Sigmoid Colectomy Research Articles

Operative management of anastomotic leak after sigmoid colectomy for left-sided diverticular disease: Ileostomy creation may be as safe as colostomy creation.

The management of anastomotic leak after sigmoid colectomy for diverticular disease has not been well defined. Specifically, there is a lack of literature on optimal types of reoperations for leaks. The aim of this study was to describe and compare reoperative approaches and their postoperative outcomes. We performed a retrospective cohort study using the NSQIP Colectomy Module (2012-2019) and single-institution chart review. Patients with diverticular disease who underwent elective sigmoid colectomy were included. Primary outcomes were anastomotic leak requiring reoperation and management of anastomotic leak. Of 37,471 patients who underwent sigmoid colectomy for diverticular disease, 1003 (2.7%) suffered an anastomotic leak, of whom 583 underwent reoperation. Of the 572 patients who were not initially diverted and underwent reoperation for leak, 302 (52.8%) were managed with stoma creation - 200 (35.0%) with colostomy and 102 (17.8%) with ileostomy. The remaining 47.2% underwent colectomy with reanastomosis, suturing of large bowel, and drainage. There were no differences in length of stay, readmission, or mortality between patients who underwent ileostomy or colostomy at reoperation (p > 0.05). Single-institution analysis demonstrated that 100% of patients with ileostomies underwent subsequent ileostomy closure, compared to 60% of patients with colostomies. In patients who suffer anastomotic leaks after sigmoid colectomy for diverticular disease and undergo reoperations, ileostomy at the time of reoperation appears to be safe, with comparable results to colostomy. Ileostomies were more frequently closed than colostomies. When faced with a colorectal anastomotic leak, ileostomy creation may be considered.

SAGES masters program: the top 10 seminal articles for the laparoscopic left and sigmoid colectomy pathway for complex disease.

The SAGES University Colorectal Masters Program is a structured educational curriculum that is designed to aid practicing surgeons develop and maintain knowledge and technical skills for laparoscopic colorectal surgery. The Colorectal Pathway is based on three anchoring procedures (laparoscopic right colectomy, laparoscopic left and sigmoid colectomy for uncomplicated and complex disease, and intracorporeal anastomosis for minimally invasive right colectomy) corresponding to three levels of performance (competency, proficiency and mastery). This manuscript presents focused summaries of the top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease. A systematic literature search of Web of Science for the most cited articles on the topic of laparoscopic complex left/sigmoid colectomy yielded 30 citations. These articles were reviewed and ranked by the SAGES Colorectal Task Force and invited subject experts according to their citation index. The top 10 ranked articles were then reviewed and summarized, with emphasis on relevance and impact in the field, study findings, strength and limitations and conclusions. The top 10 seminal articles selected for the laparoscopic left/sigmoid colectomy for complex disease anchoring procedure include advanced procedures such as minimally invasive splenic flexure mobilization techniques, laparoscopic surgery for complicated and/or diverticulitis, splenic flexure tumors, complete mesocolic excision, and other techniques (e.g., Deloyers or colonic transposition in cases with limited colonic reach after extended left-sided resection). The SAGES Colorectal Masters Program top 10 seminal articles selected for laparoscopic left and sigmoid colectomy for complex benign and malignant disease anchoring procedure are presented. These procedures were the most essential in the armamentarium of practicing surgeons that perform minimally invasive surgery for complex left and sigmoid colon pathology.

Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused.

Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation before elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semielective, same-admission sigmoid resection for acute volvulus. Patients from the 2012 to 2019 Colectomy-Targeted American College of Surgeons NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included. Multivariable logistic regression was used to compare the risk-adjusted 30-day postoperative outcomes of patients who received combined preoperative bowel preparation with those of patients who received either partial (mechanical or oral antibiotic alone) or incomplete bowel preparation. Effort was made to exclude patients whose urgency of clinical condition at hospital admission precluded an attempt at preoperative decompression and subsequent bowel preparation. Included were 2,429 patients, 322 (13.3%) of whom underwent complete bowel preparation and 2,107 (86.7%) of whom underwent partial or incomplete bowel preparation. Complete bowel preparation was protective against several postoperative complications (including anastomotic leak), mortality, and prolonged postoperative hospitalization. This study demonstrates a significant benefit for complete bowel preparation before semielective, same-admission sigmoid resection in patients with acute sigmoid volvulus. However, only a small percentage of patients in this national sample underwent complete preoperative bowel preparation. Broader adoption of bowel preparation may reduce overall rates of complication in patients who require sigmoid colectomy due to volvulus.

