Discriminating between simple and perforated appendicitis

Background: Several studies have been performed in order to diagnose an acute appendicitis using history taking and laboratory investigations. The aim of this study was to create a model for the identification of a perforated appendicitis. Methods: All consecutive patients who have undergone an appendectomy in the Reinier de Graaf hospital between January 1, 2007 and July 31, 2009, were included in a retrospective cohort study. Baseline patient characteristics, history and laboratory data were collected. Variables discriminating perforated from non-perforated appendicitis were identified using univariate and multivariable analyses. Results: A total of 498 patients were included in the study. In the univariate analysis leukocyte count, C-Reactive Protein levels, Erythrocyte Sedimentation Rate levels, days of symptoms and temperature were identified as predictors of perforated appendicitis. The predicted probability (P) of a perforated appendicitis can be calculated from the following model: (P) = 1/(1 + e(-(-2.788 + 0.012 CRP+0.207days with complaints))). Conclusions: Perforation of appendicitis can be predicted from the CRP level and the duration of abdominal pain. These findings might influence th

Recurrence and survival after resection of adenocarcinoma of the gastric cardia

In a retrospective study, the results after resection of carcinoma of the gastric cardia in the era without neoadjuvant therapy or extended lymph node dissection were evaluated. All 184 patients who underwent resection between January 1983 and December 1993 were included. Recurrence of disease, survival and prognostic factors were determined. The overall cumulative 5-year recurrence rate was 71% and the survival rate 23%. Multivariate analysis identified locoregional lymph node and distant metastases as the crucial prognosticators of recurrence of disease and survival. These results were similar to those from a previous study concerning our patients operated during the years 1983-88. The prognosis of a resected cardiacarcinoma has remained unchanged in our hands over the past 10 years. These results stress the importance of exploring new ways, such as the use of new diagnostic tools, to optimize preoperative patient selection and more aggressive treatment regimens to improve final outcom

A multi-centred randomised trial of radical surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer

Background: Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5-20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients. Methods/Study design: In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients. Discussion: The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a radically removed intermediate risk early rectal cancer by polypectomy or transanal surgery that is conventionally treated with subsequent radical surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME surgery. Trial registration:NCT02371304, registration date: February 2015

Multispectral characterization of tissues encountered during laparoscopic colorectal surgery

AIMS: This study investigated the feasibility of automated differentiation between essential tissue types encountered during laparoscopic colorectal surgery using spectral analysis. METHODS: Wide band (440-1830 nm) spectra were collected using an optical fiber probe and spectrometer from freshly explanted, ex vivo, human colonic specimens. These data were normalized at 810 nm (an isobestic wavelength for hemoglobin and oxy-hemoglobin) and mathematically analyzed using total principal component regression (TPCR). RESULTS: 929 spectra were collected from specimens of 19 patients, distinguishing 5 tissue types: mesenteric fat (MF, n=269), blood vessels (BV, n=377), colonic tissue (CT, n=213), ureter (UR, n=10) and tumorous tissue in colon (TT, n=60). For each individual tissue type the distinctive ability was determined against all other tissue types pooled as a group. Paired probability density function (PDF) of "tissue" (centered around label 1) versus "all other pooled tissues" (centered around label 0) and the cumulative distribution function (CDF) at label crossover value 0.5 was determined for each tissue type (MF: CDF=0.99 [SD=0.19]; BV: CDF=0.95 [SD=0.29]; CT: CDF=0.98 [SD=0.22]; UR: CDF=0.99 [SD=0.09]; TT: CDF=0.99 [SD=0.18]). CONCLUSION: Automated spectral differentiation of blood vessel, ureter, mesenteric adipose tissue, colonic tissue and tumorous tissue in colon, is feasible in freshly explanted human colonic specimens. These results may be exploited for further steps toward multi- or hyperspectrally enhanced in vivo (laparoscopic) surgical imaging