Health-related quality of life in patients with colorectal neoplasm and cost-effectiveness of colorectal cancer screening in Hong Kong

Key Messages 1. Compared with the Hong Kong general population norm, Chinese patients with colorectal neoplasm (CRN) reported worse physical health-related quality of life (HRQOL) but better mental HRQOL and comparable health preference scores. 2. The CRN stage at diagnosis was the most significant determinant of HRQOL. Colorectal cancer was associated with worse physical HRQOL and health preference scores. 3. Immunochemical faecal occult blood testing every 2 years is the most cost-effective colorectal cancer screening strategy, with an incremental cost-effectiveness ratio of HK$43 660 per quality-adjusted life year gained.published_or_final_versio

Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options

PURPOSE: This study examined the accuracy of Portsmouth Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity system (P-POSSUM) in predicting the mortality of patients who underwent operations for obstructing colorectal cancer. It also is attempted to analyze the actual mortality and the predicted P-POSSUM mortality of different surgical options for obstructing left-sided cancer. METHODS: Data on patients who underwent surgery for obstructing colorectal cancer during 1998 to 2002 were collected. Mortality predicted by P-POSSUM was compared to the actual mortality with the method of linear analysis. The accuracy of using P-POSSUM to predict mortality in this group of patients was assessed by Hosmer and Lemeshow goodness of fit test and Receiver Operator Characteristic curve analysis. The predicted and actual mortality of patients who underwent different surgical options also were analyzed. RESULTS: A total of 160 patients were included in the study and 18 patients died postoperatively. The operative mortality was 11.3 percent. P-POSSUM predicted overall mortality of 15 percent. The observed and predicted mortality was found to have no significant lack of fit (chi-squared = 5.98; degree of freedom = 3; P = 0.11). The area under Receiver Operator Characteristic curve analysis was 0.75. For patients with left-sided tumors, P-POSSUM predicted mortality and actual mortality of patients who had resection without anastomosis were both significantly higher than patients with single-stage resection and primary anastomosis ( P = 0.044 and 0.011, respectively). CONCLUSIONS: P-POSSUM system is valid for prediction of overall mortality in patients with operations for obstructing colorectal cancer. Estimation of P-POSSUM predicted mortality during operation and its ability to correlate with choice of procedure is an area that is worth further study in emergency colorectal surgery. © The American Society of Colon and Rectal Surgeons.link_to_subscribed_fulltex

Laparoscopic colectomy with and without routine mechanical bowel preparation before operation: a comparative study

BACKGROUND: Although it is a common belief that preoperative mechanical bowel preparation (MBP) reduces the risk of complications after elective colorectal operations, many studies have shown that MBP does not improve operative outcomes. However, most of the evidence was from open surgery. The study evaluates the outcomes of elective laparoscopic colectomy with and without bowel preparation. METHODS: This is a retrospective comparative study of patients who had elective laparoscopic colectomy for colon cancer without preoperative MBP in our centre during the period of October 2009 to July 2011 (No-MBP group) and patients with MBP during Jan 2007 – May 2009 (MBP group). Patient demographics, operative outcomes, morbidity and mortality were retrieved from a prospective database and comparison between the two groups was compared. RESULTS: The No-MBP group had 97 patients and the MPB group had 159 patients. The mean age of No-MBP and MBP groups were both 70.7 (p = 0.988). Conversion rates in No-MBP and MBP groups were 5.2% and 6.9% respectively (p = 0.572). The ASA score of the patients, size of tumour and stage of disease were all similar in both groups. There were no significant difference between two groups in operative time, blood loss and hospital stay. The anastomotic leakage rates were the same (1%) in both groups. Two patients in No-MBP group (2.2%) and 1 patient (0.7%) in MBP group had intraabdominal collection (p = 0.560). Wound infection rate were 4.1% and 3.8% in No-MBP group and MBP group respectively (p = 1.000). Other surgical complication included postoperative bleeding [3 patients (3.1%) in No-MBP group & 1 patient (0.6%) in MBP group; p=0.560], intestinal obstruction [4 patients (4.1%) in No-MBP group & 1 patient (0.6%); p=0.07]. Total surgical morbidity rate was 11.3% in No-MBP group and 8.2 % in MBP group (p = 0.399). Six patients (6.2%) in No-MBP group and 4 patients (2.5%) in MBP group required reoperations (p=0.186). There was no mortality in No-MBP group and one mortality (0.6) in MBP group (p= 1.000). CONCLUSION: Preoperative MBP offers no additional benefits to laparoscopic colectomy for colon cancer and routine administration of preoperative MBP is not indicated.postprin

