Collecting Duct Carcinoma of the Native Kidney in a Renal Transplant Recipient

Collecting duct carcinoma (CDC) is a rare and aggressive form of renal cell carcinoma (RCC) arising from the epithelium of Bellini’s duct. It presents earlier in life and has a poorer prognosis than the clear-cell type. Historically, immunosuppressed renal transplant patients are more likely to develop malignancies than the general population. We report a case of CDC of the native kidney in a 59-year-old man who initially underwent kidney transplantation five years before the time of presentation. To our knowledge, CDC in the setting of renal transplant and long-term immunosuppression has not been previously described

Laparoscopic vs Open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes

Background: Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. Methods: Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. Results: Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17). Conclusions: LPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed

Risk of venous thromboembolism during and after hospitalisation in patients with inflammatory bowel disease activity

Background: Inflammatory bowel disease (IBD) increases the risk of venous thromboembolism. Aim: To determine when patients are at high risk of thromboembolic events, including after major surgery, and to guide timing of thromboprophylaxis. Methods: Each inflammatory bowel disease patient from Clinical Practice Research Datalink, linked with Hospital Episode Statistics, was matched to up to five non-IBD patients in this cohort study. We examined their risk of thromboembolism in hospital and within six weeks after leaving hospital, with or without undergoing major surgery, and while ambulant. Hazard ratios were estimated using Cox regression, with adjustment for age, sex, body mass index, smoking and history of malignancy or thromboembolism. Results: Overall 23,046 inflammatory bowel disease patients had a thromboembolic risk 1.74 times (95% CI = 1.55–1.96) higher than 106,795 non-IBD patients. Among ambulant patients, the thromboembolic risk was raised during acute (hazard ratio = 3.94, 2.79–5.57) or chronic disease activity (3.97, 2.90–5.45) but their absolute risk remained below 5/1000 person-years. The hazard ratio for thromboembolism among in-patients not undergoing major surgery was 1.13 (0.63–2.02), compared to 2.43 (1.20–4.92) among surgical patients, with a near doubling of absolute risk associated with surgery (59.5/1000 person-years, compared with 31.1 without surgery). The absolute risk remained elevated within six weeks after leaving hospital (18.6/1000 person-years in inflammatory bowel disease patients after surgery). Conclusions: Inflammatory bowel disease patients are at an increased risk of venous thromboembolism. Absolute risks are raised during active disease, when in hospital, and after leaving hospital following major surgery