Impact of laparoscopic versus open surgery on hospital costs for colon cancer: a population-based retrospective cohort study

OBJECTIVE: Laparoscopy is increasingly being used as an alternative to open surgery in the treatment of patients with colon cancer. The study objective is to estimate the difference in hospital costs between laparoscopic and open colon cancer surgery. DESIGN: Population-based retrospective cohort study. SETTINGS: All acute hospitals of the National Health System in England. POPULATION: A total of 55 358 patients aged 30 and over with a primary diagnosis of colon cancer admitted for planned (elective) open or laparoscopic major resection between April 2006 and March 2013. PRIMARY OUTCOMES: Inpatient hospital costs during index admission and after 30 and 90 days following the index admission. RESULTS: Propensity score matching was used to create comparable exposed and control groups. The hospital cost of an index admission was estimated to be £1933 (95% CI 1834 to 2027; p<0.01) lower among patients who underwent laparoscopic resection. After including the first unplanned readmission following index admission, laparoscopy was £2107 (95% CI 2000 to 2215; p<0.01) less expensive at 30 days and £2202 (95% CI 2092 to 2316; p<0.01) less expensive at 90 days. The difference in cost was explained by shorter hospital stay and lower readmission rates in patients undergoing minimal access surgery. The use of laparoscopic colon cancer surgery increased 4-fold between 2006 and 2012 resulting in a total cost saving in excess of £29.3 million for the National Health Service (NHS). CONCLUSIONS: Laparoscopy is associated with lower hospital costs than open surgery in elective patients with colon cancer suitable for both interventions

Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2 rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision with en bloc resection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision

Isolation, Screening and Development of Local Bacterial Consortia With Azo Dyes Decolourising Capability

A total of 1540 bacterial isolates were isolated and screened for their ability to degrade selected azo dyes. Of these, nine isolates were chosen for further studies based on their ability to degrade a wide spectrum of dyes efficiently and rapidly. Several microbial consortia were developed and tested for their effectiveness. Overall the consortia were able to degrade 70 - 100% colour within 72 hours compared to 60 – 97% colour removed by individual isolates. A microbial consortium labelled C15 showed good growth in agitation culture but the colour removal was best in static culture with 80 - 100% colour removed in less than 72 hours. Based on the 16S rRNA sequencing, two of the bacterial isolates in C15 belong to the Chryseobacterium genus while the other one belongs to Flavobacterium genus

Ultrasonic Waves Assisted Synthesis of Curcuminoids Based on 3-Methylacetylacetone and in Situ Synthesis of Gold Nanoparticles Capped with Curcuminoids

Ultrasonic irradiation was used to induce the Knuevenagle reaction between aromatic aldehydes and 3-methylacetylacetone to synthesize curcumin analogues with moderate to good yields. The structures of the compounds were established by elemental analysis and from their mass and 1HNMR spectra. In situ curcumin-gold nanoparticles were synthesized. The solutions of the prepared nanoparticles have purple to deep-red colors and their UV-vis spectra were characterized by the Surface Plasmon Resonance bands within the range 538-554 nanometer

Sexual dysfunction following rectal cancer surgery

INTRODUCTION: Sexual and urological problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. The urogenital function is dependent on dual autonomic sympathetic and parasympathetic innervation, and four key danger zones exist that are at risk for nerve damage during colorectal surgery: one of these sites is in the abdomen and three are in the pelvis. The aim of this study is to systematically review the epidemiology of sexual dysfunction following rectal cancer surgery, to describe the anatomical basis of autonomic nerve-preserving techniques, and to explore the scientific evidence available to support the laparoscopic or robotic approach over open surgery. METHODS: According to the PRISMA guidelines, a comprehensive literature search of studies evaluating sexual function in patients undergoing rectal surgery for cancer was performed in Medline, Scopus, Web of Science, Embase, and Cochrane Central Register of controlled trials. RESULTS: An increasing number of studies assessing the incidence and prevalence of sexual dysfunction following multimodality treatment for rectal cancer has been published over the last 30 years. Significant heterogeneity in the prevalence of sexual dysfunction is reported in the literature, with rates between 5 and 90%. CONCLUSIONS: There is no evidence to date in favor of any surgical approach (open vs laparoscopic vs robotic). Standardized diagnostic tools should be routinely used to prospectively assess sexual function in patients undergoing rectal surgery

