Showing papers in "Diseases of The Colon & Rectum in 2018"
TL;DR: The American Society of Colon and Rectal Surgeons is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus.
Abstract: The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to assuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of Society members who ar
186 citations
TL;DR: Most risk factors for earlyAnastomotic leakage were surgery-related factors, representing surgical difficulty, which might lead to technical failure of the anastomosis, which may imply healing deficiencies in patients and tissues.
Abstract: BACKGROUND:Anastomotic leakage remains a major complication after surgery for colorectal carcinoma, but its origin is still unknown. Our hypothesis was that early anastomotic leakage is mostly related to technical failure of the anastomosis, and that late anastomotic leakage is mostly related to hea
127 citations
TL;DR: The recurrence rate in a large population-based cohort after modern staging, surgery, and pathology have been implemented is less than that previously observed in historical materials, but current, commonly used risk factors are still useful in evaluating recurrence risks.
Abstract: BACKGROUND:Developments in the quality of care of patients with colon cancer have improved surgical outcome and thus the need for adjuvant chemotherapy.OBJECTIVE:To investigate the recurrence rate in a large population-based cohort after modern staging, surgery, and pathology have been implemented.D
107 citations
TL;DR: The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus.
Abstract: The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen
107 citations
TL;DR: There is insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care, and larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned toPrehabilitation programs.
Abstract: BACKGROUND:Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery. Prehabilitation before GI cancer surgery is curren
101 citations
Memorial Sloan Kettering Cancer Center1, University of South Florida2, University of California, San Francisco3, University of Vermont4, Washington State University Spokane5, Oregon Health & Science University6, University of North Carolina at Chapel Hill7, University of Chicago8, Creighton University9, University of California, Irvine10, Case Western Reserve University11
TL;DR: Adding modified FOLFOX6 after chemoradiotherapy and before total mesorectal excision increases compliance with systemic chemotherapy and disease-free survival in patients with locally advanced rectal cancer.
Abstract: BACKGROUND:Adding modified FOLFOX6 (folinic acid, fluorouracil, and oxaliplatin) after chemoradiotherapy and lengthening the chemoradiotherapy-to-surgery interval is associated with an increase in the proportion of rectal cancer patients with a pathological complete response.OBJECTIVE:The purpose of
96 citations
TL;DR: It is revealed that indocyanine green was associated with a lower anastomotic leakage rate after colorectal resection, and larger, multicentered, high-quality randomized controlled trials are needed to confirm the benefit of indocianine green fluorescence angiography.
Abstract: BACKGROUND:Anastomotic leak is a life-threatening complication of colorectal surgery. Recent studies showed that indocyanine green fluorescence angiography might be a method to prevent anastomotic leak.OBJECTIVE:The purpose of this study was to investigate whether intraoperative indocyanine green fl
86 citations
TL;DR: These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines.
Abstract: DISEASES OF THE COLON & RECTUM VOLUME 61: 1 (2018) The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by development of clinical practice guidelines based on the best available evidence. These guidelines are inclusive but not prescriptive. Their purpose is to provide information to support decision making, rather than to dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. It should be recognized that the guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.
85 citations
TL;DR: Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events, but evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes.
Abstract: Background Enhanced surgical recovery protocols are designed to reduce hospital length of stay and health care costs. Objective This study aims to systematically review and summarize evidence from randomized and controlled clinical trials comparing enhanced recovery protocols versus usual care in adults undergoing elective colorectal surgery with emphasis on recent trials, protocol components, and subgroups for surgical approach and colorectal condition. Data sources MEDLINE from 2011 to July 2017; reference lists of existing systematic reviews and included studies were reviewed to identify all eligible trials published before 2011. Study selection English language trials comparing a protocol of preadmission, preoperative, intraoperative, and postoperative components with usual care in adults undergoing elective colorectal surgery were selected. Intervention The enhanced recovery protocol for colorectal surgery was investigated. Main outcome measures Length of stay, perioperative morbidity, mortality, readmission within 30 days, and surgical site infection were the primary outcomes measured. Results Twenty-five trials of open or laparoscopic surgery for cancer or noncancer conditions were included. Enhanced recovery protocols consisted of 4 to 18 components. Few studies fully described the various components. Length of stay (mean reduction, 2.6 days; 95% CI, -3.2 to -2.0) and risk of overall perioperative morbidity (risk ratio, 0.66; 95% CI, 0.54-0.80) were lower in enhanced recovery protocol groups than in usual care groups (moderate-quality evidence). All-cause mortality (rare), readmissions, and surgical site infection rates were similar between protocol groups (low-quality evidence). In predefined subgroup analyses, findings did not vary by surgical approach (open vs laparoscopic) or colorectal condition. Limitations Protocols varied across studies and little information was provided regarding compliance with, or implementation of, specific protocol components. Conclusions Enhanced recovery protocols for adults undergoing colorectal surgery improve patient outcomes with no increase in adverse events. Evidence was insufficient regarding which components, or component combinations, are key to improving patient outcomes. PROSPERO registration number: CRD42017067991.