The SAGES MASTERS program presents: the top 10 seminal articles for laparoscopic left and sigmoid colectomy pathway for uncomplicated disease.

As one of the 8 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program clinical pathways, the Colorectal Pathway aims to deliver educational content for the general surgeon organized along 3 levels of performance (competency, proficiency and mastery) each represented by an anchoring procedure. In this article, the SAGES Colorectal Task Force presents focused summaries of the top 10 seminal articles selected for laparoscopic left/sigmoid colectomy for uncomplicated disease. Using a systematic literature search of Web of Science, the most cited articles on laparoscopic left and sigmoid colectomy were identified, reviewed, and ranked by members of the SAGES Colorectal Task Force. Additional articles not identified in the literature search were included if deemed impactful by expert consensus. The top 10 ranked articles were then summarized, including their findings, strengths and limitations with emphasis on relevance and impact in the field. The top 10 articles selected focus on variations in minimally invasive surgical techniques, video demonstrations, stratified approaches for benign and malignant disease as well as assessments of the learning curve. The selected top 10 seminal articles for laparoscopic left and sigmoid colectomy in uncomplicated disease are considered by the SAGES colorectal task force to be fundamental to the knowledge base of minimally invasive surgeons as they progress to mastery in these procedures.

Isolated diffuse intestinal ganglioneuromatosis presented as a redundant sigmoid colon: a case report.

A 38-year-old man presented with refractory chronic constipation. An abdominal computed tomography scan revealed a redundant sigmoid colon, then he underwent a sigmoid colectomy. Histopathologic examination showed diffuse ganglioneuromatosis. However, the patient was in good health 18 months after surgery. Intestinal ganglioneuromas commonly occur in children with systemic syndromes such as multiple endocrine neoplasia type 2B and neurofibromatosis type 1. The most frequent symptoms are abdominal discomfort, constipation, ileus, weight loss, appendicitis, and obstruction in more severe cases. surgical resection is the standard management in diffuse ganglioneuromatosis. Although diffuse ganglioneuromatosis is uncommon, it should be considered in patients with refractory constipation.

AN UNUSUAL MANIFESTATION OF METASTATIC CROHN’S DISEASE: A CASE REPORT

Abstract INTRODUCTION Crohn’s Disease (CD) is a chronic granulomatous inflammatory disease involving any section of the gastrointestinal (GI) tract. Metastatic Crohn’s Disease (MCD) is a rare extraintestinal manifestation of CD defined as cutaneous granulomatous lesions non-adjacent to the GI tract. We present a case of suppurative lymphadenitis as a presentation of MCD. This has not yet been reported in the literature. CASE REPORT A 22-year-old female with a history of iron deficiency anemia and left calf abscess, secondary to Methicillin-Resistant Staphylococcus Aureus (MRSA) infection, was diagnosed with ileocolonic CD at 18. Her CD was complicated by strictures and abdominal and left tubo-ovarian abscesses with a fistula to the sigmoid. She underwent Ileocolonic resection, sigmoid colectomy and left salpingo-oophorectomy. Histology of the ovarian abscesses unveiled granulation tissue with pseudocysts. Azathioprine and Infliximab were started. At 20, the patient reported acute onset of swelling and pain on the left side of her neck. She denied any constitutional symptoms, sick person or animal contacts, travel, use of recreational drugs and sexual activities. Physical exam was remarkable for a tender, rubbery, 2-centimetre left cervical lymph node. The neck Ultrasound showed cervical lymphadenitis. Antibiotic was started and later extended to target resistant infections. Despite this, she reported worsening symptoms. Computed Tomography of the neck noted a collection suggestive of suppurative lymphadenitis. Incision and Drainage (I & D) of the abscess was done; MRSA was detected. Histology exposed necrotizing granulomata encircled by palisading histocytes and giant cells. There was no evidence of dysplasia, fungal, acid-fast bacilli or spirochetes. Further, Human Immunodeficiency Virus serology, Interferon-Gamma Release Assay and chest radiograph were unremarkable. Later, she underwent surgical excision revealing a fistula to the lower mandible. A drain was placed and then removed upon recovery. Meantime, her CD stayed stable; Infliximab was held till the completion of antibiotics. A year later, she reported a tender, swollen lump on the left side of her groin with an ultrasound confirming inguinal suppurative lymphadenitis. Antibiotics were started, and I &D was done for lasting symptoms. The culture and histology were similar to the previous. Considering the history of CD and histology findings, MCD was concluded as the etiology of this patient’s recurrent MRSA abscesses. CONCLUSION Patients on biologic therapy are immunocompromised and presumed high risk for super-infections. In a setting of a persistent infection, despite antibiotics, the possibility of MCD as the cause of lymphadenitis should be raised to cue the clinician to alter therapy and address the MCD within a multidisciplinary setting.

