The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes

Cirurgia colorectal; Atenció perioperatòria; ProbiòticsCirugía colorrectal; Atención perioperatoria; ProbióticosColorectal surgery; Perioperative care; ProbioticsThe perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.This research received no external funding

We still need to operate at night!

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Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Risk-adjustment in gastrointestinal surgery

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Operative and diagnostic strategies in pelvic floor disease and incontinence

Introduction: Pelvic floor disease affects many patients, with age, female gender and multiparity being significant associations. This can present clinically as pelvic organ prolapse, internal and external rectal mucosal intussuception, obstructed defecation syndrome, rectocele, cystocele and urinary/faecal incontinence. Diagnostic and treatment strategies for the management of such disorders is significantly varied, and evidence for current surgical management is poor. This thesis explores diagnostic and operative strategies currently regarded as state of the art and examines a novel method of pelvic floor assessment using MRI-based statistical shaped modelling. Methods: Meta-analysis in accordance with Cochrane collaboration guidelines was performed to assess laparoscopic versus open techniques for urinary incontinence, as well as endoanal ultrasound (EUS) scanning versus MRI in the assessment of faecal incontinence. The efficacy of sacral nerve stimulation (SNS) was reviewed. In addition, decision analysis was performed to assess the cost-effectiveness of delayed versus immediate anal sphincter repairs, and current operative treatments for end-stage faecal incontinence, and operative strategies for end-stage incontinence. MRI-based statistical shaped biomechanical modelling was performed to assess normal pelvic floors in comparison with patients with obstructed defecation syndrome. 15 asymptomatic volunteers aged 18 to 60 years were scanned and compared against 7 with obstructed defecation (ODS). Finally, 7 patients who were treated surgically for ODS were reassessed 6 months post-operation. Results: There were significant benefits to laparoscopic colposuspension for urinary incontinence. EUS was superior to MRI at detecting internal sphincter lesions, but not for external sphincter lesions. Immediate sphincter repairs were more cost-effective than delayed repairs. The artificial bowel sphincter and end stoma were more acceptable to both patient and institution than dynamic graciloplasty. Patients with obstructed defecation had significantly more irregular levator muscles with wider levator hiatus. Pressure during straining was concentrated in the posterior aspect of the hiatus, potentially contributing to the rectal neuropathy noted in obstructed defecation. Conclusions: Sacral nerve stimulation is an effective treatment for faecal incontinence. The artificial bowel sphincter and end stoma were cost-effective long-term strategies for end-stage faecal incontinence. A new technique for dynamic imaging and functionally assessing pelvic floor musculature has been developed and is showing promise as an adjunct to conventional assessment. Conventional defecating proctography does not provide the dynamic and functional assessment provided by this technique, and may translate well into a means of functional radiological assessment in the future.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Management and Outcomes in Anal Canal Adenocarcinomas—A Systematic Review

(1) Background: Anal canal adenocarcinomas constitute 1% of all gastrointestinal tract cancers. There is a current lack of consensus and NICE guidelines in the United Kingdom regarding the management of this disease. The overall objective was to perform a systematic review on the multitude of practice and subsequent outcomes in this group. (2) Methods: The MEDLINE, EMBASE, EMCARE and CINAHL databases were interrogated between 2011 to 2021. PRISMA guidelines were used to select relevant studies. The primary outcome measure was 5-year overall survival (OS). Secondary outcome measures included both local recurrences (LR) and distant metastases (DM). The Newcastle–Ottawa Scale (NOS) was used to assess the quality of studies retrieved. The study was registered on PROSPERO (338286). (3) Results: Fifteen studies were included. Overall, there were 11,967 participants who were demographically matched. There were 2090 subjects in the largest study and five subjects in the smallest study. Treatment modalities varied from neoadjuvant chemoradiotherapy (CRT), CRT and surgery (CRT + S), surgery then CRT (S + CRT) and surgery only (S). Five-year OS ranged from 30.2% to 91% across the literature. LR rates ranged from 22% to 29%; DM ranged from 6% to 60%. Study heterogeneity precluded meta-analysis. (4) Conclusions: Trimodality treatment with neoadjuvant chemoradiotherapy (CRT) followed by radical surgery of abdominoperineal excision of rectum (APER) appeared to be the most effective approach, giving the best survival outcomes according to the current data