Background: Spinal cord injury (SCI) has a significant impact on the quality of life (QoL) of affected patients. The aim of this review was to determine whether colostomy formation improves QoL in patients with SCI. Methods: The Cochrane Register, MEDLINE, Embase and CINAHL were searched using medical subject headings. The search was extended to the reference lists of identified studies, ClinicalTrials.gov and the WHO International Clinical Trials Registry. All clinical trials that included spinal injury and QoL, time spent on bowel care, and patient satisfaction with stoma were assessed. Results: A total of 15 studies were found (including 488 patients with a stoma), of which 13 were retrospective cross-sectional studies and two were case-control studies, one of which was prospective research. Nine of 11 studies focusing on QoL reported that patients' QoL was improved by the stoma, whereas the remaining two studies found no difference. Time spent on bowel care was significantly reduced in all 13 studies that considered this outcome, with patients reducing the average time spent on bowel care from more than 1 h to less than 15 min per day. All 12 studies assessing patient satisfaction with their stoma reported high patient satisfaction. Conclusion: Stoma formation improves QoL, reduces time spent on bowel care, and increases independence. Stoma is an option that could be discussed and offered to patients with spinal cord injury.

Background There is an increasing incidence of early-onset colorectal cancer; however, the psychosocial impacts of this disease on younger adults have been seldom explored. Methods A systematic review was conducted according to the PRISMA guidelines. The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PubMed, and Scopus were searched, and papers were included if published in English within the last 10 years and if they reported results separately by age (including early-onset colorectal cancer, defined as colorectal cancer diagnosed before the age of 50 years). Critical appraisal of all studies was done using the Joanna Briggs Institute tools. The primary outcome of interest was the global quality of life in patients with early-onset colorectal cancer. Secondary outcomes included the effect on sexual function, body image, finances, career, emotional distress, and social and family functioning. Results The search yielded 168 manuscripts and 15 papers were included in the review after screening. All studies were observational, and included a total of 18 146 patients, of which 5015 were patients with early-onset colorectal cancer. The studies included scored highly using Joanna Briggs Institute critical appraisal tools, indicating good quality and a low risk of bias, but data synthesis was not performed due to the wide range of scoring systems that were used across the studies. Six papers reported significant negative impacts on quality of life in patients with early-onset colorectal cancer. Three of the four studies that compared the quality of life in patients with early-onset colorectal cancer with older patients found that the younger group had worse mean quality-of-life scores (P ≤ 0.05). Secondary outcomes measured in five studies in relation to sexual dysfunction, body image, financial and career impacts, and social and family impacts and in eight studies in relation to emotional distress were found to be more severely impacted in those with early-onset colorectal cancer compared with those with late-onset colorectal cancer. Conclusion Whilst data are limited, the impact of colorectal cancer is different in patients with early-onset colorectal cancer compared with older patients in relation to several aspects of the quality of life. This is particularly prominent in areas of global quality of life, sexual functioning, family concerns, and financial impacts.

BackgroundThe overall incidence of colorectal cancer is decreasing in much of the world, yet the incidence in those under 50 years of age is increasing (early onset colorectal cancer (EOCRC)). The reasons for this are unclear. This study was undertaken to describe the clinical, pathological and familial characteristics of patients with EOCRC and their oncological outcomes and compare this with previously published data on late onset colorectal cancer (LOCRC).MethodsA retrospective review of all patients diagnosed with EOCRC in Canterbury between 2010 and 2017 was conducted. Data was collected on demographics, family history, treatment, and oncologic outcomes. Kaplan–Meier survival curves were calculated to assess overall survival based on disease stage.ResultsDuring the study period (2010–2017) there were 3340 colorectal cancers diagnosed in Canterbury, of which 201 (6%) were in patients under 50 years (range: 17–49). Of these, 87 (43.3%) were female and 125 (62.2%) were aged between 40 and 49 years. 28 (13.9%) were associated with hereditary conditions. Of the 201 patients, 139 (69.2%) had rectal or left‐sided cancers. 142 (70.6%) patients presented with either stage 3 or 4 disease and the 5‐year overall survival by stage was 79.1% and 14.4%, respectively.ConclusionEOCRC is increasing and usually presents as distal left sided cancers, and often at an advanced stage. They do not appear to have the common risk factors of family history or inherited pre‐disposition for colorectal cancer. Planning by healthcare providers for this epidemiological change is imperative in investigating symptomatic patients under 50 and optimizing early detection and prevention.

This article reviews common bile duct stones and describes our technique of laparoscopic common bile duct exploration (LCBDE) through a transverse choledochotomy at Hawke's Bay Hospital, New Zealand.

A 74-year-old man was diagnosed in 2014 with metastatic melanoma of unknown primary. The single 8-cm right upper lobe lung mass was identified incidentally on a routine abdominal aortic aneurysm surveillance scan. Computed tomography (CT)-guided fine-needle aspiration (FNA) confirmed the diagnosis of metastatic melanoma with FNA in this setting has a sensitivity and specificity of 0.97 and 0.98. 1 Clinical examination as well as a positron emission tomography (PET) CT failed to identify a primary lesion, however, also showed two small foci of increased activity just anterior to the inferior vena cava and in the duodenum. The lung lesion was PET positive. These other two foci, however, were never biopsied but were suspicious for further metastatic disease. He was later declined surgical resection of the lung mass following discussion with cardiothoracics (Figs 1,2).He admitted to 4 kg weight loss in recent months but denied any shortness of breath, cough, chest pain or malaise. He had no personal or family history of melanoma.His tumour was B-RAF negative; therefore, he was not a candidate for B-RAF or MEK inhibitors. In 2015, the New Zealand (NZ) public health system did not fund immunotherapy with checkpoint inhibitors. He was offered an anti-CTLA-4 antibody (Ipilimumab) which could be administered privately at a personal cost of NZ$120 000 for four doses. His only funded option was Dacarbazine which has a response rate of only around 8%, with no Fig. 3. Chest X-ray of the same patient 6 months later showing complete regression. A further chest X-ray 18 months after looked the same.