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Long-Term Quality of Life after Acute Uncomplicated Diverticulitis: A Cross-Sectional Study

Background: Diverticulitis is a common medical condition that usually affects older patients. Antibiotic therapy in patients with acute uncomplicated diverticulitis (AUD) has been questioned. Currently, there is limited data on the quality of life (QoL) of patients after AUD. Objectives: The aim of this study was to investigate the long-term QoL in patients with AUD and to assess if antibiotic therapy or recurrent disease impacts the QoL of patients. Design: Cross-sectional questionnaire study. Setting: Two teaching hospitals in Southern Sweden. Patient and Methods: The records of patients who were treated for AUD from 2015 to 2017 were extracted, and their medical charts were used to gather data. Three questionnaires (EuroQol-5 Dimension-5L, the Gastrointestinal Quality of Life Index, and the short health scale) were sent 3–5 years after hospitalization (year 2020) to evaluate the QoL of the patients. Main Outcome Measure: Long-term QoL measured by the aforementioned questionnaires. Sample Size: The original cohort was reduced to 509 due to death, duplications, and sigmoid colectomy. The final patient cohort consisted of 273 patients after exclusion of non-responders or patients who declined participation. Results: In the EuroQol-5 Dimension scale, 147 (55%) patients reported problems in one or more QoL dimension but only 4% experienced severe problems. The Gastrointestinal Quality of Life Index median score was 105.0 (90.0–113.8), while the median short health scale score was 4.0 (0.9–12.5). Among the patients, 76% were treated with antibiotics, but no differences were observed between the antibiotics and no antibiotics groups in any QoL score. Recurrent disease was associated with lower QoL scores. Conclusion: This study showed that 161 (59%) of the patients with AUD experienced QoL problems, with recurrent disease being a risk factor. Antibiotic therapy did not affect the long-term QoL of the patients. Larger prospective studies are needed to confirm these results, and future efforts should be made to prevent the recurrence of AUD. Limitations: Limited sample size, non-randomized study. Conflict of Interest: The authors have no conflict of interest to declare.

The Extraperitoneal Approach to Left-Sided Colorectal Rectal Resections: EXPERTS Procedure.

