Search

Approximately 1%–2% of patients with colorectal cancer (CRC) develop para‐aortic lymph node (PALN) metastases, which are typically considered markers of systemic disease, and are associated with a poor prognosis. The utility of PALN dissection (PALND) in patients with CRC is of ongoing debate and only small‐scale retrospective studies have been published on this topic to date. This systematic review aimed to determine the utility of resecting PALN metastases with the primary outcome measure being the difference in survival outcomes following either surgical resection or non‐resection of these metastases. A comprehensive systematic search was undertaken to identify all English‐language papers on PALND in the PubMed, Medline, and Google Scholar databases. The search results identified a total of 12 eligible studies for analysis. All studies were either retrospective cohort studies or case series. In this systematic review, PALND was found to be associated with a survival benefit when compared to non‐resection. Metachronous PALND was found to be associated with better overall survival as compared to synchronous PALND, and the number of PALN metastases (2 or fewer) and a pre‐operative carcinoembryonic antigen level of <5 was found to be associated with a better prognosis. No PALND‐specific complications were identified in this review. A large‐scale prospective study needs to be conducted to definitively determine the utility of PALND. For the present, PALND should be considered within a multidisciplinary approach for patients with CRC, in conjunction with already established treatment regimens. [ABSTRACT FROM AUTHOR]

Objectives: Right hemicolectomy is a common colorectal operation for resection of cancers of the right colon. The ileocolic anastomosis may be created using a stapled end‐to‐side, stapled side‐to‐side or handsewn technique. Anastomotic leak and post‐operative bleeding are uncommon but serious causes of morbidity and mortality, while post‐operative ileus contributes to prolonged length of stay. The aim of this study was to evaluate differences in short‐term outcomes between different anastomotic configurations following right hemicolectomy for colon cancer. Methods: We conducted a retrospective study using data from the Bowel Cancer Outcomes Registry (BCOR), including 94 hospitals across Australia and New Zealand, of all patients who underwent right hemicolectomy or extended right hemicolectomy for colon cancer with formation of a primary anastomosis between 2007 and 2021. Results: We included 8164 patients in the analysis. There was no significant difference in rates of anastomotic leak and anastomotic bleeding based on anastomotic technique. A stapled end‐to‐side anastomosis was associated with a lower rate of post‐operative ileus than stapled side‐to‐side anastomosis (6.5% vs. 7.2%; P = 0.03). Conclusion: Both handsewn and stapled anastomosis techniques may be utilized for oncologic right hemicolectomy, with comparable rates of anastomotic leak and post‐operative bleeding. Stapled end‐to‐side anastomosis resulted in lower rates of prolonged ileus compared to stapled side‐to‐side anastomoses. [ABSTRACT FROM AUTHOR]

Background: As coronavirus (COVID‐19) cases continue to rise, healthcare workers have been working overtime to ensure that all patients receive care in a timely manner. Our study aims to identify the impact and outcomes of COVID‐19 on colorectal cancers presentations across the five major colorectal units in Melbourne, Australia. Methods: This is a retrospective study from a prospectively collected database from the binational colorectal cancer audit (BCCA) registry, as well as inpatient records. All patients with colorectal cancer between Pre‐COVID‐19 period (1 July 2018–2030 June 2019) and COVID‐19 period (1 July 2020–2030 June 2021) were compared. Benign pathology and other cancer types were excluded. Results: A total of 1609 patients were included in the study (700 Pre‐COVID‐19 period, 906 COVID‐19 period). During COVID‐19 period, there was a higher proportion of emergency surgery (28.1% vs. 19.8%; P < 0.001), a higher nodal (P = 0.024) and metastatic stage (P = 0.018) at presentation, but no increase in the rate of return to operating theatres (P = 0.240), inpatient death (P = 0.019) or 30‐day readmission (P = 0.000). There was also no difference in the post‐operative surgical complications (P = 0.118). Utility of neoadjuvant therapy did not increase during the pandemic (P = 0.613). Conclusion: The heightened measures in the healthcare system ensured CRC patients still received their surgery in a timely fashion. With the current rise in the new strain of COVID‐19 (Omicron), we have to continue to come up with new strategies to provide timely access to CRC care. [ABSTRACT FROM AUTHOR]