82 citations
TL;DR: In this article, the authors systematically review the literature to determine safety and efficacy of mesenchymal stem cells for perianal Crohn’s disease, and present a systematic review of the literature.
Abstract: BACKGROUND:There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn’s disease.OBJECTIVE:The purpose of this work was to systematically review the literature to determine safety and efficacy of mesenchymal stem cells for
74 citations
TL;DR: In this paper, a lack of detailed data specifically evaluating factors associated with readmission with dehydration was identified, and patients with a history of an ileostomy have often bee readmitted.
Abstract: BACKGROUND:Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, patients with a history of an ileostomy have often bee
TL;DR: Transanal total mesorectal excision is a safe and feasible technique that results in a high-quality rectal cancer resection specimen and favorable 30-day postoperative outcomes.
Abstract: BACKGROUND:Transanal total mesorectal excision is a novel and promising technique in the treatment of low and middle rectal cancer.OBJECTIVE:This study aimed to compare the safety and feasibility of transanal total mesorectal excision versus laparoscopic total mesorectal excision.DESIGN:This was a r
TL;DR: Assessing patients’ perioperative care and recovery they value most when queried in the postoperative period helps elucidate the outcomes patients truly consider valuable, and surgeons should focus on these outcomes when making surgical decisions.
Abstract: BACKGROUND:Colorectal surgery outcomes must be accurately assessed and aligned with patient priorities. No study to date has investigated the patient’s subjective assessment of outcomes most important to them during and following their surgical recovery. Although surgeons greatly value the benefits
TL;DR: This randomized trial shows that perioperative pain management with liposomal bupivacaine transversus abdominis plane block is as effective as epidural analgesia and is associated with less opioid use and less cost.
Abstract: BACKGROUND:Multimodal pain management is an integral part of enhanced recovery pathways The most effective pain management strategies have not been determinedOBJECTIVE:The purpose of this study was to compare liposomal bupivacaine transversus abdominis plane block with epidural analgesia in patien
TL;DR: Knowing the rate and risk factors for recurrent acute diverticulitis is required to aid discussion and decision making with patients regarding the need and timing of elective surgery, and weight reduction and smoking cessation can be championed.
Abstract: BACKGROUND
Diverticular disease accounts for significant morbidity and mortality and may take the form of recurrent episodes of acute diverticulitis. The role of elective surgery is not clearly defined.
OBJECTIVE
This study aimed to define the rate of hospital admission for recurrent acute diverticulitis and risk factors associated with recurrence and surgery.
DESIGN
This is a retrospective population-based cohort study.
SETTINGS
National Health Service hospital admissions for acute diverticulitis in England between April 2006 and March 2011 were reviewed.
PATIENTS
Hospital Episode Statistics data identified adult patients with the first episode of acute diverticulitis (index admission), and then identified recurrent admissions and elective or emergency surgery for acute diverticulitis during a minimum follow-up period of 4 years. Exclusion criteria included previous diagnoses of acute diverticulitis, colorectal cancer, or GI bleeding, and prior colectomy or surgery or death during the index admission.
INTERVENTIONS
There were no interventions.
MAIN OUTCOME MEASURES
The primary outcomes measured were recurrent admissions for acute diverticulitis and patients requiring either elective or emergency surgery during the study period.
