No abstract

This study is one of the first to explore the CLIHMET database and the first to use it for investigating risk factors for POI development. Modifiable risk factors such as epidural anaesthesia and intraoperative blood transfusion should be used with caution in order to decrease POI rates.

Background/Aim: Preoperative radiochemotherapy (RCT) followed by total mesorectum excision has become the gold standard for locally advanced carcinoma of the low and middle rectum. The aim of the study is to evaluate the short and long-term outcomes of patients in complete pathological response (PR) following this treatment sequence. Patients and Methods: One hundred and thirty patients were retrospectively included between 2005 and 2017 in an expert centre, with 3 groups formed, according to the PR: i) complete PR (absence of tumour cells on the surgical specimen ypT0N0), ii) partial PR (T or N downsizing) and iii) without PR. Results: The complete PR rate was 13.1%. The complete PR group tended to develop less symptomatic fistulas compared to partial PR and without PR groups (5.8% versus 13.5% versus 18.7, respectively; p=0.607). The 5-year disease-free survival was increased for complete-PR patients (93% versus 79% versus 47%, respectively; p=0.0003) without an improvement in overall survival. Conclusion: Complete PR is associated with an improvement in survival without recurrence and without an improvement in the overall survival at 5 years.

Conversion to open surgery is reported in up to 20 per cent of laparoscopic colectomies for cancer. This study aims to compare postoperative outcomes and survival between converted and successful laparoscopic right colectomy for cancer. Records of patients who underwent laparoscopic right colectomy for cancer between 2005 and 2015 were retrieved from the CLermontFerrand Ircad Mondor Hopital European Tours (CLIMHET) database. Perioperative, postoperative, and survival outcomes were evaluated. Multivariate analysis was performed to identify predictive factors for conversion. Overall, 445 patients underwent a successfully completed laparoscopic right colectomy and 28 (5.9%) were converted to open surgery. A higher rate of minor complications was found in the conversion group, whereas patient recovery outcomes were similar. Previous open and laparoscopic surgeries were significant predictors of conversion. No significant difference was found in overall and disease-free survival rates between converted and nonconverted procedures. In the setting of laparoscopic right colectomy for cancer, the conversion rate is low and does not have an impact on patient survival. Conversion is associated with higher rates of minor postoperative complications but recovery and survival outcomes are comparable with successful laparoscopic colectomies. The present results support the use of laparoscopy for right colon resection even in patients at risk of conversion.