Evaluations of Laparoscopic Proctocolectomy Versus Traditional Technique in Patients With Rectal Cancer

These authors conclude that laparoscopic surgery for rectal cancer can be performed safely with a reduced rate of postoperative complications, need for blood transfusions, infection, and hospital stay

Current surgical status of thyroid diseases

Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one

Oil Media on Paper: Investigating the Effect of Linseed Oils on Pure Cellulosic Paper Supports. A Research Matter of Damage Assessment

Oil media on paper, such as oil paintings, sketches, prints, and books, occasionally present problems associated with the effect of oil medium on the paper support, raising a composite matter of condition assessment as it depends on several factors. The present work examines the effect of linseed oil on paper and, in particular, the changes caused by three types of linseed oil on the optical, morphological, mechanical, and chemical properties of pure cellulosic paper, employing mock-ups submitted to artificial ageing in controlled conditions of relative humidity and temperature in airtight vessels. The study involved colorimetry, opacity, tensile strength, pH measurements, SEM, FTIR, and VOC analysis with GC-MS. Processing of the results has so far indicated that thermal-humid ageing caused the gradual darkening of the oil-impregnated mock-ups, as well as alterations in opacity, intense fall of pH values, and severe reductions in tensile strength, while linseed oil processing during manufacture has a significant impact. FTIR spectra have indicated that chemical changes upon ageing are in accordance with those of optical and mechanical changes, while VOC emissions are mostly associated with the drying and degradation of the different types of linseed oil

Oil Media on Paper: Investigating the Effect of Linseed Oils on Lignocellulosic Paper Supports

Condition assessment of works of art created with oil media on paper could be a complex matter when presenting problems of damage due to the absorption of oil binders by the paper support, since they depend on several factors and occur in variable conditions. The present work refers to the results of an investigation on the effect of linseed oils on the color, opacity, morphology, tensile strength, and chemical properties of lignocellulosic papers, in comparison to that of pure cellulosic papers. Lignocellulosic papers are involved in research on new, yet significant, parameters that might influence the behavior of the oil-impregnated areas of the supports upon aging. The research was applied to mock-ups, made of two types of lignocellulosic paper impregnated with three types of linseed oil and subjected to accelaratated ageing in specific conditions of relative humidity and temperature in closed environment. The research involved colorimetry, opacity, tensile strength, pH measurements, SEM, FTIR, and VOC analysis with GC-MS. The results indicated that thermal-humid ageing caused the gradual darkening of the oil-impregnated mock-ups, alterations in opacity, and decrease of pH values, depending mainly on the formulation of linseed oil, as well as a reduction in tensile strength. FTIR analysis results indicated that the chemical changes that occur upon ageing supported the recorded optical and mechanical alterations, while VOC emissions are both associated with the paper type and the kinetics of degradation of the different types of linseed oil

A contribution in the study of inflammatory reaction in open and laparoscopic colectomy for colorectal cancer