Sustained improvement in diabetic control on long-term self-monitoring of blood glucose

The benefits of self-monitoring of blood glucose (SMBG) were assessed in 38 Chinese adults on conventional insulin regimens who had been performing SMBG for a mean duration of 26 months (range 15-40). For analysis patients were divided into 2 groups. Group A consisted of 27 insulin-requiring patients who were referred for SMBG because of poor control or young age (≤35 years). Group B consisted of 11 IDDM patients who were on SMBG from diagnosis. Mean age and duration of SMBG were similar in the 2 groups though group A had longer duration of disease. In group A, mean haemoglobin A 1 (HbA 1) decreased from 12.4 ± 0.5% before SMBG to 10.9 ± 0.5% at 6 months (P < 0.005), 10.7 ± 0.5% at 12 months (P < 0.005) and 10.3 ± 0.4% after long-term SMBG. This was accompanied by a significant reduction in insulin requirement from 0.82 ± 0.07 U/kg/day to 0.72 ± 0.07 U/kg/day (P < 0.05). In group B, insulin requirement progressively decreased in the first 6 months. At 12 months, mean HbA 1 was 9.0 ± 0.5% and insulin requirement was 0.58 ± 0.08 U/kg/day. No significant change in HbA 1 or insulin requirement was observed beyond the first year. After long-term SMBG, 82% of patients in group B had good control (HbA 1 ≤ 10%) compared to 45% only in group A (P < 0.05). Long-term SMBG is associated with sustained improvement in diabetic control and is particularly beneficial if introduced to diabetic patients right from diagnosis.link_to_subscribed_fulltex

Effect of different casting methods on adolescent idiopathic scoliosis

Scoliosis is a three-dimensional spinal deformity. Although orthotic treatment for moderate adolescent idiopathic scoliosis (AIS) has been well recognized, there are few studies documenting the effectiveness of different casting methods in the fabrication of thoraco-lumbo-sacral orthoses (TLSO). The current study was a retrospective clinical evaluation of the effectiveness of two commonly used casting methods namely, the frame casting method and the supine with traction casting method in the treatment of AIS. Eighty (80) female patients with AIS were recruited and they were all treated by TLSOs. The frame casting method was used in 37 patients while the remaining 43 patients were under the supine with traction casting method. The responses of spinal deformities under the two different casting methods were analyzed for the period from pre-brace to 2 years after bracing. The studied parameters included the AP Cobb's angle, the apical vertebral rotation and the trunk listing (cervico-sacral lateral offset). The results of the current study showed that the orthoses manufactured from the two casting methods could provide an effective control of AIS (change of Cobb's angle within (±5°). For the frame casting, the Cobb's angles at pre-brace and 2 years after off-brace were 36.0° and 33.8° respectively while for the supine with traction casting, the corresponding Cobb's angles were 32.7° and 34.0°. The frame casting method could give a better control of the apical vertebral rotation at the early stage of treatment (pre-brace=18.2° and the 4th month=13.8° while the supine with traction casting method was more effective in the long-term control of the trunk listing (pre-brace=10mm and 2 years after off-brace=3.3mm).link_to_subscribed_fulltex

Impact of conversion on the outcome and survival following laparoscopic resection of colorectal cancer

Poster Presentation - Colorectal: no. P139Background: Conversion to open surgery occurred in 12-29% of the patients who underwent laparoscopic colorectal resection. This study aimed to evaluate the impact of conversion on the operative outcome and prognosis of patients who underwent laparoscopic resection for colorectal cancer. Methods: The prospectively collected data of 473 patients who underwent laparoscopic colectomy between May 2000 and December 2006 were analyzed. Patient demographics, operative details, postoperative complications and follow up data were collected prospectively. Conversion was defined as the need for an unplanned incision to complete the attempted laparoscopic procedure due to patients’ factors, tumor factors as well as intraoperative complications. Results: The overall conversion rate to open surgery was 8.7% (41 patients). There was no difference in age, comorbid illness, location of tumour, use of adjuvant therapy and stage of disease between the laparoscopic and conversion group. The most common reasons for conversion include adhesions (34.1%), tumour invasion into adjacent structures (17.1%), bulky tumour (9.8%), and uncontrolled haemorrhage (9.8%). A male preponderance was observed in the conversion group. Tumour size was significantly larger in the conversion group compared with the laparoscopic group (5cm vs. 4cm, p=0.002). Although there was no difference in the operative time between the two groups, increased operative blood loss (300ml vs. 100ml .....