Current transperitoneal approaches to colorectal resections can be technically challenging, especially in obese patients. The head-down position can lead to rare but serious complications, e.g. compartment syndrome and brachial plexus injuries. The aim of this study was to assess the safety and feasibility of a novel extraperitoneal approach in patients requiring anterior resection. The extraperitoneal left-sided approach was performed in the supine position. A 5cm LIF incision was created into which a Gelpoint port was inserted. The full video of the procedure is embedded in the QR code below. The procedure was performed by three surgeons with experience in minimally invasive surgery. Patients requiring left colonic resections were prospectively selected over a 2-year period. Forty-one patients were prospectively assessed between March 2020 and April 2022; 26 were males, with a median age of 67 (55-88)years. The average body mass index (BMI) was 30 (22-40). 38/41 cases were cancers and three were diverticular diseases; 31 cases had anterior resection and 11 had sigmoid colectomies. Peak airway pressures were significantly less (10 cmH20) in the supine position compared with the head-down position (p<0.0001). Median time to identify the ureter and gonadal vessels was 23 (3-55)min, and median time to return of bowel function and length of stay was 2 (0-13) and 5 (IQR 3-7) days, respectively. No intraoperative complications or postoperative mortality occurred within 90 days of discharge. Three patients had anastomotic complications, and an R0 resection was achieved in all 38 cancer patients. The median lymph node count was 16. Extraperitoneal surgery for left colonic resections is safe and clinically feasible, and allows for early identification of important retroperitoneal structures.

OGC P36 Unmet needs in survivorship: Increased anxiety post oesophago-gastric cancer surgery

Abstract Background Oesophago-Gastric (OG) cancer is an aggressive malignant disease, and patients are offered extensive surgical treatment often in combination with neoadjuvant and adjuvant oncological intervention. The treatment process is emotionally demanding and affects treatment outcomes (Fangand, &amp; Schnoll, 2002). However, the available research is concentrated on generalised anxiety and depression (Hellstadius et al, 2017), despite the unique concerns of this cohort. This study examines the trajectory of patients’ unique OG symptoms related anxiety through utilising a specialist measure. Methods The Oesophageal Anxiety and Hypervigilence Scale (EHAS) is a newly validated self-report questionnaire that detects oesophageal anxiety in patience with GI disorders. It has been shown to demonstrate good internal consistency and validity (Taft et al, 2018). Patients with oesophageal cancer were recruited from at Guy's and St Thomas’ Hospital, London. As part of their routine clinic appointments between September 2021-February 2022, patients completed the EHAS measure across four key time points within their treatment trajectory; diagnosis (Time 1), pre-operatively (Time 2), two weeks post operatively (Time 3), and 6–12 months post operatively, often termed ‘survivorship’ (Time 4). Results A total of 106 EHAS measures were completed by 83 patients (79% male, 20% female, mean age = 64) at different stages within their treatment trajectory, representing a between-subjects design. 61% of patients underwent oesophagectomy, 22% total gastrectomy, 10% subtotal gastrectomy and 7% underwent other surgeries including sigmoid colectomy, and jejunal resection. Pooling the sample z-score, the cut off score for clinical significance was calculated at 33. The EHAS outcomes revealed high anxiety at Time 1 (T1 mean = 28/33) which decreased by 32% from to Time 2 (T2 mean = 19/33). Anxiety remained low in the period between Time 2 to Time 3 (T3 mean = 21/33). Surprisingly, anxiety scores increased by 42% from Time 3 to Time 4 (T4 mean = 29/33), matching the elevated levels observed at Time 1. Other important findings related to the proportion of patients that scored above clinical cut off. Whilst 12% of patients scored above cut off at Time 1, this rose to 32% at Time 4, indicating marked anxiety during the phase of recovery greater than that experienced at diagnosis. At this level of analysis there is no evidence to indicate a relationship between type of surgery and elevated anxiety. Conclusions With the use of a specialist anxiety measure, we demonstrate that oesophageal anxiety is common among OG cancer patient cohort. The trajectory of anxiety observed in this study has clinical implications for the timing of support and enhanced recovery programme; this study revealed that OG anxiety fluctuated across the treatment pathway, and peaked at two distinct time points; diagnosis and survivorship. This challenges the often held assumption that patients anxiety increases pre-operatively (Hellstadius et al, 2017), and instead refocuses the need for input at both the diagnosis and survivorship periods. The high anxiety observed at the survivorship stage may also affect patients’ ability to process and adhere to treatment advice, further exacerbating their symptoms and jeopardising their physical recovery. Patients are monitored less during their survivorship period as the intensity of treatment cease, however the results indicate need for continued input.

