When controlled for probability of morbidity, laparoscopy decreases the rate of postoperative complications. Given the equivalent outcomes of laparoscopic approaches, we conclude that laparoscopy should be offered to all patients who lack an absolute contraindication for laparoscopic surgery.

Objective The objective of this study was to identify risk factors for delays in chemotherapy after rectal cancer surgery and evaluate the effects of delayed therapy on long term outcomes. We also sought to clarify what time frame should be used to define delayed adjuvant chemotherapy. Background Postoperative complications have been found to influence timing of chemotherapy in colon cancer patients. Delays in chemotherapy have been shown to be associated with worse overall and disease free survival in colorectal cancer patients, although timing of delay has not been agreed upon in the literature. Study Design We performed a retrospective review of a prospectively maintained rectal cancer database. Univariate analysis was used to identify risk factors for delayed chemotherapy. Kaplan Meier curves were generated to compare overall and disease free survival in patients based on complications and timing of chemotherapy. Settings This study was performed at the University of Wisconsin Hospital, Madison, WI between 1995 and 2012. Patients Patients with rectal cancer who underwent proctectomy with curative intent were included in this study. Outcome Measures Timing of chemotherapy, 30 day complications and 30 day readmissions were the main outcome measures. Results Postoperative complications and 30 day readmissions were associated with delays in chemotherapy ≥ 8 weeks after surgery. Patients who received chemotherapy ≥ 8 weeks postoperatively were found to have worse local and distant recurrence rates and worse overall survival as compared with patients who received chemotherapy within 8 weeks of surgery. Limitations Limitations of this study include its retrospective nature and that it was performed at a single institution. Conclusions We found complications and readmissions to be risk factors for delayed chemotherapy. Patients who received therapy ≥ 8 weeks postoperatively had worse disease free and overall survival.

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Patients with ileus and multiple complications are at significantly increased risk for adverse outcomes. Older patients with more comorbidity were found to be at risk for adverse outcomes in addition to ileus, begging the question of whether these patients may benefit from preoperative optimization.

During the past 8 years, a total of 36 patients were diagnosed as having either ilioinguinal or genitofemoral neuralgia. A multidisciplinary approach (surgeon, neurologist, anesthesiologist) as well as local blocks of the ilioinguinal nerve or paravertebral blocks of L1,2 were essential to determine which nerve was likely to be entraped. Seventeen of the 19 patients having a diagnosis of ilioinguinal neuralgia after previous inguinal herniorraphy were completely free of pain after resection of the entrapped portion of the nerve. Seventeen patients were diagnosed as having genitofemoral neuralgia after previous inguinal herniorraphy, blunt abdominal trauma, or another operation. Neurectomy of the genitofemoral nerve proximal to the entrapment controlled the persistent pain in 12 of 17 of these patients. Ilioinguinal or genitofemoral nerve entrapment neuralgias are rare complications of operations in the inguinal region. When the diagnosis is made by a multidisciplinary approach, neurectomy is frequently successful in relieving severe pain and paresthesias without serious morbidity.