Recently there has been recognition that conventional colonic surgery may be suboptimal [1], particularly in comparison to rectal cancer where standardized surgery (total mesorectal excision, TME) has become the accepted technique [2,3]. Resection along embryological avascular mesorectal fascial planes results in an intact specimen including regional lymphatics, vessels and surrounding fatty tissue bounded by the mesorectum [4]. This reduces local recurrence rates and improves disease-free and overall survival [5].
Aim: This systematic review aims to assess dehydration prevalence and dehydrationrelated morbidity from diverting ileostomy compared to resections without ileostomy formation in adults undergoing colorectal resection for cancer.Method: MEDLINE, Embase, CENTRAL and ClinicalTrials.gov were searched for studies of any design that reported dehydration, renal function and dehydration-related morbidity in adult colorectal cancer patients with diverting ileostomy (last search 12 August 2020). Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials and the Risk of Bias in Non-randomized Studies of Interventions tool.Results: Of 1927 screened papers, 22 studies were included (21 cohort studies and one randomized trial) with a total of 19 485 patients (12 209 with ileostomy). The prevalence of dehydration was 9.00% (95% CI 5.31-13.45, P < 0.001). The relative risk of dehydration following diverting ileostomy was 3.37 (95% CI 2.30-4.95, P < 0.001). Three studies assessing long-term trends in renal function demonstrated progressive renal impairment persisting beyond the initial insult. Consequences identified included unplanned readmission, delay or non-commencement of adjuvant chemotherapy, and development of chronic kidney disease.Discussion: Significant dehydration is common following diverting ileostomy; it is linked to acute kidney injury and has a long-term impact on renal function. This study suggests that ileostomy confers significant morbidity particularly related to dehydration and renal impairment.
Background: People with diabetes mellitus (DM) have higher long-term mortality following abdominal aortic aneurysm (AAA) repair than those without DM. However, whether this adverse outcome is directly related to their aneurysm is unclear. Aims: To determine the rates of complications in people with and without DM post endovascular abdominal aortic aneurysm repair. Primary outcome data include AAA sac enlargement, reinterventions, endoleaks, post-operative AAA rupture and conversion to open surgical repair. Methods: PubMed, Embase and Cochrane databases were searched for primary research studies between 2005 and 2023 according to PRISMA guidelines. Those undergoing AAA repair via endovascular aneurysm repair were included. Results: Thirty-five studies were identified totalling 90,347 people in the control group, and 17,660 in the DM group. Those with DM had a lower rate of reintervention compared to controls (9.94% v 11.58%; OR 0.89, 95% CI [0.82-0.97]; P=0.005), however there was no significant difference in the rate of overall, type I or type II endoleaks (P=0.22, P=0.29, P=0.15 respectively). People with DM were also less likely to have sac enlargement post AAA repair (9.66% v 11.27%; OR 0.79, 95% CI [0.68-0.93]; P=0.003). Additionally, people with DM had a significantly reduced rate of conversion to open surgery (2.11 % DM v 3.12% control; OR 0.80, CI [0.66-0.97]: P=0.02). Conclusion: Reinterventions, sac enlargement post AAA repair, and conversion to open surgical repair were significantly lower in people with DM, however the cause for these differences remains unclear.
Introduction Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes. Method A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years. Results 3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group. Conclusions CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.
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