Risk factors for small bowel obstruction after open rectal cancer resection

Background: Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery. Methods: A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed. Results: In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129-7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO. Conclusions: One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy

Low risk of intra-abdominal infections in rectal cancer patients treated with Hartmann's procedure : a report from a national registry

To describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann's procedure (HP). Data were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007-2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed. Of 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3-4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14-2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08-3.67), T4 tumours (OR, 1.68; 95% CI 1.04-2.69) and female gender (OR, 1.73; 95% CI, 1.15-2.61) as risk factors for intra-abdominal infection. ASA score 3-4 (OR, 1.62; 95% CI, 1.12-2.34), elevated BMI (OR, 1.05; 95% CI, 1.02-1.09) and female gender (OR, 2.06; CI, 1.41-3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP. Despite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann's procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer

Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT

Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method. Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated. Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT. Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10 -10), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10 -10) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10 -10) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.</p