RESULTS
Some 65,162 patients were identified with the first episode of acute diverticulitis. The rate of hospital admission for recurrent acute diverticulitis was 11.2%. A logistic regression model examined factors associated with recurrent acute diverticulitis and surgery: patient age, female sex, smoking, obesity, comorbidity score >20, dyslipidemia, and complicated acute diverticulitis increased the risk of recurrent acute diverticulitis. There was an inverse relationship between patient age and recurrence. Similar factors were associated with elective and emergency surgery.
LIMITATIONS
The cases of acute diverticulitis required inpatient management and the use of Hospital Episode Statistics, relying on the accuracy of diagnostic coding.
CONCLUSIONS
This is the largest study assessing the rates of hospital admission for recurrent acute diverticulitis. Knowledge of the rate and risk factors for recurrent acute diverticulitis is required to aid discussion and decision making with patients regarding the need and timing of elective surgery. Some factors associated with recurrence are modifiable; therefore, weight reduction and smoking cessation can be championed. See Video Abstract at http://links.lww.com/DCR/A449.
TL;DR: A pattern-based approach combining tumor morphology with distinct diffusion-weighted imaging patterns results in good diagnostic performance to assess response in rectal cancer.
Abstract: BACKGROUND:Diffusion-weighted imaging is increasingly used in rectal cancer MRI to assess response after chemoradiotherapy. Certain pitfalls (eg, artefacts) may hamper diffusion–MRI assessment, leading to suboptimal diagnostic performance. Combining diffusion-weighted MRI with the underlying morphol
TL;DR: The combination of an increasing incidence of colorectal cancer in those under 50 years of age and the predominance of left-sided cancer suggests that screening by flexible sigmoidoscopy starting at age 40 in average-risk individuals may prevent cancer by finding asymptomatic lesions.
Abstract: Background National databases show a recent significant increase in the incidence of colorectal cancer in people younger than 50. With current recommendations to begin average-risk screening at age 50, these patients do not have the opportunity to be screened. We hypothesized that most of the cancers among the young would be left sided, which would create an opportunity for screening the young by flexible sigmoidoscopy. Objective This study aims to analyze the anatomic distribution of sporadic colorectal cancers in patients under the age of 50. Design This is a retrospective review of a prospectively maintained database. Setting This study was conducted at a single high-volume tertiary referral center. Patients Patients under the age of 50 with colorectal cancer between the years 2000 and 2016 were included. Patients with IBD, familial adenomatous polyposis, Lynch syndrome, or hereditary nonpolyposis colorectal cancer were excluded. Main outcome measures The primary outcomes measured were tumor location and stage, demographics, and family history. Results A total of 739 patients were included. Age range at diagnosis was 18 to 49 years; median age was 44 years. Five hundred thirty patients were between the ages of 40 and 49, 167 were between the ages of 30 and 39, 40 were between the ages of 20 and 29, and 2 were under 20. Two hundred thirty-one patients (32%) had a family history of colorectal cancer. The anatomic distribution of the cancers was: 485 rectum (65%), 107 sigmoid colon (15%), 19 descending colon (3%), and 128 right colon and transverse colon (17%). Therefore, 83% of the tumors were theoretically within the range of flexible sigmoidoscopy. Limitations Referral bias favors rectal cancer. Conclusion The combination of an increasing incidence of colorectal cancer in those under 50 years of age and the predominance of left-sided cancer suggests that screening by flexible sigmoidoscopy starting at age 40 in average-risk individuals may prevent cancer by finding asymptomatic lesions. See Video Abstract at http://links.lww.com/DCR/A579.
TL;DR: The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus.
Abstract: The American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines Committee is charged with leading international
TL;DR: Closure of perianal fistulas using a laser should be considered as a treatment option but with modest expectations, and the complete healing rate was not as high as in earlier studies, but this technique is a reasonable option with nearly no risk of sphincter damage when treating perianAL fistulas.
Abstract: BACKGROUND:Primary closure of the fistula tract using energy emitted by a radial fiber connected to a diode laser is a novel procedure for treating perianal fistulas.OBJECTIVE:The aim of this study was to determine the long-term effectiveness of this new technique.DESIGN:The surgical objective was t
TL;DR: Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay and currently there are insufficient data to support the predictive role of the field walk test in colorectal surgery.
