Introduction: Young individuals with colorectal cancer (CRC) tend to be diagnosed at advanced stages and are not routinely included in screening programmes. This study describes the incidence, disease pattern and factors affecting overall survival in young- onset CRC. Methods: A retrospective study of young-onset CRC patients diagnosed between 2010 and 2017 in a tertiary hospital was conducted. Results: There were 99 patients, 69.7% had left-sided while 30.3% had right-sided CRC. The mean age was 43.3 years (43.3±5.0) and 62 patients (62.6%) were male. The incidence of young-onset CRC has been on the rise since 2014. Out of 99 patients, 65 (65.7%) underwent elective surgery, 30 (30.3%) underwent emergency surgery and the remainder 5 (4.0%) were palliated. The most common presenting complaints for patients who underwent elective surgery were abdominal pain, per-rectal bleeding and altered bowel habits. For patients who required emergency surgery, 20 (66.6%) presented with intestinal obstruction and 10 (33.3%) had intestinal perforation. There were 42 (42.4%) stage III CRC and 20 (20.2%) stage IV CRC. The most frequent metastatic site was the liver (20/20, 100%). Five patients had signet ring cells (5.1%) in their histology while 15 (15.2%) had mucinous features. The overall 5-year survival of young-onset CRC was 82.0%. Advanced overall stage (hazard ratio (HR) 6.1, CI 1.03–3.62) and signet ring histology (HR 34.2, CI 2.24–5.23) were associated with poor prognosis. Conclusion: Young-onset CRC tend to be left-sided with advanced presentations. However, their 5-year survival remains favourable as compared to the general population. Keywords: Colorectal screening in the young, early-onset colorectal cancer, signet ring cell colorectal cancer
Aim: The Emergency Surgery and Trauma (ESAT) team is a dedicated consultant-led service to streamline the emergency surgical workload in Singapore. As acute appendicitis is one of the most common acute surgical conditions, we aim to compare outcomes of patients with appendicitis in the ESAT model as compared to the traditional on-call model. Methods: A retrospective review of patients admitted to Khoo Teck Puat Hospital, Singapore, with acute appendicitis between two periods: May-October 2014 (6 months pre-ESAT) versus January-June 2017 (post-ESAT). Patient demographics, operative details, efficiency, clinical outcomes, and hospital bill savings were evaluated. Results: There were 192 patients in the pre-ESAT period and 179 patients in the post-ESAT period. Patient demographics and comorbidities were comparable (P > 0.05). Time from emergency department referral to surgical review was significantly reduced in the ESAT period: 77.8 AE 46.9 min versus 127 AE 102 in the pre-ESAT period (P = 0.002). Time from case booking to operating theatre was significantly shorter in the ESAT period: 72.4 AE 55.2 min compared to 157.3 AE 209.1 (P < 0.01). More cases were carried out in the daytime during the ESAT period, 50.2% versus 39.1% (P = 0.029). The majority underwent laparoscopic appendectomy 156/179 (87.2%) in the ESAT period, with fewer open appendectomies 3/179 (1.7%) as compared to the pre-ESAT period (P = 0.062). There were higher intraoperative consultant supervision rates during the ESAT period, 38/166 (22.9%) as compared to 12/166 (6.7%) in the pre-ESAT period (P = 0.001). There were fewer complications (Clavien-Dindo grade II and above) in the ESAT period, 1 (0.6%) as compared to 6 (3.4%) pre-ESAT (P = 0.07). Conclusion: The ESAT service is associated with better efficiency outcomes for patients with acute appendicitis.
Dear Editor, Emergency laparotomy (EL) is a common procedure in the treatment of a myriad of potentially life-threatening abdominal conditions. Unlike elective surgery, EL is associated with high morbidity and mortality. 1-3 Compared to their younger counterparts, elderly patients are at higher risk of postoperative complications and mortality that are attributed to multiple comorbidities and reduced physiological reserves. 3-5 Additionally, patients who require EL tend to be critically ill with limited time for preoperative optimisation. Studies on EL have revealed substantial variations in processes and lack of coordination of EL care. 6-8 In the United Kingdom (UK), the National Emergency Laparotomy Audit (NELA) has shown a reduction in 30-day mortality from 11.8% to 9.5% since 2013. 6 In its third report, NELA described 9 key standards that can improve efficiency in the management of EL patients. To date, there is no standard practice in EL management in our institution and postoperative EL outcomes in Singapore are not known. In this study, we described EL outcomes in an acute hospital in Singapore, determined factors associated with 30-day mortality and explored perioperative outcomes in elderly patients.
faced the threat of the novel coronavirus disease 2019 (COVID-19) when it announced her first imported case on 23 January 2020. All inbound flights from Wuhan, China have ceased that day. On 30 January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a Public Health Emergency of International Concern. 1 The following day, Singapore recorded her first locally transmitted COVID-19 case. Within a week, on 7 February 2020, Singapore raised the "Disease Outbreak Response System Conditio" (DORSCON) level from Yellow to Orange as more new cases surfaced to suggest spread within the local community. 2 Since the escalation of the DORSCON level, attendance to Singapore's National Centre for Infectious Diseases (NCID) has been on a rise. Consequently, in addition to existing manpower from the emergency department in Tan Tock Seng Hospital, doctors from surgical specialties have been deployed to aid in the screening efforts at NCID. We had learnt from the severe acute respiratory syndrome (SARS) outbreak in 2003 that anxiety, isolation and depression are not uncommon amongst healthcare workers (HCWs), 3 highlighting the importance of support for HCWs. Similarly, in this COVID-19 outbreak, front-line HCW face a plethora of challenges. These include isolation due to reduced interaction with families and friends for fear of transmitting disease and adjustment issues while managing illnesses that are beyond their usual job scope. Furthermore, it is not uncommon for HCWs or their colleagues to be quarantined after exposure, succumb to illness or infectious diseases. Discomfort from long hours of donning personal protective equipment (PPE) and strict infection control measures may also result in fatigue. The sudden disruption in usual work commitments, training requirements or projected leave schedules may also result in disgruntlement and significant changes in personal life plans. Besides risk exposure at work, there are practical concerns regarding disease transmission between family members living in the same household. Experiences with the public's shunning of healthcare workers and increasing difficulty in booking public
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