Background: Surgical interventions are related with activation of a cascade of reactions, which result in an aseptic inflammatory reaction. This inflammatory response initiates the organism’s innate immunity. Laparoscopic surgery reduces the trauma and the patients benefit from diminished surgical trauma and maintained immune function. Cytokines levels and CRP are related with the magnitude of surgical trauma and surgical stress. Toll-like receptors (TLRs) 2 and 4 are the first sensors-recognition receptors of the invading pathogens for the innate immune response. α-Ντεφενσίνες play an important role in host defense, early acting in phagocytosis. Aim: To compare the inflammatory response, and then the stress response, during Laparoscopic and Open colectomy for cancer by calculating together with IL-6, TNF-a, and hsCRP, a-ντεφενσίνες, TLR-2 and TLR-4 as the first sensor-recognition receptors. Material and Methods: A total 40 patients with colorectal cancer were randomized in two groups. Group A (n=20) open colectomy. Group B (n=20) Laparoscopic colectomy. One hour preoperatively an epidural catheter was placed in all patients and Rupivocaine was administered perioperatively and 48 hours postoperatively. Blood samples have taken for calculation of IL-6, TNF-a, hsCRP, a-ντεφενσίνες, TLR-2 and TLR-4 preoperatively, 5 min after deflation of pneumoperitoneum (group B) or 5 min after division of the colon (group A), 6 and 24 hours postoperatively. Results: The mean operative time was 115 for group A and 142 min for group B. The mean blood loss was 240 and 105 ml respectively (p<0.001). The mean hospital stay was 8 and 5 days respectively (p<0.05). IL-6 was significant higher in group A vs B at 6 and 24 h postoperatively (p<0.0001), hsCRP was significant higher in group A vs B at 24 h postoperatively (p<0.001). No difference in TNF-a values. TLR-2 was significant higher in group A vs B at 5 min and 24 h postoperatively (p=0.02, p=0.01 respectively). TLR-4 was significant higher in group A vs B at 5 min postoperatively (p<0.0001). α-Ντεφενσίνες levels were statistically significant lower in group B vs group A, 5 min and 24 hours postoperatively (p<0.002 and p<0.007 respectively). Conclusion: The inflammatory response, and then the stress response, is significant decreased during laparoscopic colectomy than during open colectomy, for colorectal cancer. This is obvious in short-term clinical benefit of the patient, and gives the tinder for further investigation of the long-term results of laparoscopic colectomy versus open colectomy for colorectal cancer. (Clinical Trials identifier: NCT00942461 at www.clinicaltrials.gov)Εισαγωγή: Οι χειρουργικές επεμβάσεις σχετίζονται με έναν καταρράκτη αντιδράσεων, που οδηγεί στην άσηπτη φλεγμονή και ενεργοποιεί την εγγενή (φυσική) άμυνα του οργανισμού. Η λαπαροσκοπική χειρουργική μειώνει το χειρουργικό τραύμα, και κατά συνέπεια το χειρουργικό stress, προς όφελος της φυσικής άμυνας του οργανισμού. Οι κυτταροκίνες και η CRP συνδέονται με το χειρουργικό τραύμα και το στρες. Οι Toll-Like Receptors (TLRs) 2 και 4 είναι οι πρώτοι υποδοχείς αναγνώρισης των παθογόνων που εισέρχονται στον οργανισμό. Οι a-ντεφενσίνες παίζουν σημαντικό ρόλο στην άμυνα με τη δράση τους στην πρώιμη φαγοκυττάρωση. Σκοπός: Μελετήθηκαν IL-6, TNF-a, hsCRP, TLR-2, TLR-4 και a-ντεφενσίνες στους ασθενείς που υποβλήθηκαν σε ανοιχτή και λαπαροσκοπική προσπέλαση για ορθοκολικό καρκίνο, για τη σύγκριση της φλεγμονώδους αντίδρασης μεταξύ των δύο αυτών προσπελάσεων. Υλικό-Μέθοδος·. Συνολικά 40 ασθενείς τυχαιοποιήθηκαν σε δύο ομάδες των 20 ασθενών. Ομάδα A (n=20) ανοιχτή κολεκτομή. Ομάδα Β (n=20) λαπαροσκοπική κολεκτομή. Μια ώρα προεγχειρητικά τοποθετήθηκε επισκληρίδιος καθετήρας και έγινε έγχυση ρουπιβοκαϊνης περιεγχειρητικά και 48 ώρες μετεγχειρητικά. Έγινε συλλογή αίματος για την μέτρηση των επιπέδων IL-6, hsCRP, TLR-2.TLR-4 TNF-a και a-ντεφενσίνες προεγχειρητικά, 5 λεπτά μετά την διαίρεση του εντέρου, 6 και 24 ώρες μετεγχειρητικά. Αποτελέσματα: Μέσος χειρουργικός χρόνος A vs B : 115 vs 142 λεπτά (p<0.05). Μέση απώλεια αίματος A vs B : 240 ml vs 105 ml (p<0.001). Μέσος χρόνος νοσηλείας 8 ημέρες για την ομάδα A και 5 ημέρες για την ομάδα Β (p=0.05). Τα επίπεδα IL-6 ήταν υψηλότερα στην ομάδα A στις 6 και 24 ώρες (p<0.0001). Η hsCRP ήταν υψηλότερη στην ομάδα A στις 24 ώρες (p=0.001). Για τους TNF-a δεν υπήρχε στατιστικά σημαντική διαφορά στις δυο ομάδες. Τα επίπεδα TLR-2 ήταν υψηλότερα στην ομάδα A στα 5 λεπτά και τις 24 ώρες (p=0.02 και p=0.01 αντίστοιχα). Οι TLR- 4 ήταν υψηλότερη στην ομάδα A στα 5 λεπτά (p<0.0001). Οι α-Ντεφενσίνες ήταν υψηλότερες στην ομάδα Β στα 5 λεπτά και τις 24 ώρες (p=0.002 και p=0.007 αντίστοιχα). Συμπεράσματα: Η φλεγμονώδης αντίδραση, και κατά συνέπεια το χειρουργικό στρες, είναι χαμηλότερα στην λαπαροσκοπική κολεκτομή για ορθοκολικό καρκίνο με θετική βραχυπρόθεσμη επίδραση στην πορεία του ασθενούς. Αυτό δίνει το έναυσμα για μεγαλύτερες και μακροχρόνιες μελέτες ώστε να ελεγχθεί το πιθανό ογκολογικό όφελος

Long-term outcome after segmental colonic resection for slow transit constipation

PurposeColectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC.MethodsFifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n=43) received a bowel function questionnaire and a questionnaire about patient-reported outcome.ResultsAfter a median follow-up of 19.8years, 13 patients had undergone rescue surgery (n=12) or used irrigation (n=1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p=0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p=0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients' global assessment, 10 stated a very good result, seven a good result and two a poor result.ConclusionsHemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

Objective:To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL).Background:AL after RC resection often results in a permanent stoma.Methods:This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated.Results:This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76).Conclusions:The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies