Open or laparoscopic surgery for colorectal cancer: A retrospective comparative study

Laparoscopic surgery for colorectal cancer has been used with success since 1991. During the last decade, many studies have compared laparoscopic surgery with open colectomy. The aim of this retrospective study was to present the advantages and disadvantages of laparoscopic and open colectomy for cancer, focusing on the postoperative care of patients. Eighty-eight consecutive patients suffering from cancer of the colon and rectum, surgically treated, were studied. They were divided into 2 groups: Group A patients (n = 48) underwent laparoscopic colectomy, and Group B patients (n = 40) were treated with an open procedure. For postoperative care of the patients, analgesia, median hospital stay, overall cost, and complications between the 2 groups were studied and statistically compared. Laparoscopic colectomy was associated with a shorter average hospital stay, fewer complications, earlier start of a normal diet, and better control of postoperative pain. Nonetheless, the cost of surgical instruments used in laparoscopic operation is higher. Laparoscopic surgery, despite its higher cost, seems to add significant advantages in the postoperative recovery of patients suffering from colorectal cancer. Copyright © 2013 Society of Gastroenterology Nurses and Associates

Effects of the Enhanced Recovery Program on the Recovery and Stress Response in Patients with Cancer Undergoing Pancreatoduodenectomy

Aim the study was the comparison of enhanced recovery after surgery (ERAS) versus conventional care (CON) protocols in patients undergoing pancreatoduodenectomy with regard to pain intensity, emotional response (optimism/sadness/stress), and stress biomarker levels (adrenocorticotropopic hormone, cortisol). We conducted a prospective two-group randomized controlled study with repeated measures in 85 patients with cancer pancreatoduodenectomy. In the ERAS group (N = 44), the ERAS protocol was followed, compared with the CON group (N = 41). We assessed pain with the numeric rating scale and a behavioral scale (Critical Care Pain Observation Tool), emotional responses (numeric rating scale), and serum adrenocorticotropopic hormone and cortisol levels at three time points: T1, admission day; T2, day of surgery; and T3, discharge day (ERAS) or the fifth day of stay (CON). Data were analyzed by linear mixed modeling to account for repeated measurements. We observed decreased postoperative pain in ERAS patients after adjusting for confounders (p =.002) and a trend for less complications. No significant associations with stress/emotional responses were noted. Only age, but not protocol, appeared to have a significant effect on adrenocorticotropopic hormone levels despite a significant interaction with time toward increased adrenocorticotropopic hormone levels in the ERAS group. In conclusion, despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain. © 2020 Society of Gastroenterology Nurses and Associates

Comparative Evaluation of Pain, Stress, Neuropeptide Y, ACTH, and Cortisol Levels Between a Conventional Postoperative Care Protocol and a Fast-Track Recovery Program in Patients Undergoing Major Abdominal Surgery

Background: Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols. Objectives: To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols. Method: A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT (n = 29) or CON (n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge. Results: ACTHT1 and ACTHT2 levels were positively correlated with self-reported stress levels (ρ =.43 and ρ =.45, respectively, p <.05) in the FT group. NPY levels in the FT group were higher than those in the CON group at all time points (p ≤.004); this difference remained significant after adjusting for T1 levels through analysis of covariance for age, gender, and body mass index (F =.003, F =.149, F =.015, respectively, p >.05). Conclusions: Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress. © 2016, © The Author(s) 2016

Colorectal cancer metastases to the thyroid gland—a systematic review: Colorectal cancer thyroid metastases

