Category Archives: Colorectal Surgery

Negative Pressure Wound Therapy Use to Decrease Surgical Nosocomial Events in Colorectal Resections

Posted on by
Reply

“Surgical site infection (SSI) is one of the most common complications following open colon and rectal surgery. Significant morbidity—secondary to increased length of stay, delay in adjuvant treatments, and psychosocial effects—has been well established in the literature. Further, SSIs confer additional monetary costs to the healthcare system.6 Despite best practice recommendations including prophylactic antibiotics and aseptic technique, SSIs remain common in open colorectal surgery. Rates of SSI in the literature range between 15
and 30%. Increased use of laparoscopy in colorectal surgery has significantly impacted rates of SSI but the uptake of laparoscopy has not been complete as certain patients are not candidates and conversion to open is required in approximately 15% of cases.”

Continue reading →

Simultaneous resection of primary colorectal cancer and synchronous liver metastases

Posted on by
Reply

Kleive D, et al. Simultaneous Resection of Primary Colorectal Cancer and Synchronous Liver Metastases: Contemporary Practice, Evidence and Knowledge Gaps. Oncol Ther. 2021 Jun;9(1):111-120. Free full-text.

Key Summary Points

  • High-level evidence in simultaneous resection of colorectal cancer and colorectal liver metastasis remains scarce.
  • Simultaneous resections may be considered in patients with good performance status and limited liver tumour burden.
  • Simultaneous resections should be avoided when requiring major liver resection and major colorectal resection.
  • Treatment strategies should be made by a multidisciplinary team.
  • Simultaneous resections should be performed as part of a clinical trial.
Continue reading →

Surgical Management of Liver Metastases From Colorectal Cancer

Posted on by
Reply

“Surgical resection remains one of the major curative treatment options available to patients
with colorectal liver metastases. Surgery and chemotherapy form the backbone of the
treatment in patients with colorectal liver metastases. With more effective chemotherapy
regimens being available, the optimal timing and sequencing of treatments are important. A
multidisciplinary approach with the involvement of medical oncologists and surgical
oncologists from the beginning is crucial.”

Continue reading →

Role of Deficient DNA Mismatch Repair Status in Patients With Stage III Colon Cancer Treated With FOLFOX Adjuvant Chemotherapy

Posted on by
Reply

“While most studies have found that patients with dMMR (vs proficient MMR [pMMR]) tumors have a more favorable stage-adjusted prognosis, other studies have not detected a significant difference in clinical outcome or have suggested that any favorable prognostic effect of dMMR is limited to patients with earlier-stage tumors. Furthermore, studies have shown that dMMR tumors may not benefit from fluorouracil-based adjuvant chemotherapy. However, the impact of MMR status remains controversial in the era of the standard FOLFOX adjuvant chemotherapy.
In a pooled analysis, we examined the association of MMR status with disease-free survival (DFS) in patients with stage III colon cancer treated with FOLFOX from 2 phase 3 randomized clinical trials.”

Continue reading →

Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: Foxtrot Study

Posted on by
Reply

“Preoperative (neoadjuvant) chemotherapy and radiotherapy are substantially more effective than similar postoperative therapy in oesophageal, gastric, and rectal cancer. Earlier treatment might be more effective at eradicating micrometastatic disease than the same treatment 3 months later, the typical period between diagnosis and starting postoperative chemotherapy, particularly because surgery increases growth factor activity in the early postoperative period, promoting more rapid tumour progression.”

Continue reading →

Management of the rectal stump after emergency sub-total colectomy

Posted on by
Reply

“Subtotal colectomy and ileostomy with preservation of the rectal stump is established as the preferred operation for acute severe colitis which fails to respond to medical therapy. The surgical management of the rectal stump, however, remains controversial. The options include creation of a low sigmoid mucous fistula, closure of the rectosigmoid but leaving the closed stump in the subcutaneous plane at the lower end of a midline wound, or closure of the rectal stump at the level of the sacral promontory (leaving the rectal suture ⁄ staple-line in the peritoneal cavity).”

Continue reading →

Life-threatening pelvis sepsis

Posted on by
Reply

“Although extremely uncommon, severe sepsis does occur post-treatment for haemorrhoids and all surgeons who treat such patients should be aware of the potential complications and alert to their presenting features. Early presentation without evidence of tissue necrosis may be managed conservatively, although most cases are managed by means of surgery.”

“Treatments for haemorrhoids can be divided in to conservative measures such as anal hygiene and topical ointments or suppositories, and interventions.

These are either office-based such as:
-injection sclerotherapy
-rubber band ligation (RBL)
-surgical procedures.

Haemorrhoidectomy has long been the mainstay of surgical therapy, but recently new techniques have been described, principally the stapled haemorrhoidopexy or procedure for prolapsing haemorrhoids (PPH).”

Continue reading →