Colorectal resections - clinical and immunological results

INTRODUCTION: Surgery induces a generalized state of postoperative immunosuppression responsible for a lot of complications in postoperative period. Magnitude and type of the intraoperative injury depend on the extent and duration of postoperative immune suppression. This study compared clinical outcomes and immune changes after minimally invasive and open colorectal resections in patients with colorectal cancer (CRC).MATERIAL AND METHODS: Study included 40 patients with CRC who underwent colorectal resections in our clinic last year. Twenty one of them underwent minimally invasive surgery, with a mean age of 64.8 years (49-86). The rest 19 patients underwent conventional surgery, with a mean age of 66.2 years (56-84). Blood tests were performed 24 hours prior to surgery, 24 hours and 7 days after surgery. Analysis included full blood count, total protein, albumin and markers of inflammation (CRP, ESR, fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leucocytes, according to the expression of HLA-DR, CD38, CD279, CD163 and some clinical parameters. All data were analyzed using SPSS version 21.RESULTS: There was no significant difference in preoperative results between minimally invasive group and conventional group. At 24 hours after surgery there were significant decrease in lymphocyte percentages and increased leucocyte count, granulocyte percentages and CRP levels in conventional group. This ratio maintained at 7 days after surgery. Activated monocyte (CD 163+), total protein and albumin, eosinophiles, percentage of monocytes, lymphocytes and NKT-cells (CD3+ CD16/CD56+) were significant decrease in conventional group compared with minimally invasive group at first postoperative day.CONCLUSIONS: Minimally invasive colorectal cancer resection is a technically feasible option, with comparable results in terms of oncologic clearance, lesser degrees of tissue injury, surgical metabolic stress, and immunosuppressive response to conventional open surgery. Patients undergoing minimally invasive resections demonstrated improved clinical recovery and shorter hospital stay than patients undergoing open surgery. 

TRANSANAL ENDOSCOPIC MICROSURGERY IN THE MANAGEMENT OF RECTAL CARCINOID.

AIMS: Carcinoid tumors, a type of neuro-endocrine tumors (NETs), comprise a heterogeneous group of neoplasms arising from cells of the neuro-endocrine system. Rectal carcinoid tumors are relatively uncommon, representing 1,1% to 1,3% of all rectal neoplasms. Their incidence is dramatically increasing. The aim of this study was to review our department`s experience and assess the efficacy of transanal endoscopic microsurgery (TEM) in the management of rectal carcinoid tumor.METHODS: Between 2013 and 2015, four patients with rectal carcinoid underwent TEM, and their clinical data were reviewed retrospectively. RESULTS: Two patients (50%) were identified as high-risk patients and underwent TEM, full-thickness excision and two ones (50%) were identified as low-risk patients and underwent TEM, submucosal resection. One patient from the high-risk group was referred to us by gastroenterologist from another hospital for complete surgery after endoscopic polypectomy with microscopically tumor positive resection margin. Tumor size was bigger in high-risk patients than in low-risk ones (14 and 20 mm versus 7 and 9 mm). There was no lymphovascular invasion in both groups. The operation time was longer in the full-thickness excision than in the submucosal resection group (45 and 55 min versus 27 and 33 min). One patient with full-thickness excision was complicated with acute urinary retention. There was neither local recurrence, nor distant metastasis in our patients during the follow-up period. CONCLUSIONS: Our data suggest that TEM is a safe, minimally invasive approach for local excision of rectal carcinoid tumors and, generally, leads to good oncological and surgical outcomes. Furthermore, for patients with microscopically positive margins after endoscopic polypectomy, TEM can be an effective surgical option for complete residual tumor removal

THE ROLE OF TRANSANAL ENDOSCOPIC MICROSURGERY IN THE TREATMENT OF T1N0 RECTAL CANCER – CASE SERIES AND REVIEW OF THE LITERATURE

Background: Currently, there has been an increasing trend toward transanal endoscopic microsurgery as a definitive treatment of T1 rectal cancer. Despite the promising results from the earlier series, the more recent studies reported a higher rate of local recurrences. Methods: A retrospective analysis of 20 patients with T1 rectal cancer managed by transanal endoscopic microsurgery is presented. Results: The patients were followed-up for mean 39.3 months. Local recurrences occurred in 5.3% of low-risk, 50% of high-risk T1 cases. The 3-year and 5-year cancer-specific survival in T1 group were 94.4% and 73.5%, respectively with mean time without LR was 81.5 months (90.5 months in the low-risk and 21 months in the high-risk group). Conclusion: The results corroborate the excellent prognosis for low-risk T1 cancers treated by TEM alone. For a high-risk T1 cancer adjuvant radiotherapy or conventional resection is highly recommended

Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey

The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results