Background: Despite its rich vasculature, the thyroid gland is a rare site of metastatic disease. We present a systematic review of colorectal cancer (CRC) thyroid metastases, with emphasis on diagnosis, therapeutic management, and oncological outcomes. Methods: A systematic review of the English literature (1990 to 2019) was performed, using the PubMed, Embase, and Google Scholar bibliographic databases. For each patient, epidemiological, surgical, histopathological, and oncological data were extracted. Results: A total of 111 patients (40% males, mean age 61 ± 12 years) were included in the final analysis. The primary CRC was locally advanced (T3-T4) in 83%, had positive lymph nodes (N+) in 65%, and had distant metastases (M+) in 28%. Thyroid metastases were synchronous in 15% and metachronous in 80%, with a mean interval of 51 ± 31 months from primary tumor treatment. Thyroid metastatic disease was diagnosed clinically (60%), radiologically (33%), biochemically (2%), or postmortem (5%). When performed, FNA biopsy was diagnostic in 73% and highly suspicious in 13%. A total of 63% of patients had additional distant metastases, usually in the liver or lungs, while 68% of patients underwent surgical excision (total or subtotal thyroidectomy 58%, lobectomy 42%) and 43% received adjuvant chemotherapy or radiotherapy. Mean overall survival after primary CRC was 55.5 ± 34.7 months, with mean disease-free survival of 31.3 ± 27.2 months. Following diagnosis or treatment of thyroid metastases, 1-, 2- and 3-year survival rates were 79, 66, and 60%, respectively. Mean survival following diagnosis of thyroid metastases was 11.3 months. Conclusions: CRC thyroid metastasis is a relatively uncommon event, usually associated with locoregionally advanced tumors. Prognosis is poor, mainly due to multimetastatic disease. © 2020, Hellenic Endocrine Society

Fast-track recovery after major liver and pancreatic resection from the nursing point of view

Postoperative fast-track recovery protocols combine various methods to support immediate care of patients who undergo major surgery. These protocols include control of postoperative pain and early beginning of oral diet and mobilization. The combination of these approaches may reduce the rate of postoperative complications and facilitate hospital discharge. The aim of this study was to evaluate progress and parameters of fast-track recovery after major liver and pancreatic resection. A descriptive bibliographical review from 2001 to 2012 via electronic databases such as MEDLINE, PubMed, and Google Scholar was undertaken. Articles that focused on a fast-track protocol were studied. Reports focusing on the implementation of a fast-track protocol in the postoperative recovery of patients after major hepatectomy or pancreatectomy were selected. Fast-track protocols may be applicable to patients recovering after major liver or pancreatic resection. Future research should be focused on particular parameters of the fast-track protocol separately. © 2014 Society of Gastroenterology Nurses and Associates

Diagnostic Accuracy of Preoperative Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Detecting Occult Papillary Thyroid Microcarcinomas in Benign Multinodular Goitres

Objective. To investigate the diagnostic accuracy of neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR) ratios in detecting occult papillary thyroid microcarcinomas in benign, multinodular goitres. Methods. 397 total thyroidectomy patients were identified from the institutional thyroid surgery database between 2007 and 2016 (94 males, 303 females, mean age 53 ± 14.5 years). NLR and PLR were calculated as the absolute neutrophil and absolute platelet counts divided by the absolute lymphocyte count, respectively, based on the preoperative complete blood cell count. Results. NLR was significantly higher in carcinomas and microcarcinomas compared to benign pathology (p=0.026), whereas a direct association could not be established for PLR. Both NLR and PLR scored low in all parameters of diagnostic accuracy, with overall accuracy ranging between 45 and 50%. Conclusions. As surrogate indices of the systemic inflammatory response, NLR and PLR are inexpensive and universally available from routine blood tests. Although we found higher NLR values in cases of malignancy, NLR and PLR cannot effectively predict the presence of occult papillary microcarcinomas in otherwise benign, multinodular goitres. © 2018 Dimitrios K. Manatakis et al

Association of Baseline Neutrophil-to-Lymphocyte Ratio with Clinicopathological Characteristics of Papillary Thyroid Carcinoma