S195 Is There a "Golden Window" for Endoscopic Reduction of Acute Sigmoid Volvulus: A Multicenter Retrospective Study

Introduction: Colonic volvulus accounts for around 2% of all bowel obstructions in the United States. the involvement of the sigmoid colon consists of the overwhelming majority of colonic volvulus cases, possibly 60.9–80%. [1]. Per the American Society of Gastrointestinal endoscopy guidelines (ASGE), Non-operative detorsion with flexible sigmoidoscopy is considered first-line therapy in the management of sigmoid volvulus in patients without signs of peritonitis, perforation, or with recurrent or unsuccessful nonoperative decompression [2][3][4]. Despite this recommendation, the ideal timing for endoscopic intervention remains unclear. Methods: We conducted a retrospective study in adult patients admitted for acute sigmoid volvulus in 4 academic centers from January/2010-January/2020. 47 Patients were identified using ICD-9 and ICD-10 codes. Inclusion criteria included adult patients who were initially managed with endoscopic detorsion. The time interval between diagnosis and endoscopic intervention was collected. Primary outcomes included the need for subsequent urgent surgical intervention within 30 days of the endoscopic intervention. Secondary outcomes were hospital length of stay and mortality. Results: A total of 47 patients met the inclusion criteria. 33 patients were males (70.2%). The mean age of the sample was 71.0 (±16.5) years. Successful non-surgical reduction was achieved in 43 patients (91.5%). Endoscopic intervention was aborted in 4 patients for concerns of bowel ischemia or nonviable mucosa. 31 (66%) patients required urgent surgical intervention within 30 days of the endoscopic reduction, with an average interval period of 7 (±8.5) days. Surgical interventions included Hartmann’s procedure, sigmoid colectomy with primary colorectal anastomosis, and total abdominal colectomy. Early endoscopic reduction resulted in fewer subsequent urgent and emergent surgical interventions (p-value = 0.013). Using the ROC curve, a cut-off point of 8.5 hours was determined to be predic table of favorable outcomes with a sensitivity and specificity of 74.2%, and 75%, respectively. (Figure) Early endoscopic intervention was associated with shorter hospitalization (p-value = 0.001). Conclusion: Endoscopic decompressive intervention within 8.5 hours of diagnosis of acute sigmoid volvulus decreased early volvulus recurrence, bowel ischemia and subsequent need for urgent surgical interventions. This in return decreased hospital length of stay and allowed for planned prophylactic surgical resection.Figure 1

S2202 A Rare Case of Colonic Intussusception After Self Expandable Metal Stent Placement

Introduction: Endoscopically placed colonic stenting is a palliative measure that can be used for unresectable etastatic colon cancer. It is a relatively safe procedure with a low mortality rate of about 1%. Intussusception is a rare complication of colonic stenting that occurs when the bowel telescopes about itself, possibly leading to obstruction or ischemia. Here we present a patient with intussusception 6 days after placement of a self-expandable rectosigmoid metal stent. We demonstrate successful reduction of rectosigmoid intussusception through a colonoscopy with air insufflation. Case Description/Methods: A 35-year-old female presented with 3 days of constant and progressively-worsening rectal pain, bloody rectal discharge, and thin stool. Her past medical history was significant for metastatic colon cancer treated with sigmoid colectomy and chemotherapy 2 years prior, with recurrence of disease requiring palliative self-expandable rectosigmoid metal stent placement 6 days prior to arrival. Vital signs were normal. She did not appear in acute distress and was hemodynamically stable. Pertinent examination findings included lower abdominal tenderness, normal bowel sounds, and normal rectal tone. Labs revealed WBC 12.4, Hgb 13.2, Plt 443, AST 14, ALT 8, ALP 77, total bilirubin 0.7, and a lactate of 0.9. CT scan of the abdomen and pelvis revealed intussusception at the proximal sigmoid colon without evidence of bowel obstruction. Colonoscopy revealed ball-shaped mucosa with a dusky appearance at the proximal end of the stent, consistent with intussusception and ischemic colitis. The intussusception was successfully reduced with air insufflation through colonoscopy. The patient tolerated the procedure well and was started on a diet the next day with an improvement in her rectal pain and resolution of rectal discharge (Figure). Discussion: Endoscopic colonic stenting remains a valuable palliative treatment for metastatic colon cancer. Survival rates of metastatic colon cancer do not significantly differ between palliative colonic stenting and colonic resection. However, there are fewer complications with colonic stenting than colectomy, making palliative stenting a preferred option. Intussusception is a rare complication of colonic stenting that is often treated surgically in adults. Here we demonstrate successful reduction of intussusception through colonoscopic air insufflation. We hope to bring awareness of this complication and consideration to air insufflation as first-line therapy.Figure 1.: A. A view of the distal aspect of the rectosigmoid stent revealing adequate translocation of tumor mass without evidence of obstruction. B. A view of the proximal aspect of the rectosigmoid stent revealing a dusky appearance,with thickening of the bowel. C. A view of the proximal aspect of the stent with the ball-shaped mass in a dusky appearance consistent with intussusception, as seen by arrows.

