In a training center, 1,131 inguinal hernias were repaired in 1,000 consecutive patients in 6 years. The documents of these patients were reviewed retrospectively for surgical complications. A total of 38 complications were encountered in 35 patients, including wound infection (1.9%), recurrence (0.9%), tethered testis (0.3%), bladder injury (0.3%), was deferens injury (0.2%), iatrogenic orchiectomy (0.1%), and postoperative death. Most of them occurred in the early years of the clinic, and nearly one-half were technical in nature. Careful training, stressing the importance of gentle handling of the tissues, and meticulous dissection with emphasis on learning groin anatomy should reduce the incidence of such complications.
Laparoscopic rectal surgery has advantages over open surgery with respect to short-term and long-term clinical results and when performed in high-volume centers.
The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors.Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann–Whitney U test and the Mantel–Cox log-rank sum test.A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics or surgical treatment between the patients who had positive CRM and who had negative CRM, but a higher positive CRM rate was observed in patients undergone abdominoperineal resection (APR) (P < 0.001). Advanced T-stage (P < 0.001), lymph node invasion (P = 0.001) and incomplete mesorectum (P = 0.007) were encountered significantly more often in patients with positive CRM status. Logistic regression analysis revealed that APR (P < 0.001) and open resection (P = 0.046) were independent predictors of positive CRM status. Moreover, positive CRM was associated with decreased 5-year overall and disease-free survival (P = 0.002 and P = 0.004, respectively).This large single-institution series demonstrated that APR and open resection were independent predictive factors for positive CRM status in rectal cancer. Positive CRM independently decreased the 5-year overall and disease-free survival rates.
The aim of this study is to compare survival rates between right and left colon cancers following curative intent oncologic resection. The data of right-(between cecum and proximal two-thirds of the transverse colon) and left-sided (between distal onethird of the transverse colon and distal sigmoid colon) colon cancer patients, operated with curative intent including central vascular ligation between January 2005 and 2015, were recorded in a prospectively compiled database. Epidemiologic and clinical characteristics (laparoscopic resection, multivisceral resection, lymph node yield, metastatic lymph node yield, pathologic stage, duration of operation), early post-operative results, and overall 5-year survival rates were abstracted. A total of 426 patients were included. There were no differences in epidemiologic and clinical characteristics between two groups (p > 0.05), except a higher median lymph node yield in right-sided colon cancers (31 vs 24, p ˂ 0.001). Cox regression analysis identified no differences in overall 5-year survival rates between right (76.9%) and left colon (76.4%) cancers (p = 0.752). In right-sided colon cancer group, 5-year overall survival was significantly higher with laparoscopic resection (60.5% vs 78.9%, p = 0.008). There were no significant differences in left-sided colon cancer group per surgical approach (p = 0.357). Curative intent oncologic resection with central vascular ligation provided similar overall 5-year survival rates in right-vs left-sided colon cancers. Laparoscopic resection provided a significantly increased 5-year overall survival in right colon cancer group.
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