Laparoscopic adrenalectomy in a consecutive series of patients

Laparoscopic adrenalectomy (LA) has become the procedure of choice for most adrenal pathologies. A number of uncertainties remain which include: 1. The impact of variable adrenal vasculature on LA. 2. The blood supply to the adrenal remnant after subtotal adrenalectomy. 3. Haemodynamic changes during LA for phaeochromocytoma resection. 4. The role of LA for large adrenal tumours (≥6cm). 5. The outcomes of patients undergoing open adrenalectomy (OA) in a series where LA is performed routinely. 6. The role of LA for isolated adrenal metastasis. The aim of the thesis was to examine these uncertainties using our adrenalectomy series (Jan 1999 – Jan 2009) and anatomical dissection. We found: 1. The main adrenal vein was remarkably constant and multiple small arteries and veins surround the adrenal gland. 2. During laparoscopic subtotal adrenalectomy, a non functioning adrenal remnant would be unlikely due to an inadequate arterial supply or due to division of the main adrenal vein. 3. LA for phaeochromocytoma was associated with increased episodes of severe intraoperative hypertension (systolic blood pressure 200-220mmHg) when compared to the laparoscopic resection of other adrenal tumours. There were no other significant differences in terms of hypotensive episodes, cardiac arrhythmias or intravenous fluid requirements. 4. In the absence of local invasion, LA for tumours ≥6cm has shown that oncological outcome and post-operative morbidity were comparable to LA for tumours <6cm. 5. In a series where LA was routine, OA was performed infrequently. In the absence of the requirement for an additional open procedure, OA was a demanding procedure associated with resection of adjacent structures and high local recurrence rates. 6. The recovery and oncological outcomes for isolated adrenal metastasis from a renal origin compared very favourably to other series where a more selective policy for laparoscopy was adopted

Increased lymph node yield in colorectal cancer is not necessarily associated with a greater number of lymph node positive cancers

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Improved outcomes for patients undergoing colectomy for acute severe inflammatory colitis by adopting a multi-disciplinary care bundle

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Lymph node yield in colorectal cancer analysed by year.

<p>Lymph node yield in colorectal cancer analysed by year.</p

The frequency of individual tumour stages in colon cancer from 1975–2012.

<p>The 2005–2012 data excludes screen detected cancers thus allowing direct comparison with the historic data set prior to the introduction of the bowel cancer screening programme. Rectal cancers have also been excluded as the introduction of neo-adjuvant therapy for rectal cancers excludes the direct comparability of rectal cancer staging.</p

Lymph node yield for all colorectal cancers 2005–2012.

<p>Lymph node yield for all colorectal cancers 2005–2012.</p

Clinico-pathological parameters of the contemporary and historic colorectal cancer datasets.

<p>1. No lymph nodes assessed or no comment about lymph node positivity</p><p>2. Complete pathologic response (i.e. ypT0N0) to pre-operative neoadjuvant therapy.</p

The tumour stage frequency distribution of colorectal cancer 2005–2012.

<p>A. All colorectal cancers, B. cases that did not receive neoadjuvant therapy, C. colon cancers, D. colon cancers excluding bowel screening detected cases.</p

Overview of the distribution of colorectal cancers in the historic dataset.

<p>Overview of the distribution of colorectal cancers in the historic dataset.</p