Laser Doppler blood flow measurement in rectal resection for carcinoma — comparison between the straight and colonic J pouch reconstruction

Objectives: Our aim was to compare surgical treatment rates and survival rates for Aboriginal and non‐Aboriginal people in New South Wales with colorectal cancer, and to describe the medical treatment received by a sample of Aboriginal people with colorectal cancer. Design, setting and participants: All people diagnosed with colorectal cancer in NSW during 2001–2007 were identified and their cancer registry records linked to hospital admissions data and death records. A medical records audit of a sample of Aboriginal people diagnosed with colorectal cancer during 2000–2011 was also conducted. Main outcome measures: Cause‐specific survival, odds of surgical treatment, and the proportions of people receiving adjuvant treatments. Results: Of 29 777 eligible colorectal cancer cases, 278 (0.9%) involved Aboriginal people. Similar proportions of Aboriginal (76%) and non‐Aboriginal (79%) people had undergone surgical treatment. Colorectal cancer‐specific survival was similar for Aboriginal and non‐Aboriginal people up to 18 months after diagnosis, but 5 years post‐diagnosis the risk of death for Aboriginal people who had had surgical treatment was 68% higher than for non‐Aboriginal people (adjusted hazards ratio, 1.68; 95% CI, 1.32–2.09). Of 145 Aboriginal people with colorectal cancer identified by the medical records audit, 117 (81%) had undergone surgery, and 56 (48%) had also received adjuvant chemotherapy and/or radiotherapy. Conclusions: Aboriginal people with colorectal cancer had poorer survival rates than non‐Aboriginal people, although rates of surgical treatment, complications and follow‐up colonoscopy were similar. More work is needed to identify and understand why outcomes for Aboriginal people with colorectal cancer are different from those of other New South Wales residents.

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“…91 This may explain the anecdotal reports of a reduction in leakage seen after pouch-anal anastomosis. …”

Section: The Role Of Colonic Pouches After Elective Anterior Resectionmentioning

confidence: 98%

Comparing colorectal cancer treatment and survival for Aboriginal and non‐Aboriginal people in New South Wales

Weir

Supramaniam

Gibberd

et al. 2016

Medical Journal of Australia

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“…Hallbook et al demonstrated in 30 patients that the side of the bowel cm above the cut proximal end has a better blood supply than the cut end. 8,13,17 The authors felt this supported the use of aside-to-end technique and hence colonic pouches, but did not comment on a difference in flow depending on whether the ascending left colic artery was preserved. Hall et al demonstrated that sigmoid colon tissue oxygen tension decreased following inferior mesenteric artery origin ligation in an elegant study involving 62 patients.…”

Section: Resultsmentioning

confidence: 99%

Splenic flexure cancer optimum level of vessel ligation

Rao¹,

Reddy²,

Chilukoti³

2017

Int Surg J

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Background: Incidence of splenic flexure carcinoma is very low in colorectal cancer but often time presented in an advanced stage with high risk of obstruction, contributing poor prognosis. Aim of the study was to investigate the adequacy of vessel ligation in SFC in term of overall survival.Methods: 35 patients diagnosed with splenic flexure carcinoma enrolled and analyzed, patients categorized based on the level of vessel ligation as group-A, left branch of middle colic (LMA) and left colic artery division (LCA) compared, group-B, LCA and marginal of middle colic artery (MMC).Results: CEA marker was not significantly changed post-operatively, as it was within normal range preoperatively at an average of 9-12 µg/ml. There is no significance in staging of tumors in all stages, and recurrence of tumor is present in 5 in group A. Radical margins both proximal and distal ends are not significant. Tumor clearance achieved successfully in both arms in term of proximal margin achieved at 7.9±3.5cm in groups B and 8.3±4.1 cm in group A, p = 0.312. Distal margin reported at 8.7±4.1 cm and 8.9±3.98cm, p = 0.58, respectively. Lymph nodes are positive in group-A and group-B without any significance. Tumor size or diameter ranging from 5.1±3.1 in group-A and 4.76±3.8 in group-B. According to the cell differentiation, majority of the tumor grade turned out to be moderately differentiated cancer, rated at 14 patients (40.1%) in group A and 13 patients (37.1%) in group B. one patients found to be well or poorly differentiated cell tumors in group-A. Overall p-values were insignificant in regards tumor cell differentiation in both groups, p = 0.213. Incidence of lympho-vascular invasion reached only 3 (8.5%) vs. 4 patients (11.2%), p = 0.562, in A and B group.Conclusions: Higher level of vessel ligation has no added significance in overall outcome, but has role to lower the risk of recurrence rate in Splenic flexure carcinoma patients.

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“…The findings of the present study may be attributed to the fact that some studies without a protective stoma included only extraperitoneal anastomosis, while tension-free anastomosis was strictly performed in the present study by means of complete mobilization of splenic flexure, proximal ligation of inferior mesenteric vessels and no coloplasty or colonic pouch formation. There was evidence that side-to-end colorectal anastomosis which was performed in two-thirds of our patients provided better blood supply than straight reconstruction [17], and the long-term bowel function produced by this side-to-end procedure was as good as colonic pouch formation [18]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

Lohsiriwat

Lohsiriwat²,

Boonnuch³

et al. 2008

Dig Surg

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Background/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by a multivariate model to determine their association with anastomotic leakage. Results: The patients’ median age was 64 years. Median tumor height was 8 cm (range 3–15) from the anal verge. Overall 30-day mortality rate was 1.2%. Postoperative complications were diagnosed in 38 patients (22%) including 14 cases of anastomotic leakage (8.2%), of which 10 cases (71%) required surgical intervention. Tumor height within 5 cm from the anal verge was the only independent factor for leakage (OR 4.04; 95% CI 1.25–13.08). Conclusion: A sphincter-saving operation without a protective stoma and pelvic drain can be performed safely in the vast majority of rectal cancer patients. Tumor height within 5 cm from the anal verge is an independent risk factor for anastomotic leakage. Thus, the routine use of a protective stoma and pelvic drainage might be unnecessary.

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Laser Doppler blood flow measurement in rectal resection for carcinoma — comparison between the straight and colonic J pouch reconstruction

Cited by 135 publications

References 20 publications

Comparing colorectal cancer treatment and survival for Aboriginal and non‐Aboriginal people in New South Wales

Comparing colorectal cancer treatment and survival for Aboriginal and non‐Aboriginal people in New South Wales

Splenic flexure cancer optimum level of vessel ligation

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

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