian, Coloured and White patients respectively. There were minimal variations in anatomical sub-site distribution. There was no difference in staging regardless of age and race. Tumour stage was similar in all population groups as well as in older and young adults. Mucinous differentiation was more common in Africans and in young patients and poor differentiation was more common in African patients. Africans had a significantly lower resection rate compared to the other population groups (p =0.001). Younger patients had a significantly lower resection rate compared to the other population groups (p = 0.001). CONCLUSION: African patients were the youngest compared to the other population groups. Mucinous differentiation predominated in Africans and young adults and poor differentiation predominated in Africans, resection rate was lower for African patients and in young patients.

Objective: To assess the diagnostic accuracy of whole-body MRI using diffusion-weighted sequence (WB-DWI) to determine the peritoneal cancer index (PCI) in correlation with surgical and histopathological findings.Methods: Twenty-seven patients underwent preoperative WB-MRI, followed by cytoreductive surgery for primary tumors of the appendix (n = 15), colorectum (n = 12), and associated peritoneal disease. A total of 351 regions were retrospectively reviewed. The sensitivity, specificity, and accuracy were calculated at 13 anatomical sites. The WB-DWI PCI and PCI type were compared with surgical and histopathological findings.Results: No statistical difference was found between the WB-DWI PCI and surgical PCI (P = 0.574). WB-DWI correctly predicted the PCI type in 24 of 27 patients with high accuracy (88.9%), including 10 of 10 patients with small-volume tumor, 12 of 14 with moderate-volume tumor, and 2 of 3 with large-volume tumor. WB-DWI correctly depicted tumors in 163 of 203 regions, with 40 false-negative and 23 false-positive regions. The overall sensitivity, specificity, and accuracy of WB-DWI for the detection of peritoneal tumors were 80.3%, 84.5%, and 82.1%, respectively. For lesions < 0.5 cm in diameter, WB-DWI demonstrated good sensitivity (69.4%).Conclusions: WB-DWI accurately predicted PCI before surgery in patients undergoing evaluation for cytoreductive surgery.

Introduction: the burden of colorectal carcinoma (CRC), once considered rare in Africa, may be changing with the disease being increasingly diagnosed and there is a suggestion that age and race influence tumour behaviour. We sought to describe the clinicopathological spectrum of CRC among the different race and age groups in a South African setting. Methods: analysis of prospectively collected data from an on-going colorectal cancer database, including demographics, clinical presentation, site, staging and grading on all patients enrolled over an 18-year period. Results: a total of 2232 patients with CRC were accrued over the study period (Africans, 798; Indians, 890; Coloureds, 104; and Whites, 440). Mean age was 57.7 (SD 14.4) but varied considerably by race (p < 0.001) with Africans being significantly younger. Young adults (aged < 40 years) totalled 305 and older patients (aged > 40 years) totalled 1927. The proportion of young patients (< 40 years old) was 28%, 7%, 9% and 3% among Africans, Indian, Coloured and White patients respectively. There were minimal variations in anatomical sub-site distribution. There was no difference in tumour stage between the various races and between older and young adults. Mucinous differentiation was more common in Africans and in young patients and poor differentiation was more common in African patients. Africans had a significantly lower resection rate compared to the other race groups (p < 0.001). Younger patients had a significantly lower resection rate compared to the older age group (p < 0.001). Conclusion: African patients were the youngest compared to the other race groups. Mucinous differentiation predominated in Africans and young adults. Poor differentiation predominated in Africans. Resection rate was lower for African patients and in young patients. [ABSTRACT FROM AUTHOR]

Background: The number of harvested lymph nodes (LNs) in colorectal cancer surgery relates to oncologic radicality and accuracy of staging. In addition, it affects the choice of adjuvant therapy, as well as prognosis. The American Joint Committee on Cancer defines at least 12 LNs harvested as adequate in colorectal cancer resections. Despite the importance of the topic, even in high-volume colorectal centres the rate of adequacy never reaches 100%. The aim of this study was to identify factors that affect the number of harvested LNs in oncologic colorectal surgery.Materials and Methods: We prospectively collected all consecutive patients who underwent colorectal cancer resection from January 1st 2013 to December 31st 2017 at Emergency Surgery Unit St Orsola University Hospital of Bologna.Results: Six hundred and forty-three consecutive patients (382 elective, 261 emergency) met the study inclusion criteria. Emergency surgery and laparoscopic approach did not have a significant influence on the number of harvested LNs. The adequacy of lymphadenectomy was negatively affected by age >80 (OR 3.47, p < 0.001), ASA score ≥3 (OR 3.48, p < 0.001), Hartmann's or rectal resection (OR 3.6, p < 0.001) and R1-R2 resection margins (OR 3.9, p = 0.006), while it was positively affected by T-status ≥3 (OR 0.33 p < 0.001).Conclusion: Both the surgical technique and procedure regimen did not affect the number of lymphnodes retrieved. Age >80 and ASA score ≥3 and Hartmann's procedure or rectal resection showed to be risk factors related to inadequate lymphadenectomy in colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

