high number of comparisons, to enter the multivariate model a significance level of < 0.01 was used. Results Of 555 patients, 141 (25%) developed recurrence. Frequency of VI detection was 54%. On logistic regression, elastica detected VI, T stage, lymph node involvement, serosal involvement, margin involvement, tumour perforation, peri-tumoural inflammation (Klintrup grade) and tumour necrosis were predictors of recurrence (any site, all P < 0.05). Differentiation was not. On multivariate analysis VI (OR 3.27, P < 0.001), lymph node involvement (OR 2.34, P = 0.005), serosal invasion (OR 2.38, P = 0.005), Klintrup grade (OR 0.68, P = 0.037) were independently predictors of recurrence. Most recurrence was systemic (75%). The same features predicted systemic recurrence as did overall recurrence but on multivariate analysis, only VI (OR 2.90, P = 0.004), lymph node involvement (OR 2.27, P = 0.012) and necrosis (OR 1.63, P = 0.013) were independent predictors of systemic recurrence. In the 35 cases of local recurrence VI, T stage, lymph node involvement, serosal involvement and margin involvement were significantly related (P < 0.05). On multivariate analysis, only VI (OR 2.28, P = 0.057) and T stage (OR 2.53, P = 0.003) were independent predictors. Conclusion Whilst several pathological features predict local and systemic recurrence after surgery, VI detected at increased frequency (54%) with elastica stains was the only consistent, independent predictor of recurrence, at least as important as nodal spread. These results support implementation of routine measures such as elastica staining to optimise reporting of VI. Introduction Pivotal treatment for localised recurrent colorectal cancer is surgical resection. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) has been accepted as an effective tool to identify disease localizations for patients with known or suspected recurrent colorectal cancer. This study is to analyse the survival benefit of FDG-PET on the diagnosis and indication of surgical intervention for Methods Consecutive 61 patients, with known or suspected recurrence of colorectal cancer based on elevation of tumour markers or abnormal findings on the follow-up CT image, underwent FDG-PET for 85 times between December 2003 and September 2009. Patients were aged between 39 and 94 years (median 66); 35 were male, 22 were Duke's A or B stage, and 31 had a history of colon cancer. The average period between operation and first FDG-PET was 24 months (range 4-114). Of 61 cases 50 had elevated serum CEA or CA19-9 (82.0%). For each case the diagnosis of FDG-PET image was compared with that of CT image and the final diagnosis. Results Recurrence developed 2 times in average (range 1-6). Of 61patients five were identified recurrence by FDG-PET solely and indicated operation for 7 times. One of four shows disease-free survival for 70 months after common iliac replacement operation. FDG-PET showed one false-positive and three false-negative findings. Totally, the sensitivity of FDG-PET was 93.3% ...
Background: Transanal dissection of the rectum has been recently introduced for ileal pouch-anal anastomosis (IPAA) in UC showing promising results. Thanks to the precise identification of the rectotomy site the risk of long rectal stump is avoided, and a single stapled anastomosis is performed easily. The aim of this study is to analyze our initial experience of transanal IPAA (Ta-IPAA), considering postoperative complications and medium-term functional outcomes. Methods: Our Center has experienced the transanal approach for proctectomy and IPAA since October 2018. All patients underwent Enhanced Recovery After Surgery (ERAS) protocol. Postoperative complications occurring within 30 days after surgery were taken into consideration. Results: Until March 2019, 8 patients underwent Ta-IPAA. In all cases the laparoscopic approach was performed during the transabdominal phase; abdominal drainage was never used. At the time of the pouch construction a defunctioning ileostomy was created in all patients. Stoma closure was performed in all cases at a median time of 6 months after surgery. Postoperative complications occurred in only one patient, who showed rectal bleeding. There were no cases of anastomotic leakage. Medium-term functional outcomes were determined prospectively by a validated questionnaire (Cleveland Global Quality of Life). Fecal incontinence for liquid or solid stool, restriction in work and social genitourinary and sexual functions were also investigated. Conclusions: In our experience, Ta-IPAA provided good short and medium-term functional results in UC. Background Restorative proctocolectomy is widely adopted in the treatment of ulcerative colitis ,, , as well as in other inflammatory and neoplastic conditions, requiring an ileal pouch-anal anastomosis (IPAA) to reconstruct gastrointestinal continuity to the anus. Conventionally, either the laparoscopic or the open approach can be employed to gain rectal dissection and creation of ileal pouch-anal anastomosis. Pouch-anal anastomosis is usually made using a stapler, leaving a 2 cm rectal cuff in order to preserve continence and to reduce the risk of inflammatory recurrence or dysplasia. The dissection of the last centimeters of the rectum, rectum resection and ileal pouch-anal anastomosis could be demanding from a technical point of view due to narrow pelvic space and cross stapling of the distal part of the rectum is often challenging for surgeons. Transanal total mesorectal excision (TaTME) has been recently described in rectal cancer treatment, with potential technical and oncologic advantages compared to transabdominal approach. The transanal approach for the proctectomy has been described also in IPAA since 2015, showing feasibility and potential technical advantages; some series ,,, and initial comparative studies have been published , , showing a not increased rate of postoperative morbidity, equivalent quality of life and functional results. The aim of our study is to analyze a single centre experience of transanal IPAA (Ta-IPAA), examining e...
Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidencedbased enhanced perioperative protocol. Methods Studies were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of goodquality trials (quality of evidence and recommendations according to the GRADE system). Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced
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