Abstract: BACKGROUND Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acceptability, in particular, in elderly patients. OBJECTIVE This systematic review evaluated the predictive value of cardiopulmonary exercise testing and field walk tests in surgical outcomes after colorectal surgery. DATA SOURCE A systematic search was undertaken using Medline, PubMed, Embase, CINAHL, and PEDro. STUDY SELECTION Adult patients who had cardiopulmonary exercise testing and/or field walk test before colorectal surgery were included. MAIN OUTCOME MEASURE The primary outcomes measured were hospital length of stay and postoperative morbidity and mortality. RESULTS A total of 7 studies with a cohort of 1418 patients who underwent colorectal surgery were identified for inclusion in a qualitative analysis. Both pooled oxygen consumption at anaerobic threshold (range, 10.1-11.1 mL·kg·min) and peak oxygen consumption (range, 16.7-18.6 mL·kg·min) were predictive of complications (OR for anaerobic threshold, 0.76; 95% CI, 0.66-0.85, p<0.0001; OR for peak oxygen consumption, 0.76; 95% CI, 0.67-0.85, p<0.0001). Patients had significant increased risk of developing postoperative complications if their anaerobic threshold was below this cut point (p<0.001). However, it was not predictive of anastomotic leak (p = 0.644). Shorter distance (<250 m) walked in incremental shuttle walk test, lower anaerobic threshold, and lower peak oxygen consumption were associated with prolonged hospital length of stay, which was closely related to the development of complications. CONCLUSIONS Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay. Currently, there are insufficient data to support the predictive role of the field walk test in colorectal surgery.
TL;DR: In this paper, the authors reported conflicting evidence about the association between hospital/surgeon volume and rectal cancer outcomes, given advances in rectal colon cancer resection, such as total mesorectal excisio
Abstract: BACKGROUND:Previous reviews and meta-analyses, which predominantly focused on patients treated before 2000, have reported conflicting evidence about the association between hospital/surgeon volume and rectal cancer outcomes. Given advances in rectal cancer resection, such as total mesorectal excisio
TL;DR: Cancer-related financial stress and strain were significantly associated with low health-related quality of life in colorectal cancer survivors, and additional research is needed to better understand how both objective and subjective financial distress influence survivors’ health- relatedquality of life.
Abstract: BACKGROUND: The financial impact and consequences of cancer on the lives of survivors remain poorly understood. This is especially true for colorectal cancer.
OBJECTIVE: We investigated objective cancer-related financial stress, subjective cancer-related financial strain, and their association with health-related quality of life in colorectal cancer survivors.
DESIGN: This was a cross-sectional postal survey.
SETTINGS: The study was conducted in Ireland, which has a mixed public–private healthcare system.
PATIENTS: Colorectal cancer survivors, diagnosed 6 to 37 months prior, were identified from the population-based National Cancer Registry.
MAIN OUTCOME MEASURES: Cancer-related financial stress was assessed as impact of cancer on household ability to make ends meet and cancer-related financial strain by feelings about household financial situation since cancer diagnosis. Health-related quality of life was based on European Organisation for Research and Treatment of Cancer QLQ-C30 global health status. Logistic regression was used to identify associations between financial stress and strain and low health-related quality of life (lowest quartile, score ≤50).
RESULTS: A total of 493 survivors participated. Overall, 41% reported cancer-related financial stress and 39% cancer-related financial strain; 32% reported both financial stress and financial strain. After adjustment for sociodemographic and clinical variables, the odds of low health-related quality of life were significantly higher in those who reported cancer-related financial stress postdiagnosis compared with those who reported no change in financial stress postcancer (OR = 2.54 (95% CI, 1.62–3.99)). The odds of low health-related quality of life were also significantly higher in those with worse financial strain postdiagnosis (OR =1.73 (95% CI, 1.09–2.72)). The OR for those with both cancer-related financial stress and financial strain was 2.59 (95% CI, 1.59–4.22).
LIMITATIONS: Survey responders were younger, on average, than nonresponders. Responders and nonresponders may have differed in cancer-related financial stress and strain or health-related quality of life.
CONCLUSIONS: Four in 10 colorectal cancer survivors reported an adverse financial impact of cancer. Cancer-related financial stress and strain were significantly associated with low health-related quality of life. To inform support strategies, additional research is needed to better understand how both objective and subjective financial distress influence survivors’ health-related quality of life.