Multiple primary neoplasms (MPN) are rare and can affect any system especially the upper aero-digestive system. They can be simultaneous, synchronous or metachronous. Their management depends on the individual organ system affected and simultaneous resection is possible as shown by T. Suzuki. We encountered a 77-year-old male who had had malena and constipation for 2 months and on investigation was found to have a rectosigmoid and an esophageal adenocarcinoma as well as a calcified lesion in the brain. He underwent surgery for the rectosigmoid growth only (according to the patient's preference) and received chemotherapy. Unfortunately, he developed acute intestinal obstruction after 2 cycles of chemotherapy and died. MPNS are defined as presence of two or more histologically distinct tumours in the same individual. It can be synchronous or metachronous. Various factors like genetic and environmental play crucial role in its development. Management of these depends up on the status of the patient, stage of disease. MPNS are rare but their rising trend suggests it should be kept in mind while working up a patient with any malignancy. • MPNs are defined as multiple tumours originating independently in a single individual. • The association of esophageal with colorectal adenocarcinoma is also rare with an incidence around 0.2% to 7.8% synchronously and 1 to 4.6% metachronously. • The management of MPNs is challenging as it often requires multimodal therapy including surgery, chemotherapy, and radiotherapy. [ABSTRACT FROM AUTHOR]

Aim Under the current increased financial constraints affecting the National Health Service ( NHS), clinical negligence claims and associated compensations are constantly rising. Our aim was to identify the magnitude, trends and causes of malpractice claims in relation to a common pathology such as colorectal malignancy in the NHS. Method Data requests were submitted to the NHS Litigation Authority ( NHSLA) and to the Medical Defence Union ( MDU) and Medical Protection Society ( MPS). Data were reviewed, categorized clinically and analysed in terms of causes and costs behind claims. Results Data from the MPS and MDU were unavailable. In all, 169 claims were identified from the NHSLA database between 2003 and 2012; 123 (73%) cases had been closed, 80 (65%) of which were successful. An increasing overall claim frequency and success rate were found over the last few years. Total litigation expenses were £8.6 million, with 39% paid out as legal expenses. The commonest cause of complaint in successful claims was in relation to diagnostic delays or failures (58%, £5.1 million), with a delay or failure by the clinician to take action in response to an abnormal investigation result being a major factor. The occurrence of peri-operative complications (20%, £1.6 million) was the second commonest cause. Conclusion Average frequency and success rates of malpractice claims in secondary care in the NHS are rising, leading to significant overall payouts. The failure or delay in diagnosing colorectal malignancy or its postoperative complications is a common cause behind malpractice claims. Improvement in these areas could enhance patient care and reduce future claims. [ABSTRACT FROM AUTHOR]

Background: The CO laser's unique wavelength of 10.6 μm has the advantage of being readily absorbed by water but historically limited it to line-of-sight procedures. Through recent technological advances, a flexible CO laser fiber has been developed and holds promise for endoluminal surgery. We examined whether this laser, along with injection of a water-based gel in the submucosal space, will allow safe dissection of the intestines and enhance the potential of this tool for minimally invasive surgery. Methods: Using an ex vivo model with porcine intestines, spot ablation was performed with the flexible CO laser at different power settings until transmural perforation. Additionally, excisions of mucosal patches were performed by submucosal dissection with and without submucosal injection of a water-based gel. Results: With spot ablation at 5 W, none of the specimens was perforated by 5 min, which was the maximum recorded time. The time to perforation was significantly shorter with increased laser power, and gel pretreatment protected the intestines against spot ablation, increasing the time to perforation from 6 to 37 s at 10 W and from 1 to 7 s at 15 W. During excision of mucosal patches, 56 and 83% of untreated intestines perforated at 5 and 10 W, respectively. Gel pretreatment prior to excision protected all intestines against perforation. These specimens were verified to be intact by inflation with air to over 100 mmHg. Furthermore, excision of the mucosal patch was complete in gel-pretreated specimens, whereas 22% of untreated specimens had residual islands of mucosa after excision. Conclusion: The flexible CO laser holds promise as a precise dissection and cutting tool for endoluminal surgery of the intestines. Pretreatment with a submucosal injection of a water-based gel protects the intestines from perforation during ablation and mucosal dissection. [ABSTRACT FROM AUTHOR]

Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital stay [ABSTRACT FROM AUTHOR]

One of the most controversial issues in minimally invasive surgery has been the implementation of laparoscopic techniques for the curative resection of colorectal malignancies. Initial concerns included the potential violation of oncologic principles, the effects of carbon dioxide, and the phenomenon of port site tumor recurrence. Basic science research and large randomized controlled trials are now demonstrating that these fears were unjustified. Long-term outcomes of laparoscopic colon resection compared with open colon resection for malignancy are comparable, and there may even be a survival benefit for a subset of patients who undergo laparoscopic resection. [ABSTRACT FROM AUTHOR]