S1990 Colonic Lymphangiomatosis

Introduction: Colonic Lymphangiomatosis Case Description/Methods: A 73-year-old male with history of diabetes mellitus and chronic kidney disease underwent CT abdomen and pelvis with IV contrast (for the evaluation of hematuria and renal cyst), which showed incidental finding of free intraperitoneal air. The patient had a history of recent colonoscopy which showed a large concentration of ‘polyps’ in the sigmoid, not amenable for endoscopic removal. Subsequently the patient developed abdominal pain and nausea, and labs showed worsening leukocytosis 17K/uL. Repeat computed tomography (CT) abdomen revealed moderate free intraperitoneal air and innumerable colonic mucosal cysts of the very redundant sigmoid colon in the right upper quadrant. The patient underwent exploratory laparotomy, and although no perforation was seen, the sigmoid colon exhibited soft-tissue fullness, prompting partial sigmoid colectomy with primary anastomosis. The resected specimen showed large contiguous well circumscribed and simple cystic structures (up to 3 cm size) giving a sessile “polypoid” appearance of the mucosa ( Figure a). Histologic sections demonstrated overlying unremarkable colonic mucosal surface without epithelial dysplasia or serrated neoplasia, large cystic spaces extending into the submucosa, focally separated by thin fibrous septae (Figure b). The contiguous cystic spaces within the muscularis propria were noted to be lined by a bland and attenuated cell layer, showing immunoreactivity for CD31, CD34 and D2-40 (podoplanin – an immunostain defining lymphatic space endothelium) (Figure c); compatible with dilated lymphatic spaces and consistent with colonic lymphangiomatosis (CL). Discussion: CL should be considered as a differential in patients with multiple aggregated mucosal lesions that appear as polyps on endoscopy. Speculation on etiology has ranged from developmental (failure to establish connections to lymphatic drainage sites), or seen secondarily after trauma, prior surgeries, radiation, lymphatic obstruction possibly secondary to adjacent mass lesion, or previous inflammatory processes. Free intraperitoneal air may suggest impending clinical decline in such patients. Surgical resection is the treatment of choice in symptomatic patients.Figure 1.: (a) Gross image of the sigmoid colon, bottom aspect showing partial deroofing of the mucosa of a simple cystic cavity (b) Hematoxylin and Eosin (H&E) stain 40X (c) D2-40 positivity (brown membranous and cytoplasmic staining) 100X.

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

IATROGENIC PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER SMALL-BORE FEEDING TUBE PLACEMENT IN A PATIENT WITH EHLERS-DANLOS SYNDROME

Sarcomatoid Carcinoma of the Colon in a 46-Year-Old: A Rare Disease With Limited Literature

Sarcomatoid carcinoma (SCA) is an extremely aggressive, rare malignancy composed of mixed epithelial and mesenchymal components. Fewer than 10 cases of SCA of primary colonic origin have been reported in the literature. SCA has a poor prognosis. Currently, there is limited consensus regarding treatment recommendations. We review the current literature and present the case of a 46-year-old man with stage 3c sigmoid sarcomatoid carcinoma who presented with 3 months of abdominal distension, weight loss, and abdominal mass. The patient had a sigmoid colectomy with adjuvant chemotherapy and is currently alive at 8 months.