Objective. To investigate the potential association of neutrophil-to-lymphocyte ratio (NLR), a surrogate systemic inflammatory biomarker, with clinical and pathological characteristics of papillary thyroid cancers. Methods. 205 patients with papillary carcinoma were identified from the institutional thyroid cancer database between 2006 and 2015 (55 males, 150 females, mean age 51.2 ± 14.7 years). NLR was calculated as the absolute neutrophil count divided by the absolute lymphocyte count, based on the preoperative complete blood cell counts. Results. NLR was significantly higher in carcinomas with extrathyroidal invasion (2.74 ± 01.24 versus 2.39 ± 0.96, p=0.04) and bilateral (2.67 ± 1.15 versus 2.35 ± 0.96, p=0.03) and multifocal tumours (2.65 ± 1.08 versus 2.29 ± 0.96, p=0.01), as well as lymph node-positive tumours (3.12 ± 1.07 versus 2.41 ± 1.02, p=0.03). On the other hand, NLR values were not associated with gender, age, tumour size, histologic subtype, the presence of thyroiditis, and TNM staging. Conclusions. As an index of inflammation, NLR is inexpensive, readily available, and easy to extract from routine blood tests. We found increased NLR values in papillary carcinomas with poorer histopathological profile and more aggressive clinical behaviour. Whether this systemic inflammatory response, as expressed by the NLR, represents the inflammatory microenvironment leading to tumourigenesis, or is a tumour-associated phenomenon, remains to be elucidated and warrants further study. © 2017 Dimitrios K. Manatakis et al

Fast-Track Recovery Program after Major Liver Resection: A Randomized Prospective Study

The objective of this study was to compare fast-Track (FT) recovery protocol with the conventional one in patients treated with major liver resection by evaluating perioperative morbidity, length of hospitalization, and readmission rate. Sixty-Two patients suffering from malignant liver tumors were surgically treated from May 2012 to April 2014. After randomization, they were prospectively divided into two groups: Group A patients (n = 32) followed FT recovery protocol and Group B patients (n = 30) were treated with the conventional (CON) protocol. Postoperative morbidity, readmission rate, and median hospital stay in the two groups were studied. Fast-Track protocol was associated with a decreased complication (25%, p =.002), whereas the risk of postoperative morbidity was 2.4 times higher in patients treated with the CON protocol (60%, p =.002). Readmission rate was not significantly different between the two groups (6.25%, p =.35). Age (p =.382) and body mass index (p =.818) were not a suspending factor for following the FT protocol. Overall length of stay (postoperative days) in the FT group was (mean ± SD) 5.75 ±.5 and in the CON group was 13.5 ± 6.7 (p <.001). Fast-Track recovery protocol seems to be safe and particularly efficient in patients undergoing major liver resections. © 2018 Lippincott Williams and Wilkins. All rights reserved

The Impact of Laparoscopic Nissen Fundoplication on the Long-Term Quality of Life in Patients with Gastroesophageal Reflux Disease

Laparoscopic Nissen fundoplication is now the most common surgical procedure for treatment of gastroesophageal reflux disease (GERD), offering promising long-term outcomes. Outcomes for 46 patients with GERD who underwent Nissen fundoplication during the last 5 years (November 2007-June 2012) were prospectively studied using a structured questionnaire that evaluated clinical symptom scores for heartburn, dysphagia, and satisfaction with clinical outcomes. Postoperative care of the patients including analgesia, median hospital stay, overall cost, and complications was also studied. Clinical follow-up data for 2 years after surgery were available for all 46 patients. Forty-two patients (91.3%) were satisfied with their quality of life and only eight patients (17.4%) continued to receive antacids after surgery. Dysphagia to solid and liquid occasionally appeared in 26.1% (N = 12) and 17.4% (N = 8) of patients, respectively. Laparoscopic Nissen fundoplication was an effective long-term treatment for GERD. The operation resulted in a significant reduction of symptoms and minimized the use of antacid drugs with a high degree of patient satisfaction. Although some patients may have returned to antacid treatment at late follow-up or continued to complain of mild discomfort, they were overall pleased with the outcome. © Copyright 2015 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited