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Aim The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks' interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer. Method This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3-4N0M0, TxN+M0) rectal cancer were randomized into 8- and 12-week interval groups. All the patients received long-course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5-fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end-point was pCR. Secondary end-points were sphincter preservation, postoperative morbidity and mortality. Results Two-hundred and fifty-two patients (n = 125 in the 8-week group, n = 127 in the 12-week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8-week group and 23.6% (n = 30) in the 12-week group (P = 0.021). Sphincter-preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12-week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083). Conclusion Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2-fold increase in pCR rate without any difference in mortality and morbidity.

BACKGROUND: Female gender is accepted as a poor prognostic factor for Fournier's gangrene (FG). However, there is a paucity of data in the literature regarding this matter. This case-matched study was designed to investigate the impact of gender on outcomes of FG. METHODS: Study patient data were retrieved from 120-patient, prospectively maintained database. Thirty-two female patients with FG were case-matched to 32 male patients based on symptom duration (days), FG severity index score, patient age, etiology, and presence of diabetes mellitus (DM) terms. Outcomes of FG were compared between the 2 groups. RESULTS: Median age was 57 years (range: 22-80 years), and 35 (54.7%) patients had DM. Patients underwent average of 3 debridement procedures (range: 1-9 debridements), and 15 (23.4%) received diverting stoma. Overall mortality rate was 28.1% (18 of 64 patients). Female gender was associated with widespread disease (p=0.009), increased need for consecutive debridements (p=0.005), prolonged length of intensive care unit stay (p=0.035), and increased requirement for split-thickness skin graft reconstruction (p=0.040). However, mortality rates were comparable between genders (p=0.264). CONCLUSION: FG is often more extensive in females and seems to be associated with anatomical features of female pelvis. However, female gender is not a factor affecting prognosis of patients with FG. AMAÇ: Kadın cinsiyet Fournier gangreni (FG) için olumsuz bir prognostik faktör olarak görülmektedir. Ancak literatürde bu konuya özgün yeterli veri yoktur. Bu olgu-eşleme çalışması kadın cinsiyetin FG prognozuna etkisini incelemek için yapıldı. GEREÇ VE YÖNTEM: Çalışmaya alınan hastalar kliniğimizin 120 hastalık ileriye yönelik olarak tutulan veritabanından çekildi. Otuz iki kadın hasta aşağıdaki kriterler baz alınarak 32 erkek hastayla eşleştirildi: Semptom süresi, FG severity indeks (FGSI) skoru, hasta yaşı, etiyoloji ve eşlik eden diyabetes mellitus (DM) varlığı. Daha sonra iki grup hasta klinik sonuçlar açsından karşılaştırıldı. BULGULAR: Medyan yaş 57 (22–80) idi ve 35 (%54.7) hastada DM vardı. Hastalara ortalama 3 (1–9) debridman yapıldı ve 15 hastaya (%23.4) saptırıcı stoma açıldı. Mortalite oranı %28.1 (64’te 18 hasta) idi. Kadınlarda FG daha yaygındı (p=0.009), daha fazla debridmana ihtiyaç duyulmuştu (p=0.005), kadınlar yoğun bakım ünitesinde daha fazla oranda kalmıştı (p=0.035) ve kadınlarda split thickness skin graft (STSG) ile rekonstrüksiyon daha fazla oranda yapılmıştı (p=0.040), ancak mortalite oranları iki grup arasında benzerdi (p=0.264). TARTIŞMA: Fournier gangreni kadınlarda erkeklere oranla daha yaygın seyreder. Bu muhtemelen kadınların anatomik yapısı ile ilgilidir. Ancak kadın cinsiyet FG mortalitesini artıran bir faktör değildir.

BACKGROUND: Fournier's gangrene (FG) is a devastating and potentially fatal disease requiring prompt and aggressive debridement. In this study, it was aimed to assess the predictors of mortality in a large cohort. METHODS: Prospectively maintained data of patients with FG were analyzed. Demographic data, duration of symptoms, Uludag Fournier's Gangrene Severity Index (UFGSI) scores, co-morbidities [particularly diabetes mellitus (DM)], etiologies, number of debridement, stoma requirements, length of intensive care unit and hospital stay, and morbidity and mortality rates were reviewed. Multivariate analysis was performed in order to determine factors affecting mortality. RESULTS: 120 patients (81 males) were included in the study. Median age was 58 (22-85) years. UFGSI score was median 9 (1-30). DM was present in 69 (57.5%) patients. Etiology of FG was perianal in fifty-nine, urogenital in 52, and skin in 9 patients. Median debridement count was 3 (1-12). Thirty-one patients required stoma. Forty-eight patients were admitted to intensive care unit and 25 patients required mechanical ventilation. Overall mortality rate was 20.8%. Multivariate analysis revealed UFGSI as the only predictor of mortality (p=0.001). Mortality rate was 13.64 times higher for patients with a UFGSI score of 9 or higher. CONCLUSION: Fournier's gangrene is a mortal disease requiring emergency surgery. UFGSI is an efficient predictor of mortality for patients with FG.

Bu çalışma, 09-13 Eylül 2009 tarihleri arasında Salzburg[Avusturya]’da düzenlenen 28. Annual European-Society-of-Regional-Anaesthesia Congress’da bildiri olarak sunulmuştur. Preperitoneal catheter analgesia following abdominal surgery has attracted interest in the last decade. We conducted this study to evaluate the benefits of preperitoneal catheter analgesia in managing pain after abdominal colon and rectal resections. A total of 50 patients undergoing colon and rectal resections for benign and malignant diseases received analgesic medicines via an epidural catheter placed just prior to surgery and a preperitoneal catheter placed at the end of the surgical procedure. Patients were instructed to use the epidural patient-controlled analgesia (PCA) device freely and were randomized into two groups after obtaining the approval of the Institutional Review Board: Group A received 10 ml of levobupivacaine twice a day postoperatively via preperitoneal catheter and group B received only 10 ml of saline. Demographics, surgical characteristics, pain scores recorded four days following surgery, analgesic volume used from the epidural PCA, clinical outcomes (length of stay, time to first bowel movement, time to first passage of gas or stool, time to first oral intake) and respiratory function test results (preoperative vs. postoperative) were compared. There were no significant differences in demographics or surgical characteristics between both groups. Pain scores were similar. Clinical outcomes and respiratory functions were comparable. The use of analgesic volume via epidural catheter was significantly lower in group A than in group B (P = 0.032). Preperitoneal catheter analgesia significantly decreased the need for epidural drug consumption and proved to be a beneficial adjunct for postoperative pain management of patients who underwent colon and rectal resections. European Soc Reg Anaesthesia