A systematic review and meta-analysis of the diagnostic accuracy of pyruvate kinase M2 isoenzymatic assay in diagnosing colorectal cancer

BACKGROUND: Screening programmes exist in many countries for colorectal cancer. In recent years, there has been a drive for a non-invasive screening marker of higher sensitivity and specificity. Stool-based pyruvate kinase isoenzyme M2 (M2-PK) is one such biomarker under investigation. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy, sensitivity and specificity of M2-PK as a screening tool in colorectal cancer. METHODS: A literature search of Ovid Medline, EMBASE and Google Scholar was carried out. The search strategy was restricted to human subjects and studies published in English. Data on sensitivity and specificity were extracted and pooled. Statistical analysis was conducted using summary receiver operating characteristic (SROC) curve methodology. RESULTS: A total of eight studies were suitable for data synthesis and analysis. Our analysis showed a pooled sensitivity and specificity for M2-PK to be 79% (CI 73%–83%) and 80% (CI 73%–86%), respectively. The accuracy of M2-PK was 0.85(0.82–0.88). CONCLUSION: Faecal M2-PK assay has a relatively good sensitivity and specificity and high accuracy for screening colorectal cancer

A conceptual model for the implementation of lean product development

Companies are faced with the need to address their product development challenges innovatively in order to stay competitive in today's market. One way of doing that is the integration of lean thinking in their product development process. However, due to the lack of clear understanding of the lean thinking performance measurements, the near absent of a holistic and unifying measuring method and the near or non-existence of an evaluating conceptual model to allow for the evaluation of the performance of the lean product development processes, many companies are unable to fully implement the lean thinking principle in their Product development process. In dealing with these issues, this article has therefore proposed a conceptual model which is based on some core critical success factors for the examination of lean performance in the product development process

An intuitionistic fuzzy multi-criteria decision-making method based on an exponential-related function

Intuitionistic fuzzy multiple criteria decision making (MCDM) method which is based on an exponential-related function, adopted in the Technique for order preference by similarity to ideal solution (TOPSIS) has been proposed in this study. The exponential-related function which is used for comparing intuitionistic-fuzzy-sets (IFS), and as a replacement for the traditional exponential score function which is only effective for determining priority weights that involve pairwise-comparison, has been applied, for computing the separation measure from the fuzzy positive and negative ideal solution to determine the relative closeness-coefficients of alternatives. The main advantage of this method includes (1) its ability to account for Decision-makers (DMs) attitudinal-character in the decision-making process as-well-as to represent the aggregated effect of the positive/negative evaluations in the performance ratings of the alternatives based on the IFS-data and (2) The simplicity of the method both in its concept and computational procedures. To demonstrate the feasibility of the method, it has been applied for the evaluation of some hypothetical design-related problems and for a real-life case study

A prospective case control study of functional outcomes and related quality of life after colectomy for neoplasia.

AIM: Our aim was to assess bowel function and its effect on overall quality of life (QOL) when compared to healthy controls after colectomy. METHODS: Patients undergoing resection of colorectal neoplasia were recruited pre-operatively and followed up at 6 and 12 months, to assess 'early' bowel function. Patients who underwent surgery 2 to 4 years previously were recruited for assessment of 'intermediate' bowel function. Healthy relatives were recruited as controls. The Memorial Sloan-Kettering Cancer Centre and EQ-5D questionnaires were used to assess bowel function and QOL, respectively. Statistical assessment included regression analyses, parametric and non-parametric tests. The association between QOL and Memorial Sloan-Kettering Cancer Centre (MSKCC) scores was evaluated using Spearman's rank correlation. RESULTS: Ninety-one patients were recruited for assessment of 'early' and 85 for 'intermediate' bowel function. There were 85 controls. Patients had a significantly higher number of bowel movements at each follow-up (p < 0.001). At 12 months after surgery, patients reported difficulty with gas-stool discrimination. The 'intermediate' group were found to have lower scores for flatus control (<0.001) and total frequency score (p 0.03), indicating worse function. Patients with higher total MSKCC scores, no symptoms of urgency and those able to control flatus reported better QOL (p 0.006, 0.007 and 0.005, respectively) at 6 and 12 months. Gas-stool differentiation and complete evacuation correlated with better QOL in the 'intermediate' bowel function group (p 0.02 and 0.02, respectively). CONCLUSION: Colonic resection adversely affects elements of bowel function up to 4 years after surgery. Good colonic function, represented by higher MSKCC scores, correlates with better QOL