TL;DR: Surgical approaches to colon cancer differ significantly among Western and Asian guidelines, reflecting different concepts of treatment.
Abstract: Background Guidelines are important to standardize treatments and optimize outcomes. Several societies have published authoritative guidelines for patients with colon cancer, and a certain degree of variation can be predicted. Objective This study aims to compare Western and Asian guidelines for the management of colon cancer. Data sources A literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies published between 2010 and 2017 by the online resources from the official Web sites of the societies/panels. Sources included guidelines by European Society of Medical Oncology, the Japanese Society for Cancer of the Colon and Rectum, and the National Comprehensive Cancer Network. Study selection Only full-text studies and the latest guidelines dealing with colon cancer were included. Studies and guidelines were separately assessed by 2 authors, who independently identified discrepancies and areas for further research. These were discussed and agreed with by all the authors. Main outcome measures The recommendations of the guidelines of each society were compared, seeking discrepancies and potential areas for improvement. Results Endoscopic techniques for the management of early colon cancer are discussed in detail in the Asian guidelines. Asian guidelines advocate extended (D3) lymphadenectomy on a routine basis in T3/T4 and in selected T2 patients, whereas such an approach is still under investigation in Western countries. Only US guidelines describe neoadjuvant chemotherapy and radiotherapy. All the guidelines recommend adjuvant treatment in selected stage II patients, but agreement exists that this is performed without solid evidence, because better outcomes are hypothesized based on studies including stage III or stage II/III patients. The role of cytoreductive surgery with intra-abdominal chemotherapy is dubious, and European guidelines only recommend it in the setting of trials. Asian guidelines endorse an aggressive surgical approach to peritoneal disease. Only US guidelines include a patient advocate in the drafting panel. Limitations Bias may have arisen from country-specific socioeconomic and cultural issues, and from the latest available updates. Conclusions Surgical approaches to colon cancer differ significantly among Western and Asian guidelines, reflecting different concepts of treatment. The role of adjuvant treatment in node-negative disease and quality-of-life assessment need further research.
TL;DR: Patients with increasing BMI showed an incremental and independent risk for adverse 30-day postoperative outcomes, especially surgical site infections, among patients undergoing colorectal surgery.
Abstract: BACKGROUND Obese patients undergoing colorectal surgery are at increased risk for adverse outcomes. It remains unclear whether these risks can be further defined with more discriminatory stratifications of obesity. OBJECTIVE The purpose of this study was to understand the association between BMI and 30-day postoperative outcomes, including surgical site infection, among patients undergoing colorectal surgery. DESIGN This was a retrospective cohort study. SETTINGS The 2011-2013 American College of Surgeons National Surgical Quality Improvement Program database was used. PATIENTS Patients included those undergoing elective colorectal surgery in 2011-2013 who were assessed by the American College of Surgeons National Surgical Quality Improvement Program. MAIN OUTCOME MEASURES BMI was categorized into World Health Organization categories. Primary outcome was 30-day postoperative surgical site infection. Secondary outcomes included all American College of Surgeons National Surgical Quality Improvement Program-assessed 30-day postoperative complications. RESULTS Our cohort included 74,891 patients with 4.4% underweight (BMI <18.5), 29.0% normal weight (BMI 18.5-24.9), 33.0% overweight (BMI 25.0-29.9), 19.8% obesity class I (BMI 30.0-34.9), 8.4% obesity class II (BMI 35.0-39.9), and 5.5% obesity class III (BMI ≥40.0). Compared with normal-weight patients, obese patients experienced incremental odds of surgical site infection from class I to class III (I: OR = 1.5 (95% CI, 1.4-1.6); II: OR = 1.9 (95% CI, 1.7-2.0); III: OR = 2.1 (95% CI, 1.9-2.3)). Obesity class III patients were most likely to experience wound disruption, sepsis, respiratory or renal complication, and urinary tract infection. Mortality was highest among underweight patients (OR = 1.3 (95% CI, 1.0-1.8)) and lowest among overweight (OR = 0.8 (95% CI, 0.6-0.9)) and obesity class I patients (OR = 0.8 (95% CI, 0.6-1.0)). LIMITATIONS Retrospective analysis of American College of Surgeons National Surgical Quality Improvement Program hospitals may not represent patients outside of the American College of Surgeons National Surgical Quality Improvement Program and cannot assign causation or account for interventions to improve surgical outcomes. CONCLUSIONS Patients with increasing BMI showed an incremental and independent risk for adverse 30-day postoperative outcomes, especially surgical site infections. Strategies to address obesity preoperatively should be considered to improve surgical outcomes among this population. See Video Abstract at http://links.lww.com/DCR/A607.
