Colorectal Disease 

About: Colorectal Disease is an academic journal published by Wiley-Blackwell. The journal publishes majorly in the area(s): Medicine & Colorectal cancer. It has an ISSN identifier of 1462-8910. Over the lifetime, 6331 publications have been published receiving 122684 citations. The journal is also known as: CDI.

Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome.

Abstract: Objective Total mesorectal excision (TME) as proposed by R.J. Heald more than 20 years ago, is nowadays accepted worldwide for optimal rectal cancer surgery. This technique is focused on an intact package of the tumour and its main lymphatic drainage. This concept can be translated into colon cancer surgery, as the mesorectum is only part of the mesenteric planes which cover the colon and its lymphatic drainage like envelopes. According to the concept of TME for rectal cancer, we perform a concept of complete mesocolic excision (CME) for colonic cancer. This technique aims at the separation of the mesocolic from the parietal plane and true central ligation of the supplying arteries and draining veins right at their roots. Method Prospectively obtained data from 1329 consecutive patients of our department with RO-resection of colon cancer between 1978 and 2002 were analysed. Patient data of three subdivided time periods were compared. Results By consequent application of the procedure of CME, we were able to reduce local 5-year recurrence rates in colon cancer from 6.5% in the period from 1978 to 1984 to 3.6% in 1995 to 2002. In the same period, the cancer related 5-year survival rates in patients resected for cure increased from 82.1% to 89.1%. Conclusion The technique of CME in colon cancer surgery aims at a specimen with intact layers and a maximum of lymphnode harvest. This is translated into lower local recurrence rates and better overall survival.

Risk factors for anastomotic leakage after anterior resection of the rectum

Abstract: Objective. Surgical technique and peri-operative management of rectal carcinoma have developed substantially in the last decades. Despite this, morbidity and mortality after anterior resection of the rectum are still important problems. The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re-operations in relation to anastomotic leakage.Patients and methods. In a nine-year period, from 1987 to 1995, a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. A random sample of 432 of these patients was analysed (sample size 6.3%). The associations between death and 10 patient-and surgery-related variables were studied by univariate and multivariate analysis. Data were obtained by review of the hospital files from all patients.Results. The incidence of symptomatic clinically evident anastomotic leakage was 12% (53/432). The 30-day mortality was 2.1% (140/6833). The rate of mortality associated with leakage was 7.5%. A temporary stoma was initially fashioned in 17% (72/432) of the patients, and 15% (11/72) with a temporary stoma had a clinical leakage, compared with 12% (42/360) without a temporary stoma, not significant. Multivariate analysis showed that low anastomosis (≤ 6 cm), pre-operative radiation, presence of intra-opcrative adverse events and male gender were independent risk factors for leakage. The risk for permanent stoma after leakage was 25%. Females with stoma leaked in 3% compared to men with stoma who leaked in 29%. The median hospital stay for patients Arithout leakage was 10 days (range 5-61 days) and for patients with leakage 22 days (3-110 days).Conclusion. In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.

Single-port laparoscopy in colorectal surgery

Abstract: Purpose Laparoscopy is the approach of choice for the majority of colorectal disorders that require a minimally invasive abdominal operation. As the emphasis on minimizing the technique continues, natural orifice surgery is quickly evolving. The authors utilized an embryologic natural orifice, the umbilicus, as sole access to the abdomen to perform a colorectal procedure. Herein, we present our initial experience of single-port laparoscopic colorectal surgery using a Uni-X™ Single-Port Access Laparoscopic System (Pnavel Systems, Morganville, New Jersey, USA) with a multi-channel cannula and specially designed curved laparoscopic instrumentation. Method The abdomen was approached through a 3.5 cm incision via the umbilicus and a single-port access device was utilized to perform a right hemicolectomy on a patient with an unresectable caecal polyp and a body mass index of 35. Ligation of the ileocolic artery was done with a LigaSure Device™ (Covidien Ltd, Norwalk, Connecticut, USA), and was followed by colonic mobilization, extraction and extracorporeal ileocolic anastomosis. Results The total operative time was 115 min with minimal blood loss. Hospital stay was 4 days with no undue sequelae. Conclusion Single-port laparoscopic surgery may allow common colorectal laparoscopic operations to be performed entirely through the patient’s umbilicus and enable an essentially scarless procedure. Additional experience and continued investigation are warranted.

