Preoperative serum carcinoembryonic antigen, albumin and age are supplementary to UICC staging systems in predicting survival for colorectal cancer patients undergoing surgical treatment

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to determine influence of prognostic factors in addition to UICC staging systems, on cancer-specific and overall survival rates for patients with colorectal cancer (CRC) undergoing surgical treatment.</p> <p>Methods</p> <p>Between January 1996 and December 2006, a total of 1367 CRC patients who underwent surgical treatment in Kaohsiung Medical University Hospital were analyzed. We retrospectively investigated clinicopathologic features of these patients. All patients were followed up intensively, and their outcomes were investigated completely.</p> <p>Results</p> <p>Of 1367 CRC patients, there were seven hundred and fifty-seven males (55.4%) and 610 (44.6%) females. The median follow-up period was 60 months (range, 3–132 months). A multivariate analysis identified that low serum albumin level (<it>P </it>= 0.011), advanced UICC stage (<it>P </it>< 0.001), and high carcinoembryonic antigen (CEA) level (<it>P </it>< 0.001) were independent prognostic factors of cancer-specific survival. Meanwhile, a multivariate analysis showed age over 65 years (<it>P </it>< 0.001), advanced UICC stage (<it>P </it>< 0.001), and high CEA level (<it>P </it>< 0.001) were independent prognostic factors of overall survival. Furthermore, combination of UICC stage, serum CEA and albumin levels as predictors of cancer-specific survival showed that the poorer the prognostic factors involved, the poorer the cancer-specific survival rate. Likewise, combination of UICC stage, age and serum CEA level as predictors of overall survival showed that the poorer the prognostic factors involved, the poorer the overall survival rate. Of these prognostic factors, preoperative serum CEA level was the only significant prognostic factor for patients with stage II and III CRCs in both cancer-specific and overall survival categories.</p> <p>Conclusion</p> <p>Preoperative serum albumin level, CEA level and age could prominently affect postoperative outcome of CRC patients undergoing surgical treatment. In addition to conventional UICC staging system, it might be imperative to take these additional characteristics of factors into account in CRC patients prior to surgical treatment.</p

ESPECTRO CLINICO DE LA FISTULA RECTOVAGINAL: ANALISIS DE 38 PACIENTES

Se revisa en forma retrospectiva los resultados del tratamiento quirúrgico de 38 pacientes intervenidas en forma consecutiva por una fístula rectovaginal (FRV) en un periodo de 12 años. Se define como simple una FRV baja, menor de 2,5 cm y de origen traumático o infeccioso y compleja una FRV alta, mayor de 2,5 cm y de origen neoplásico, actínico o inflamatorio. La etiología más común fue la neoplásica en el 39% (15/38) de los casos: debido a persistencia tumoral de un cáncer cervicouterino (Ca CU) tratado con radioterapia y/o cirugía en 10 pacientes, cáncer de recto en 3 y cáncer de ano en 2. En dos pacientes con cáncer de recto se efectuó cirugía radical con conservación de esfínteres en una de ellas y exenteración posterior en la otra con una sobrevida de 70 meses libre de enfermedad y fallecimiento a los 60 meses respectivamente. En los dos casos de cáncer anal se realizó una exenteración posterior por persistencia tumoral luego de recibir radioquimioterapia según el esquema de Nigro. La FRV actínica se presentó en el 34% (13/38) de los casos, 12 de las cuales fueron sometidas a una operación de Parks (anastomosis coloanal con mucosectomía rectal) con éxito en todos los casos, quedando el 40% de ellas con algún disturbio de la continencia. Cuatro pacientes (11%) corresponden a una complicación quirúrgica luego de cirugía pélvica, 3 de las cuales cierran sólo mediante una desfuncionalización. Las FRV de origen obstétrico (16%) se corrigieron mediante una reparación local generalmente mediante un colgajo rectal grueso y reparación esfinteriana simultánea con resultados satisfactorios. En los casos de persistencia tumoral por Ca CU se logró una desfuncionalización adecuada en la mayoría de los casos mediante una sigmoidostomía en asa con una sobrevida de hasta 26 meses. En esta serie, el 84% de los casos corresponden a FRV complejas y el 50% de ellas fueron sometidas a una reparación con cirugía radical por vía abdominal sin necesidad de una ostomía definitiva. Las series de FRV son muy heterogéneas probablemente por patrones de referencia distintos, lo que hace difícil hacer un análisis comparativo.A retrospective analysis of surgical treatment in 38 patients with recto-vaginal fistula (RVF) in a twelve years period is being presented. Is defined as a simple RVF when is low, less than 2.5 cm and traumatic or infections in origin, and as a complex are if it is high, larger than 2.5 cm and of neoplastic, actinic or inflammatory origin. The most common etiology was neoplastic, 39% (15/38): due to persistence of cervical cancer in 10 patients, treated with radiotherapy, surgery or both; rectal carcinoma in 3 patients and anal cancer in 2. Two patients with rectal carcinoma were treated with radical surgery and sphincter conservation in one of them and posterior exenteration on the other, they survival free of disease to and 60 months respectively. Both cases with anal cancer were managed with posterior exenteration because tumoral persistence after receiving radio and chemotherapy by the nigro scheme. Actinic RVF were present in 34% (13/38); twelve of them were treated by the Parks operation (coloanal anastomosis and rectal mucosectomy), successful in all of them, although 40% had some kind of continence disturbance. Four patients with RVF (11%) were consequence of pelvic surgery complications, three of them closed only after a diverting procedure. Obstetrical RVF (16%) were repared by a local procedure using a thick rectal flap and simultaneous sphincter repair always with good results. In cases of cervical cancer with tumoral remnants, a diverting loop sigmoidostomy was sufficient in most of them and some of them with 26 months survival. In this series, 84% are complex RVF and 50% of them were submitted to abdominal radical surgery with no need of a permanent ostomy. Series of RVF are heterogeneous in composition due diferences in etiology of each group making difficult comparative studies