Hand Assisted Laparoscopic Surgery for Colorectal Cancer: Surgical and Oncological Outcomes from a Single Tertiary Referral Centre.

The aim of this study was to report overall experience, perioperative and long-term survival results in a single tertiary referral center in Lithuania with hand assisted laparoscopic surgery (HALS) for colorectal cancer. A prospectively maintained database included 467 patients who underwent HALS for left-sided colon and rectal cancer, from April 2006 to October 2016. All those operations were performed by three consultant surgeons and nine surgical residents, in all cases assisted by one of the same consultant surgeons. There were 230 (49.25%) females, with an average age of 64 ± 9.7 years (range, 26–91 years). The procedures performed included 170 (36.4%) anterior rectal resections with partial mesorectal excision, 160 (34.26%) sigmoid colectomies, 81 (17.35%) left hemicolectomies, 45 (9.64%) low anterior rectal resections with total mesorectal excision, and 11 (2.25%) other procedures. Stage I colorectal cancer was found in 140 (29.98%) patients, 139 (29.76%) stage II, 152 (32.55%) stage III and 36 (7.71%) stage IV. There were five conversions to open surgery (1.1%). The mean postoperative hospital stay was 6.9 ± 3.4 days (range, 1–30 days). In total, 33 (7.06%) patients developed postoperative complications. The most common complications were small bowel obstruction (n = 6), anastomotic leakage (n = 5), intraabdominal abscess (n = 4) and dysuria (n = 4). There were two postoperative deaths (0.43%). Overall, 5-year survival for all TNM stages was 85.7%, 93.2% for stage I, 88.5% for stage II and 76.3% for stage III. Hand assisted colorectal surgery for left-sided colon and rectal cancer in a single tertiary referral center was feasible and safe, having all the advantages of minimally invasive surgery, with good perioperative parameters, adequate oncological quality and excellent survival.

56/f-Partial sigmoid colectomy with progressive hyponatremia : Preparation course anesthesiological intensive care medicine: case 18

56/f-Partial sigmoid colectomy with progressive hyponatremia : Preparation course anesthesiological intensive care medicine: case 18

Oligometastatic deposits of prostate cancer found within the sigmoid pericolic fat that was resected for colonic adenocarcinoma: a case report

BackgroundProstate cancer may rarely metastasize to the colon and colonic lymph nodes, and local treatment of oligometastatic deposits may improve oncological outcomes. Immunohistochemical stains are used to determine the most likely source of metastatic deposits when they are seen within surgical specimens. The aim of this case report is to illustrate how such techniques were used to identify unexpected prostatic metastases within the pericolic fat of a sigmoid colon resection specimen following elective curative surgery for colorectal cancer. To our knowledge, this is the first report of complete excision of oligometastatic deposits of prostate cancer found incidentally within the specimen of another cancer.Case reportAn 89-year-old Caucasian man underwent sigmoid colectomy for an obstructing colorectal cancer in the sigmoid colon with some mesenteric lymphadenopathy. He had previously received radical radiotherapy for prostate cancer 10 years earlier. When the specimen was examined by the histopathologist, it was noted that the pericolic fat adjacent to the colorectal adenocarcinoma contained some metastatic deposits. Positive immunohistochemical staining for prostate-specific antigen and prostate-specific acid phosphatase with negative staining for CDX2 and CK20 revealed these to be prostatic metastases rather than colonic. Since these were completely excised, and there were no other metastases, this represented a serendipitous, curative excision of oligometastatic deposits of an additional cancer to the one that was being treated.ConclusionsThis case illustrates how immunohistochemical staining may be used to distinguish the source of metastatic deposits based on the likelihood of primary tumor from a careful and thorough patient history.

Minimally Invasive Surgery Approach is Not Associated With Differences in Long-Term Bowel Function Patient-Reported Outcomes After Elective Sigmoid Colectomy.

