A b s t r a c tThe distance between an adenocarcinoma and edge of a colonic resection specimen is one of the vital components in the assessment of excision adequacy. Surgeons strive to achieve a 5-cm length of bowel in the sigmoid and a 1-cm length in the rectum between the neoplasm and distal end of the specimen because shorter lengths are associated with local recurrence.1-3 We noticed almost routine disparate results in margin lengths when the specimen is measured in vivo by the surgeon and in vitro by the pathologist. Pathology and surgical lore attributes this difference to organ shrinkage during fixation. However, we have noticed that differences in margin length also occur in unfixed specimens. We studied sigmoid and rectum resection specimens to document the amount of organ shrinkage that occurs after surgical removal and fixation. These values can be used as correction factors when interpreting surgical margin lengths when margins are measured by the pathologist in fresh and fixed specimens.
Materials and MethodsWe studied 26 sigmoid and rectal resection specimens that were resected by one of us (J.S.). Of these, 18 specimens were resected for the treatment of adenocarcinoma, and the other 8 were resected for the treatment of diverticulitis. Two patients had adenocarcinoma and diverticulosis.All of the specimens were processed in an identical manner. 4 Before vascular devitalization and surgical removal, 2 serosal sutures were placed close to the lines of resection of each specimen. A ruler was used to measure 5.0 cm back from each of the sutures, and 2 additional serosal sutures were placed to mark these distances. The 5.0-cm distance was measured while the specimen was straightened
Presented is what is believed to be the first reported case of a defunctionalized limb of small intestine serving as a reservoir for Clostridium difficile. Because of the altered intestinal continuity, the ensuing enteritis and colitis failed to respond to nonoperative management. Current treatment strategies are reviewed. Surgical intervention, including restoration of normal gastrointestinal continuity, should be considered early in the hospital course of this patient population.
Patients with stage II disease had an improved survival when ≥24 lymph nodes were harvested, and patients with stage III disease had improved survival with up to a 36 node harvest. Male sex and poorly differentiated tumors had a worse prognosis, and tumors located in the sigmoid were associated with improved survival in stage II cancers. An increased lymph node harvest is recommended to improve survival in these stages.
No complications related to this technique were noted in this five-year review. Endoscopically assisted colostomy is an acceptable method for fecal diversion without the need for laparotomy and can be accomplished using a local or regional anesthetic with sedation.
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