TL;DR: Patients with IBD, especially ulcerative colitis, might benefit from extended thromboembolism prophylaxis similar to that of patients with colon cancer, because of the elevated and sustained risk of postoperative venous thrombosis.
Abstract: BACKGROUND:The risk of postoperative venous thromboembolism is high in patients with colon cancer and IBD. Although The American Society of Colon and Rectal Surgeons suggests posthospital prophylaxis after surgery in patients with colon cancer, there are no such recommendations for patients with IBD
TL;DR: Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection, and both groups manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival.
Abstract: BACKGROUND Muscle loss, characterized by reduced muscle mass (myopenia), and infiltration by intermuscular and intramuscular fat (myosteatosis), predicts a poor short-term prognosis in patients with colorectal cancer. However, little is known about the influence of myopenia and myosteatosis on long-term outcomes. OBJECTIVE The present study aimed to evaluate the prognostic influence of both myopenia and myosteatosis on long-term outcomes after curative colorectal cancer surgery. DESIGN This is a retrospective analysis using a propensity score-matched analysis to reduce the possibility of selection bias. SETTINGS The study was conducted at a single institution. PATIENTS We performed a retrospective analysis of 211 consecutive patients with stage I to III colorectal cancer who underwent curative surgery between 2010 and 2011. INTERVENTION CT scans were analyzed to calculate the lumbar skeletal muscle index and mean muscle attenuation using a SYNAPS VINCENT. MAIN OUTCOME MEASURES The primary outcome measure was cancer-specific survival. Secondary end points included overall survival and disease-free survival. RESULTS Of 211 patients, a total of 102 and 106 were matched for myopenia and myosteatosis analyses. The median follow-up was 57.6 months. Versus the nonmyopenia group, the myopenia group manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival. Significantly shorter cancer-specific survival and overall survival times were also identified for the myosteatosis versus the nonmyosteatosis group. Before matching, multivariate analyses identified both myopenia and myosteatosis as independent prognostic factors for cancer-specific survival (p = 0.04 and p < 0.01), overall survival (p = 0.03 and p < 0.01), and disease-free survival (p < 0.01 and p < 0.01). LIMITATIONS This study is limited by its retrospective, nonrandomized design. CONCLUSIONS Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection. See Video Abstract at http://links.lww.com/DCR/A463.
TL;DR: Laroscopic lavage is associated with increased risk of major complications versus primary resection for Hinchey III diverticulitis and the lower rate of stoma reversal and higher rate of complications after the Hartmann procedure suggestPrimary resection and anastomosis as the optimal management of perforated diverticULitis.
Abstract: BACKGROUND:The traditional approach for perforated diverticulitis, the Hartmann procedure, has considerable morbidity and the challenge of stoma reversal. Alternative procedures, including primary resection and anastomosis and laparoscopic lavage, have been proposed but remain controversial.OBJECTIV
TL;DR: The Dehydration Readmission After Ileostomy Prediction score is a validated scoring system that identifies patients at risk for dehydration readmission after ileostomy formation and is a specific approach to optimize patient factors, implement interventions, and prevent readmissions.
