Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8-10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743.
Although there is no statistically significant survival benefit in the whole series, there is a survival benefit for the subset of patients considered by the surgeon to have undergone a curative operation. We recommend that this form of adjuvant therapy should be offered to all patients with locally advanced rectal cancer who are to undergo radical surgery.
Local recurrence rates of rectal carcinoma have been analysed among 284 patients in a prospective randomized multicentre trial of adjuvant preoperative radiotherapy for locally advanced rectal carcinoma. Wide variations in local recurrence rates are demonstrated depending on the definition of local recurrence employed and the subgroup studied. Thus after surgical operation alone, rates as high as 43.3 per cent or as low as 12.7 per cent can be calculated. After both adjuvant preoperative radiotherapy and operation the overall local recurrence rate is 12.8 per cent, although the local recurrence rate inside the radiotherapy field (true recurrence) may be as low as 2.3 per cent. It is recommended that local recurrence after operation for rectal carcinoma be defined as any detectable local disease at follow-up, occurring either alone or in conjunction with generalized recurrence, in patients who have undergone resection. A rate should be given both for all patients and for those operated on for cure, but not for the latter group alone as this could introduce bias.
Background-Anterior chamber aspirates on completion of extracapsular cataract surgery contain significant numbers of organisms, particularly coagulase negative staphylococci, an important cause of endophthalmitis. Methods-Culture rates were compared in 50 patients after phacoemulsification surgery, which allows the possible benefits of a small, self sealing wound and maintenance of positive intraocular pressure, with a similar number of extracapsular cases.Results-A culture positive rate of 20% and 24% respectively was found, an insignificant difference. Conclusion-Small incision surgery has no proved advantage over extracapsular surgery in terms of reducing the intraoperative bacterial inoculum. The significance of this result in terms of causation of endophthalmitis is discussed. (Br_J Ophthalmol 1995; 79: 878-880) Recent studies by this and other groups have confirmed that the anterior chambers of eyes following extracapsular cataract surgery are frequently contaminated by small numbers of bacteria.1-3 Contamination rates of 29-43% have been reported. This group found a rate of 24% in two groups of 40 patients, and that preoperative topical antibiotics (norfloxacin, MSD) had no effect on culture rates. The organisms found are in small numbers (10-40 colony forming units/ml), and are most commonly skin commensals, especially coagulase negative staphylococci. These organisms are a leading cause of endophthalmitis. It has been assumed that one route of entry is from fluid circulating in the conjunctival sac at the time of surgery, but although both povidone-iodine4 5 and topical antibiotics6 are effective in reducing skin commensals (as shown by conjunctival swabs), efforts to sterilise the conjunctival sac preoperatively are only one approach to the problem, and according to our previous work may not be reducing intraocular contamination.Phacoemulsification allows a smaller wound, and is usually combined with a scleral tunnel which has a degree of self sealing properties. The eye is, therefore, less accessible to contamination from any external source, be it conjunctiva, lashes, or air. Studies of intraoperative pressure changes do suggest that positive intraocular pressure is easier to maintain with this type of wound,7 and this, together with the small wound, should minimise influx of conjunctival fluid from the wound margins.This study has been designed to examine the contamination of anterior chambers of eyes at the completion of phacoemulsification cataract surgery, and to compare this with previous observations from extracapsular surgery.
Materials and methodsFifty patients undergoing routine phacoemulsification cataract surgery were recruited into this prospective study. Written consent for aqueous samples to be taken was obtained. Exclusion criteria included: (a) history or evidence of previous surgery or penetrating injury to the eye; (b) local or systemic infection at the time of surgery; (c) perioperative complications such as posterior capsule rupture or conversion to extracapsular surger...
HAF. Intraoperative antegrade irrigation of the large intestine. Surg Gynecol Obstet 1983; 156: 3 Keetley CB. Quoted by Corbett RS in a review of the surgical treatment of chronic ulcerative colitis. Proc R Soc Med 1945; 4 Squire R, Kiely EM, Carr B, Ransley PG, Duffy PG. The clinical application of the Malone antegrade colonic enema.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.