Multiple reports have outlined the potential benefits of the laparoscopic approach to colon surgery. Recently, randomized control trials have demonstrated the safety of applying these techniques to colorectal cancer. This study examined the long-term follow-up assessment of patients after laparoscopic colorectal cancer resections and compared them with a large prospective database of open resections. A total of 231 resections were performed for adenocarcinoma of the colon or rectum between 1992 and 2004. Of these 231 resections, 93 were rectal (40.3%) and 138 were colonic (59.7%). A total of 8 (3.2%) of the resections were performed as emergencies, and 27 (11.7%) were converted to open surgery. The mean follow-up period was 35.84 months (range, 0-132 months). The disease recurred in 51 of the patients (22.1%) before death, involving 14 (6.1%) local and 37 (16%) distant recurrences. Only two patients had wound recurrences (0.8%), and both patients had widespread peritoneal recurrence at the time of diagnosis. The overall survival rate was 65.3% at 60 months and 60.3% at 120 months. The disease-free survival rate was 58% at 60 months and 56% at 120 months. Laparoscopic techniques can be applied to a wide range of colorectal malignancies without sacrificing oncologic results during a long-term follow-up period. [ABSTRACT FROM AUTHOR]

BACKGROUND. Patients with chronic ulcerative colitis and Crohn’s colitis have an increased risk of colorectal cancer. Because of this, surveillance colonoscopy is practiced. AIMS. We aimed to describe the practice of surveillance colonoscopy in New Zealand, with comparison among specialties, and with practice internationally. SUBJECTS. New Zealand colonoscopists (both physicians and surgeons) looking after patients with inflammatory bowel disease were surveyed to evaluate attitudes about surveillance colonoscopy and ways in which colonoscopy results are interpreted. METHODS. A postal survey assessed the colonoscopist’s understanding of how and why surveillance colonoscopy is undertaken and their interpretation of the results from such evaluations. RESULTS. Of the196 physicians and surgeons surveyed, 180 responded (92 percent). Sixty responses were excluded. Only 24 of 120 respondents (20 percent) correctly defined dysplasia. The median number of biopsies taken at colonoscopy was 17. Eighty of 120 (67 percent) and 77 of 120 (64 percent) doctors underestimate the risk of invasive malignancy if low-grade or high-grade dysplasia, respectively, is identified. The colectomy referral rate for dysplasia-associated lesion or mass was 115/120 (96 percent); that for high-grade dysplasia was 110/120 (92 percent); and that for low-grade dysplasia was 26/120 (22 percent). Thirty of 120 (25 percent) doctors offer patients the option of colectomy after 20 years of colitis. Seventy of 120 (58 percent) doctors sought the opinion of a second pathologist if dysplasia was found. There were differences in responses between specialist groups, with colorectal surgeons most likely to correctly define dysplasia and appreciate the significance of low-grade dysplasia. CONCLUSIONS. Many New Zealand colonoscopists have a poor understanding of the definition and importance of dysplasia associated with colitis. Although colectomy referral rates are higher in this study than in similar studies, low-grade dysplasia is often not referred for colectomy. Improved education may improve surveillance practice. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to review the clinical presentation and characteristics of primary colorectal lymphoma, analyze the prognostic factors, and assess the results of treatment with adjuvant chemotherapy. METHODS: We identified 37 cases at our institution between 1980 and 1996. They comprised 0.48 percent of all cases of colon malignancies (37/7,658) during this period. The following clinical information was obtained: age, gender, signs and symptoms, tumor site, tumor size, histology grade, pathology, and adjuvant chemotherapy. RESULTS: The most common presenting signs and symptoms were abdominal pain (62 percent), abdominal mass (54 percent), and weight loss (43 percent). The most frequent site of involvement was the cecum (45 percent). Histologically, 29 (78 percent) were classified as high-grade, and 8 (22 percent) as intermediate-grade-to-low-grade lymphoma. Nine (24.3 percent) of the cases were Stage EI, 23 (62.2 percent) were Stage EII, and 5 (13.5 percent) were Stage EIV. Twenty-one (57 percent) cases received adjuvant chemotherapy. The five-year survival rate was 33 percent for all patients and 39 percent for patients treated with combination chemotherapy. Overall median survival time was 24 months and 36 months for those with adjuvant chemotherapy. Only histology grade, among the factors examined, was a significant prognostic factor for survival. The mean survival time of the patients with Stage II disease who received chemotherapy was 117.4 months, and it was 47.9 months for the patients with Stage II disease who did not received chemotherapy. Conclusions: In our retrospective study high grade lymphoma was the only significant adverse prognostic factor for survival. Receiving adjuvant chemotherapy significantly improved survival in patients with Stage II disease. Patients with diffuse large-cell type had better survival than patients with small noncleaved-cell type in Stage 11 high-grade lymphoma. [ABSTRACT FROM AUTHOR]