Association of Coloproctology of Great Britain and Ireland

Abstract: The Association of Coloproctology of Great Britain and Ireland has been approached by the Royal College of Surgeons on behalf of a Coroner to remind colorectal and general surgeons about the risk of large bowel obstruction caused by inadvertent delivery of the wrong end of divided bowel when fashioning an end colostomy. Risks may be increased when the trephine method is employed, especially trephine sigmoid colostomy (1,2,3). The sigmoid colon is normally identified by the presence of appendices epiploicae and absence of omentum, but errors may occur with: Trephine stoma [1, 2] Trephine sigmoid colostomy, normally identified by appendices epiploicae and absence of omentum, risks: • delivery of transverse colon in error; • difficulty in identifying the ideal segment for the stoma; • closure of the proximal segment and maturation of the distal defunctioned segment, resulting in complete colonic obstruction. It is surprising that there are few publications describing this problem, which can potentially lead to perforation and fatal peritonitis. Yet no doubt there are some colorectal surgeons, including myself, who will be anecdotally aware of such cases. So what precautions should be taken? 1 Be aware of the possibility. 2 For a sigmoid colostomy, set up in the Lloyd Davis position. It is essential to have access to the anus to allow insufflation of air to identify the proximal and distal ends of the sigmoid before dividing the bowel. With this manoeuvre, the correct end will always be brought out. 3 Consider a loop stoma, if clinically appropriate, but bear in mind that redundant bowel might still twist and obstruct. 4 After construction of an end colostomy with laparotomy, check the underside of the trephine to ensure that the ‘proximal’ end has been delivered through the trephine, and consider marking the proximal end with an identifiable suture before delivery. 5 With a trephine sigmoid colostomy consider the following alternatives: • Combining flexible sigmoidoscopy and air insufflation with either laparoscopy, or a short midline laparotomy [1]; • Insufflating air via an enterotomy in the sigmoid loop toward the rectum to confirm the distal end [3]. • Occluding the bowel with a soft clamp and inflating air from the anus. However, this may be inadequate, as inflation of a redundant divided distal segment may increase intra-abdominal pressure sufficient to cause flatus to emerge from the proximal colon [2]. • an intra-operative water soluble contrast enema [5]. 6 Orientation of a trephine ileostomy is facilitated by identification of the antimesenteric fat in the distal few centimeters of terminal ileum and ⁄ or caecum. Before delivery through the trephine, the proximal loop is ideally orientated inferiorly to achieve an optimal spout. After delivery, the distal loop should be marked to ensure that the proximal and not the distal loop is spouted. 7 Laparoscopically assisted stoma formation aids identification of the terminal ileum or sigmoid and facilitates orientation, and is probably associated with less bleeding than the trephine method [6]. 8 If the stoma fails to function after 5–7 days, arrange a CT abdominal scan and, if necessary, a water-soluble contrast enema. Evolving large bowel obstructionmay be difficult to differentiate clinically from postoperative ileus.

A meta‐analysis of the association of physical activity with reduced risk of colorectal cancer

Abstract: Background Physical activity may be associated with reduced risk of colorectal cancer. The main aim of this paper is to review the available evidence for a link between exercise and large bowel cancer. Methods A Cochrane-type methodology was performed. Data extracted included, type of study, type of physical activity measured and the numerical results. The risk ratios (RR) of the studies have been pooled according to the type of study, type of exercise, type of cancer and sex. Pooling was undertaken using fixed effect meta-analysis. A random effect meta-analysis was used where substantial heterogeneity existed. Result Data from 19 cohort studies showed a statistically significant reduction in the risk of colon cancer in physically active males, RR being 0.79 (95% CI 0.72–0.87) and 0.78 (95% CI 0.68–0.91) for occupational and recreational activities, respectively. In women only recreational activities are protective against colon cancer (RR = 0.71, 95%CI 0.57–0.88). Case-control studies showed significantly reduced risks of colon cancer in both sexes irrespective of the type of activity. No protection against rectal cancer is seen in either sex. Conclusion There is considerable evidence that physical activity is associated with reduced risk of colon cancer in both males and females.