Postoperative bowel function is a common concern for patients undergoing a sigmoidectomy. We have previously demonstrated that patients with symptomatic bowel function preoperatively have substantial improvement at long-term follow-up. However, the effect of the operative approach on patient-reported bowel function is largely unknown. We aimed to evaluate the differences in long-term patient-reported bowel function after robotic or laparoscopic sigmoid colectomies for benign and malignant disease. A retrospective analysis of a prospectively collected institutional database from July 2015 to July 2020. Patients included underwent a sigmoid colectomy for benign or malignant disease and completed the Colorectal Functional Outcome (COREFO) questionnaire at preoperative presentation, postoperatively, and long-term follow-up. Differences between preoperative and postoperative scores, as well as differences between the robotic and laparoscopic cohorts, were compared using paired t-tests. A total of 169 patients met inclusion criteria with a median age of 61y, and 55% of the patients underwent robotic sigmoid colectomy, with the most common diagnosis being diverticular disease (62%). There was no significant difference between the presentation, short-term, or long-term follow-up total COREFO scores or subdomains based on the surgical technique. Patients that present asymptomatic remain asymptomatic, while those that are symptomatic demonstrate improvements for both the robotic and laparoscopic groups. Patient-reported long-term global bowel function does not appear to differ between patients who underwent elective robotic or laparoscopic sigmoid colectomy for benign or malignant disease. Patients that present asymptomatic remain asymptomatic, while those that are symptomatic demonstrate improvements, regardless of surgical technique.

Thromboprophylaxis in surgically treated colorectal cancer patients with tinzaparin: Intermediate results from the Onco-CAST trial.

e15611 Background: The incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) after colorectal surgery is approximately 29% and 1.6% respectively. The incidence of asymptomatic postoperative DVT in colorectal cancer (CRC) patients has been reported as high as 20%, even under thromboprophylaxis. Thus, thromboprophylaxis after surgical treatment for CRC is crucial. Latest guidelines from International Initiative on Thrombosis and Cancer (ITAC 2019) recommend use of highest prophylactic dose of Low Molecular Weight Heparin (LMWH). Methods: Onco-CAST is a prospective, phase IV, observational, non-interventional cohort study evaluating a) current management approach for CRC surgical prophylaxis and b) efficacy and safety of tinzaparin at 8.000 Anti-Xa IU, once daily (OD), for at least one month post hospital discharge. Patients enrolled after signing informed consent. Onco-CAST was conducted by the Hellenic Society of Coloproctology. Results: Results from 175 CRC patients from 9 Onco Surgical Clinics are reported. Participation completed 79% of patients at report time: 66% males, 67±12 years, BMI: 27.4±5.5. Histology: adenocarcinomas NOS 81%, mucinous adenocarcinomas 9%, small cell neuroendocrine carcinomas 2%, and others. High grade differentiation indicated: 26% and 5% metastatic. 32% treated with right hemicolectomy, 20% with low anterior resection, 12% with sigmoid colectomy, 9% with abdominal-perineal resection, 9% with left hemicolectomy and other methods. 67% treated open and 33% laparoscopic while the median number of lymph nodes dissected for left and right hemicolectomy was 32.5 (Q1-Q3:26-38) and 24 (Q1-Q3: 14.5-32), p = 0.0253. Factors related to thrombosis risk are presented in table, notably, 95% of patients accumulated ≥3 risk factors. Median thromboprophylaxis duration with tinzaparin 8.000 Anti-Xa IU, OD, was: 37 days (1st-3rd quartile: 33-45 days). Three thrombotic events occurred (efficacy 98.3%, 95% CI: 95.1-99.4%), one DVT+PE, one DVT and one due to Central Venous Catheter (CVC). Eight patients experienced bleeding events (4.6%, 95%CI: 2.3-8.8%), 3 minor, 3 major and 2 CNMB, 2 had a possible relation to thromboprophylaxis (1.1%, 95%CI: 0.3-4.1%). Conclusions: Thromboprophylaxis in Surgically Treated Colorectal Cancer Patients with Tinzaparin intermediate dose seems safe and efficient approach.[Table: see text]