Lomas-Cooperman technique for rectal prolapse in the elderly patient

A variety of surgical procedures is used to correct complete rectal prolapse (RP). We analysed the immediate and long-term results of the Lomas-Cooperman technique in the management of symptomatic RP in elderly patients with severe concomitant diseases. Across a 13-year period, all patients with RP having undergone surgery with this procedure were retrospectively evaluated. The technique consisted in placing a triply folded piece of polypropylene mesh encircling the anal canal through a perineal approach. A total of 22 patients (20 female) with a mean age of 84 years (range, 72-93 years) with severe concomitant pathologies were assessed. Four patients were classified as ASA II and 18 as ASA III. Mean Karnofsky score was 50%, ranging between 40% and 60%. All patients were operated on under regional anaesthesia without incidents. Mean operative time was 35 min(range, 20-60 min) and mean hospital stay was 4.5 days (range, 2-17 days). The most common immediate postoperative complication was urinary tract infection, found in 18% of the cases. Mean follow-up was 32 months (range, 4-84 months). During follow-up, 4 cases (18%) of mesh exteriorisation were detected, requiring mesh trimming at the outpatient clinic. Rectal prolapse recurred in 2 patients; one of them was managed with a new cerclage reaching a satisfactory outcome. Thus, by intention-to-treat basis, the recurrence rate was 4.5%. Constipation was resolved in three out of 4 patients, but in 18% of the cases late faecal impact was recorded. Mean preoperative incontinence score improved from 5.1+/-0.62 to 3.4+/-1.61 (p<0.0001) after surgery. Anal cerclage with the Lomas-Cooperman technique constitutes a simple and reproducible surgical technique with an acceptable morbidity and recurrence rate in high-risk elderly patients with RP

Surgical treatment of colon cancer. Retrospective analysis of 439 patients Resultados del tratamiento quirúrgico del cáncer de colon. Análisis de 439 pacientes

Background: Mortality for colon cancer duplicated in the last 15 years in Chile. Aim: To analyze immediate and late results of surgical treatment of colon cancer. Material and Methods: Retrospective analysis of 439 patients aged 22 to 92 years, 55% women, subjected to elective surgery for colon cancer between 1991 and 2007. Results: At the moment of surgery 86% of tumors were resectable and 25% were in stage IV. Twenty one percent of patients had surgical complications, 4% had to be reoperated and 1% died. Ten years global survival for stages I to III was 82%. Survival significantly decreased for stages IIIb and forward. Preoperative carcinoembrionic antigen, vascular permeation, the number of involved lymph nodes and chemotherapy were relevant prognostic factors. If TNM classification is included in the model, only vascular permeation and lymph node involvement remain as prognostic factors. Conclusions: TNM classification and lymph node involvement are the main survival prognostic fa

Predictive factors of stenosis after stapled colorectal anastomosis: Prospective analysis of 179 consecutive patients

The incidence, risk factors, and clinical relevance of stenosis of stapled colorectal anastomosis (CRA) were studied prospectively. Anastomotic stricture was defined as the inability of traversing the anastomosis with the rigid proctoscope. The population studied consisted of 179 patients (94 males) with an average age of 59.3 years (range: 20 to 91 years). The main indication for surgery was colorectal cancer in 59% of the cases, followed by diverticular disease in 23%. The first endoscopic control was performed before 4 months in 25% of the patients, between 5 and 10 months in 50%, and during the following 10 months in 25%. Stenosis was verified with the rigid instrument in 21.1% of the cases and with the flexible colonoscope in 4.4%. The barium enema performed in 12 cases confirmed a punctiform stenosis in 5 patients, 4 of whom had been asymptomatic. An endoscopic dilatation was performed on 5 of the 8 symptomatic patients, with one relapse that required an additional dilatation. I