There was no family history of bowel cancer or inflammatory bowel disease (IBD). Small bowel obstruction in the virgin abdomen: the need for a mandatory laparotomy explored. [Extracted from the article]

Rectal injuries are uncommon and usually associated with military trauma. Studies have shown that sphincteroplasty of the internal or external sphincter injuries do result in better continence in the long run.4-6 Persistence of sphincter defects or anal incontinence symptoms may vary according to the technique of primary repair (approximating torn edges end-to-end or an overlap method).6 Accurate diagnosis and appropriate management of sphincter injuries are crucial to prevent anal incontinence. Management of penetrating extraperitoneal rectal injuries: an Eastern Association for the Surgery of Trauma practice management guideline. [Extracted from the article]

Introduction: Studies have shown that post‐operative telephone follow‐up is satisfactory and effective. As high quality evidence is scant, we conducted a randomized controlled trial to compare it against outpatient clinic review for emergency laparoscopic appendicectomy or cholecystectomy. Method: Patients who received emergency laparoscopic appendicectomy or cholecystectomy were eligible for this study. Once recruited, they were randomly allocated to either clinic review or telephone follow‐up on discharge. Participants were reviewed at 2 weeks after operation and contacted again at 4 weeks after initial follow‐up for satisfaction survey. Results: One hundred and seventy‐nine participants were recruited with one withdrawn consent and six excluded. Ninety‐six underwent laparoscopic appendicectomy and 76 had laparoscopic cholecystectomy. Ninety‐six attended clinic review and 76 had telephone follow‐up. The two groups were similar in baseline variables. Non‐attendance rate was higher for clinic review cohort (24% vs 6.6%, P = 0.002). Participants who received telephone review reported higher satisfaction level (9.31 vs 8.85, P = 0.002), and most patients prefer telephone follow‐up (73.1%, P < 0.0001). No difference was detected for missed complications (P = 0.354). Conclusion: Telephone follow‐up post laparoscopic appendicectomy or cholecystectomy is safe, satisfying and effective. [ABSTRACT FROM AUTHOR]

A 59-year-old female initially presented to the emergency department (ED) with anorectal pain and per rectal (PR) blood loss after self-administration of a water enema on a daily basis over the preceding 4 days as part of a weight loss programme. (c) Abscess cavity with rectal contrast observed to not extravasate into cavity. gl Intraoperatively, bimanual examination raised the suspicion for a low rectal perforation with fluctuance on the anterior rectal wall. 6 Kalkan IH, Oztas E, Yildiz H, Beyazit Y, Suvak B, Boyabatli M. Rectal perforation as a result of self-administration of retrograde enema in an elderly dementia patient. [Extracted from the article]

This case highlights an extremely rare case of necrotizing fasciitis from perforated sigmoid diverticulitis and reflects how occult presentations of complicated diverticulitis can lead to the potential delay in diagnosis due to non-specific symptoms. It is important to note that in such rare presentations of perforated diverticulitis, the primary pathology driving the sepsis must be treated in order for complete resolution of secondary abscesses, or in this case necrotizing fasciitis. Left-sided colonic diverticulosis is common in the Western population, with risk of diverticulitis occurring in 4% of the population.1,2 Complicated diverticulitis occurs when perforation occurs, and approximately 15-20% of patients admitted with acute diverticulitis have an abscess on computed tomography of the abdomen.2 This case report describes a rare phenomenon of a case of perforated diverticulitis presenting as gluteal necrotizing fasciitis. [Extracted from the article]

Computed tomography scan of the pelvis indicated a large, low-density mass arising from the posterior aspect of the anus extending into the natal cleft (Fig.). On microscopic review, the cyst was focally lined by an intact epithelium with cuboidal to stratified squamous cells, cells secreting mucin and other areas of cilia (Fig.). Thus, the histological identification of a variety of cloacal epithelia is characteristic, including columnar and mucinous cells, as well as squamous and transitional epithelia,[3] as demonstrated histologically in our case report. [Extracted from the article]