Abstract: Background All-cause readmission rates in patients undergoing ileostomy formation are as high as 20% to 30%. Dehydration is a leading cause. No predictive model for dehydration readmission has been described. Objective The purpose of this study was to develop and validate the Dehydration Readmission After Ileostomy Prediction scoring system to predict the risk of readmission for dehydration after ileostomy formation. Design Patients who underwent ileostomy formation were identified using the American College of Surgeons National Surgical Quality Improvement Program data set (2012-2015). Predictors for dehydration were identified using multivariable logistic regression analysis and translated into a point scoring system based on corresponding β-coefficients using 2012-2014 data (derivation). Model discrimination was assessed with receiver operating characteristic curves using 2015 data (validation). Settings This study used the American College of Surgeons National Surgical Quality Improvement Program. Patients A total of 8064 (derivation) and 3467 patients (validation) were included from the American College of Surgeons National Surgical Quality Improvement Program. Main outcome measures Dehydration readmission within 30 days of operation was measured. Results A total of 8064 patients were in the derivation sample, with 2.9% (20.1% overall) readmitted for dehydration. Twenty-five variables were queried, and 7 predictors were identified with points assigned: ASA class III (4 points), female sex (5 points), IPAA (4 points), age ≥65 years (5 points), shortened length of stay (5 points), ASA class I to II with IBD (7 points), and hypertension (9 points). A 39-point, 5-tier risk category scoring system was developed. The model performed well in derivation (area under curve = 0.71) and validation samples (area under curve = 0.74) and passed the Hosmer-Lemeshow goodness-of-fit test. Limitations Limitations of this study pertained to those of the American College of Surgeons National Surgical Quality Improvement Program, including a lack of generalizability, lack of ileostomy-specific variables, and inability to capture multiple readmission International Classification of Diseases, 9/10 edition, codes. Conclusions The Dehydration Readmission After Ileostomy Prediction score is a validated scoring system that identifies patients at risk for dehydration readmission after ileostomy formation. It is a specific approach to optimize patient factors, implement interventions, and prevent readmissions. See Video Abstract at http://links.lww.com/DCR/A746.
TL;DR: In the largest published cohort of patients with anal intraepithelial neoplasia III, ≈10% of patients were projected to develop anal cancer within 5 years and the need for effective therapies and surveillance is highlighted.
Abstract: Background The risk of anal carcinoma after previous diagnosis of anal intraepithelial neoplasia III is unclear. Objective The purpose of this study was to estimate the risk of anal carcinoma in patients with anal intraepithelial neoplasia III and to identify predictors for subsequent malignancy. Design This was a retrospective review using the Surveillance, Epidemiology, and End Results registry (1973-2014). Setting The study was composed of population-based cancer registries from the United States. Patients Patients who were diagnosed with anal intraepithelial neoplasia III were included. Main outcome measures The primary outcome was rate of subsequent anal squamous cell carcinoma. Predictors for anal cancer were identified using logistic regression and Cox proportional hazard models. Results A total of 2074 patients with anal intraepithelial neoplasia III were identified and followed for a median time of 4.0 years (interquartile range, 1.8-6.7 y). Of the cohort, 171 patients (8.2%) subsequently developed anal cancer. Median time from anal intraepithelial neoplasia III diagnosis to anal cancer diagnosis was 2.7 years (interquartile range, 1.1-4.5 y). Fifty-two patients (30.4%) who developed anal carcinoma were staged T2 or higher. Ablative therapies for initial anal intraepithelial neoplasia III were associated with a reduction in the risk of anal cancer (OR = 0.3 (95% CI, 0.1-0.7); p = 0.004). Time-to-event analysis revealed that the 5-year incidence of anal carcinoma after anal intraepithelial neoplasia III was 9.5% or ≈1.9% per year. Limitations The registry did not record HIV status, surveillance schedule, use of high-resolution anoscopy, or provider specialty. Conclusions In the largest published cohort of patients with anal intraepithelial neoplasia III, ≈10% of patients were projected to develop anal cancer within 5 years. Nearly one third of anal cancers were diagnosed at stage T2 or higher despite a previous diagnosis of anal intraepithelial neoplasia III. Ablative procedures were associated with a decreased risk of cancer. This study highlights the considerable rate of malignancy in patients with anal intraepithelial neoplasia III and the need for effective therapies and surveillance. See Video Abstract at http://links.lww.com/DCR/A764.
TL;DR: There was a short-term gain in quality of life maintained at 2 months postsurgery for those who received laparoscopic relative to open colonic resection and in intention-to-treat analyses, those assigned to Laparoscopic surgery had a better quality oflife postoperatively.
Abstract: BACKGROUND:This study reports the quality-of-life assessment of the ALCCaS trial. The ALCCaS trial compared laparoscopic and open resection for colon cancer. It reported equivalence of survival at 5 years. Quality of life was measured as a secondary outcome.OBJECTIVE:This study aimed to report on th