“Right hemicolectomy is considered one of the simplest colorectal major procedures and is often considered an appropriate first step for residents and young fellows. Despite this, complications after right hemicolectomy for cancer are common, at ≈30%, and postoperative mortality is reported to be ≈3%. Anastomotic leak (AL) after right hemicolectomy for cancer is a major contributor to this short-term morbidity and mortality. The document AL rate after right hemicolectomy ranges widely, from 1.3% to 8.4%. This also has a significant impact on healthcare costs and major oncologic consequences, as demonstrated by the higher cancer recurrence rate after AL.”
“Colorectal cancer is the second-leading cause of cancer-related mortality in both the United States and Europe. With respect to prognosis, increasing evidence has suggested that systemic inflammation is a key predictor of disease progression and survival for colorectal cancer patients undergoing surgery. Furthermore, whereas red blood cell (RBC) transfusions may be life-saving in some circumstances, there has been growing evidence that transfusions are associated with adverse postoperative outcomes, including infectious complications and cancer recurrence. These detrimental effects are thought to be related to systemic inflammation and transfusion-related immunomodulation (TRIM). Whereas the exact mechanisms remain unknown, TRIM seems to be related to various immunologic changes, including decreased interleukin (IL)-2 production, monocyte and cytotoxic cell activity inhibition, increased suppressor T-cell activity, and immunosuppressive prostaglandin release.”
“Abdominoperineal resection and pelvic exenteration for resection of malignancies can lead to large perineal defects with significant surgical-site morbidity. Myocutaneous flaps have been proposed in place of primary closure to improve wound healing. A systematic review was conducted to compare primary closure with myocutaneous flap reconstruction of perineal defects following abdominoperineal resection or pelvic exenteration with regard to surgical-site complications.”
“Angiomyolipoma (AML) is a solid mesenchymal tumor, mainly described in the kidney, and belongs to the group of perivascular epithelioid cell tumors (PEComas). Hepatic localization of AML, described for the first time in 1976, is rare, since only around 600 cases were reported after an exhaustive search of the literature up to the year 2017. Hepatic AML (HAML) poses a veritable diagnostic challenge in radiological terms, especially when fat content is low, because this type of tumor may appear as a hypervascular tumor associated with a washout phase that mimics other, more common hypervascular hepatic tumors, such as hepatocellular carcinoma”
“The reported complication rates after breast cancer surgery are low, with rates ranging from 2% to 50%, and are reportedly more common when performed in conjunction with axillary surgery and immediate breast reconstruction. A breakdown by procedure type has shown morbidity rates between 5% and 50% after mastectomy and from 3% to 35% after lumpectomy with or without reconstruction.”
“Anorectal infections in neutropenic leukemia patients are a significant and potentially life-threatening complication. The pathogenesis of this condition is not entirely understood and believed to be multifactorial, including mucosal injury as a result of cytotoxic drugs, profound neutropenia and impaired host defense. Establishing an early diagnosis is key and often made clinically on the basis of signs and symptoms, but also from imaging studies demonstrating perianal inflammation or fluid collection. The management of anorectal infections in neutropenic leukemia patients is not straightforward, as there are no well-conducted studies on this entity.”
“Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC).” “CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted. With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.”
“Conclusions: grey areas and opportunities for improvements
We found some limitations within the present guidelines:
– They fail to cover all the possible abdominal scenarios when colon cancer occurs as an emergency: for example, associated resections were not taken into considerations, neither we discussed about therapeutic strategies in case of evidence of peritoneal carcinomatosis. – Despite our attempts to underline suggestions in case of low technical resources, the present guidelines are generally oriented toward hospitals with high level of resources.
On the other side, in our opinion, the current guidelines suggest some stimuli for doctors involved in this field:
– To review the approach to patient suffering from abdominal pain by introducing and promoting the use of bedside abdominal US. – To bear in mind that the emergency surgeon should have a strong oncologic background or that the specialised colorectal surgeon should have a strong background of surgical pathophysiology, emergency surgery and damage control philosophy. – To promote the use of clinical pathways within singular Hospitals”
Surgical Focus 