This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.

/pdf/guidelines-for-perioperative-care-in-elective-colonic-1wl593eui2.pdf

Guidelines for perioperative care in elective colonic surgery: Enhanced recovery after surgery (ERAS®) society recommendations

An Astronomically Tuned Neogene Time Scale (ATNTS2012) is presented, as an update of ATNTS2004 in GTS2004. The new scale is not fundamentally different from its predecessor and the numerical ages are identical or almost so. Astronomical tuning has in principle the potential of generating a stable Neogene time scale as a function of the accuracy of the La2004 astronomical solution used for both scales. Minor problems remain in the tuning of the Lower Miocene. In GTS2012 we will summarize what has been modified or added since the publication of ATNTS2004 for incorporation in its successor, ATNTS2012. Mammal biostratigraphy and its chronology are elaborated, and the regional Neogene stages of the Paratethys and New Zealand are briefy discussed. To keep changes to ATNTS2004 transparent we maintain its subdivision into headings as much as possible.

The Neogene Period

Purpose The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required. Methods The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis. Results Seven hundred ninety-f...

https://ascopubs.org/doi/pdf/10.1200/JCO.2006.09.7758

Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group.

Summary Background Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer. Methods A non-inferiority phase 3 trial was undertaken at 30 centres and hospitals in eight countries. Patients (aged ≥18 years) with rectal cancer within 15 cm from the anal verge without evidence of distant metastases were randomly assigned to either laparoscopic or open surgery in a 2:1 ratio, stratified by centre, location of tumour, and preoperative radiotherapy. The study was not masked. Secondary (short-term) outcomes—including operative findings, complications, mortality, and results at pathological examination—are reported here. Analysis was by modified intention to treat, excluding those patients with post-randomisation exclusion criteria and for whom data were not available. This study is registered with ClinicalTrials.gov, number NCT00297791. Findings The study was undertaken between Jan 20, 2004, and May 4, 2010. 1103 patients were randomly assigned to the laparoscopic (n=739) and open surgery groups (n=364), and 1044 were eligible for analyses (699 and 345, respectively). Patients in the laparoscopic surgery group lost less blood than did those in the open surgery group (median 200 mL [IQR 100–400] vs 400 mL [200–700], p vs 188 min [150–240]; p vs 3·0 days [2·0–4·0]; p vs 9·0 days [7·0–14·0]; p=0·036). Macroscopically, completeness of the resection was not different between groups (589 [88%] of 666 vs 303 [92%] of 331; p=0·250). Positive circumferential resection margin ( vs 3·0 cm [1·8–5·0], respectively; p=0·676). In the laparoscopic and open surgery groups, morbidity (278 [40%] of 697 vs 128 [37%] of 345, respectively; p=0·424) and mortality (eight [1%] of 699 vs six [2%] of 345, respectively; p=0·409) within 28 days after surgery were similar. Interpretation In selected patients with rectal cancer treated by skilled surgeons, laparoscopic surgery resulted in similar safety, resection margins, and completeness of resection to that of open surgery, and recovery was improved after laparoscopic surgery. Results for the primary endpoint—locoregional recurrence—are expected by the end of 2013. Funding Ethicon Endo-Surgery Europe, Swedish Cancer Foundation, West Gothia Region, Sahlgrenska University Hospital.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(13)70016-0.pdf

Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial

BACKGROUND: Laparoscopic surgery for colon cancer has been proven safe, but debate continues over whether the available long-term survival data justify implementation of laparoscopic techniques in ...

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(08)70310-3.pdf

Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)66545-2.pdf

Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial

Background: Bladder and sexual dysfunction are recognized complications of mesorectal resection Their incidence following laparoscopic surgery is unknown Methods: Bladder and sexual function were assessed in patients who had undergone laparoscopic rectal, open rectal or laparoscopic colonic resection as part of the UK Medical Research Council Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, using the International Prostatic Symptom Score, the International Index of Erectile Function and the Female Sexual Function Index Sexual and bladder function data from the European Organization for Research and Treatment of Cancer QLQ-CR38 collected in the CLASICC trial were used for comparison Results: Two hundred and forty-seven (71·2 per cent) of 347 patients completed questionnaires Bladder function was similar after laparoscopic and open rectal operations for rectal cancer Overall sexual function and erectile function tended to be worse in men after laparoscopic rectal surgery than after open rectal surgery (overall function: difference − 11·18 (95 per cent confidence interval (ci) −22·99 to 0·63), P = 0·063; erectile function: difference −5·84 (95 per cent ci −10·94 to −0·74), P = 0·068) Total mesorectal excision (TME) was more commonly performed in the laparoscopic rectal group than in the open rectal group TME (odds ratio (OR) 6·38, P = 0·054) and conversion to open operation (OR 2·86, P = 0·041) were independent predictors of postoperative male sexual dysfunction No differences were detected in female sexual function Conclusion: Laparoscopic rectal resection did not adversely affect bladder function, but there was a trend towards worse male sexual function This may be explained by the higher rate of TME in the laparoscopic rectal resection group

Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique.

Bladder and Sexual Function Following Resection for Rectal Cancer in a Randomized Clinical Trial of Laparoscopic Versus Open Technique

Sterkfontein cave, South Africa, has yielded an australopith skeleton, StW 573, whose completeness has excited great interest in paleoanthropology. StW 573, or "Little Foot," was found 25 meters below the surface in the Silberberg Grotto. 238U-206Pb measurements on speleothems immediately above and below the fossil remains, corrected for initial 234U disequilibrium, yield ages of 2.17 +/- 0.17 million years ago (Ma) and 2.24(-0.07)(+0.09) Ma, respectively, indicating an age for StW 573 of close to 2.2 Ma. This age is in contrast to an age of approximately 3.3 Ma suggested by magnetochronology and ages of approximately 4 Ma based on 10Be and 26Al, but it is compatible with a faunal age range of 4 to 2 Ma.

http://science.sciencemag.org/content/sci/314/5805/1592.full.pdf

U-Pb Isotopic Age of the StW 573 Hominid from Sterkfontein, South Africa

Apoptosis has an important role in carcinogenesis and cancer treatment. The end result of this complex pathway is the formation of apoptotic bodies. These can be difficult to quantify accurately, but quantitation is important if we wish to study this process. Several techniques are available which can help. 'TUNEL' is discussed, with its potential drawbacks, and newer antibody techniques, such as M30 and caspase 3, are then reviewed.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/path.979

J. Walker

Papers

Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial

Bladder and sexual function following resection for rectal cancer in a randomized clinical trial of laparoscopic versus open technique.

Bladder and Sexual Function Following Resection for Rectal Cancer in a Randomized Clinical Trial of Laparoscopic Versus Open Technique

U-Pb Isotopic Age of the StW 573 Hominid from Sterkfontein, South Africa

Viewing apoptosis through a 'TUNEL'.