摘要:

PURPOSE:Good continence is reported after ileal pouch‐anal reconstruction, but little is known about long‐term durability. Our aim was to prospectively evaluate long‐term function in these patients.METHODS:Surveys were sent to 235 patients who had returned similar surveys in 1992; paired data were then compared with contingency tables.RESULTS:A total of 154 patients (66 percent) returned surveys. Mean age was 47 (range, 25‐72) years. Median follow‐up was 12 (range, 8‐19) years. Sixty‐eight patients (44 percent) were female. There were 5 deaths, and 11 patients had pouches removed or were given a defunctioning ileostomy. Bowel movement frequency did not change from 1992 to 2000 (24‐hour frequency = 7 in 1992vs.7.1 in 2000; night frequency = 2vs.1.4;P= NS). Compared with 1992 data, major day incontinence was worse in 18 percent of patients, improved in 1 percent, and unchanged in 81 percent. Minor day incontinence was worse in 32 percent, improved in 9 percent, and unchanged in 59 percent. Major nighttime incontinence was worse in 22 percent, improved in 6 percent, and unchanged in 72 percent of patients, whereas minor night incontinence was worse in 24 percent, improved in 22 percent, and unchanged in 54 percent. Change in continence was unrelated to gender, age, or age at operation but was related to duration of follow‐up. Twenty‐seven percent of patients 12 or more years after surgery reported worsened major daytime incontinencevs.9 percent of patients who were <12 years after surgery (P< 0.05); 33 percent reported more major nighttime incontinence (vs.10 percent;P< 0.05). Minor incontinence also worsened after 12 years. Minor daytime incontinence was seen in 48 percent of patients followed up >12 yearsvs.16 percent of those followed up <12 years (P< 0.05); minor nighttime incontinence was 28vs.19 percent, respectively.CONCLUSION:Most patients have stable pouch function over time. However, a small number improve and a larger number suffer measurable deterioration, particularly 12 or more years after surgery.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:This prospective, nonrandomized study evaluates, with a seven‐year median follow‐up, the morbidity and the functional and oncologic results of conservative surgery after high‐dose radiation for cancer of the lower third of the rectum of patients who would otherwise have undergone abdominoperineal resection.METHODS:Between June 1990 and June 1996, 43 patients with distal rectal adenocarcinoma were treated by preoperative radiotherapy (40 + 20 Gy delivered with three fields) and curative surgery. The mean distance from the anal verge was 50 (range, 25‐60) mm, and none of the tumors was fixed (15 percent T2N0, 53 percent T3N0, 32 percent T3N1).RESULTS:Postoperative mortality (2 percent) and morbidity (35 percent) were not increased by high‐dose preoperative radiation. Conservative surgery was done in 30 patients (70 percent: 26 coloanal anastomoses and 4 low stapled anastomoses). After conservative surgery, long‐term functional results showed 30 percent complete continence and 20 percent serious incontinence. Four patients had local recurrence as first development (13 percent). The seven‐year overall survival rate was 53 percent, 62 percent after conservative surgery and 31 percent after abdominoperineal resection. The univariate analysis underscores the tumor response impact on long‐term survival (pT<3 = 81 percent; pT3 = 35 percent;P= 0.0008).CONCLUSIONS:These long‐term results confirm the feasibility of conservative surgery for low rectal carcinoma after high‐dose radiation. A prospective multicentric trial began in France in June 1996 to evaluate the reproducibility of these results.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The influence of septic complications on long‐term prognosis after surgery for rectal cancer is controversial. This study was performed to investigate whether an abdominal or perineal septic complication was associated with rectal cancer recurrence.METHODS:A total of 228 patients who had undergone curative resection for rectal cancer from 1973 to 1992 were reviewed. The patients were divided into groups of those who developed either an intra‐abdominal abscess or a perineal infection after surgery (infection group) and those who did not (noninfection group).RESULTS:There was no clear difference in the overall incidence of tumor recurrence between the infection group (19/53, 36 percent) and the noninfection group (46/175, 26 percent;P= 0.25). However, the incidence of local recurrence was higher in the infection group (12/53, 23 percent) than in the noninfection group (16/175, 9 percent;P= 0.02). This increased risk was restricted to patients with a perineal infection (10/30, 33 percent;P= 0.003vs.the noninfection group), whereas patients with an abdominal infection (3/24, 13 percent) did not differ from the noninfection group.CONCLUSION:Patients with a perineal infection after an abdominoperineal resection have an increased incidence of local recurrence. However, there was no association between abdominal sepsis and prognosis after surgery for rectal cancer.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to compare the bowel function of sigmoidvs. descending colonic J‐pouches after ultralow anterior resection for rectal cancer.METHODS:A prospective, randomized trial was conducted from March 1998 to September 1999. Ninety‐two consecutive patients undergoing ultralow anterior resection for cancers arising from 3 to 10 cm from the anal verge were recruited. Forty‐eight patients were males; the mean ages (standard error of the mean) for patients with sigmoid and descending colon pouches, respectively, were 65.2 (3.1) years and 62.3 (3.1) years. A total of 46 patients were randomly assigned to each group. Two patients from each group were excluded; abdominoperineal resection was performed for two patients in the sigmoid pouch group and one patient in the descending pouch group. One patient in the descending pouch group had a transanal resection of a benign polyp. Dukes staging and use of postoperative chemoradiotherapy were statistically similar in both groups. All patients underwent a standardized ultralow anterior resection. A defunctioning loop ileostomy was used routinely. Anorectal physiology and bowel function questionnaires were performed at six weeks after ileostomy closure and again at 6 and 12 months after surgery.RESULTS:Median follow‐up was 12 (range, 7 to 25) and 12 (range, 6 to 25) months, respectively, for sigmoid and descending pouch groups. Median tumor and anastomotic heights, time to ileostomy closure, operative time, and postoperative stay were statistically similar in both groups. There were no significant differences in stool frequency, incontinence, urgency, use of pads and antidiarrheals, sensation of incomplete evacuation, and anorectal physiology results between groups (P> 0.05).CONCLUSION:Pouches made from sigmoid or descending colon give similar bowel function after ultralow anterior resection for rectal cancers.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:In case‐control studies, it was reported that microsatellite instability might be helpful in predicting the development of metachronous multiple colorectal cancers. The purpose of this cohort‐like study was to determine whether microsatellite instability is a novel independent marker in predicting metachronous colorectal carcinomas after colorectal cancer surgery.METHODS:Three hundred twenty‐eight colorectal carcinoma patients were surveyed by periodic colonoscopy for at least three years after surgery. Among these, DNA from paraffin‐embedded sections was available for 272 cases. DNA of these cases was studied for six microsatellite markers (five dinucleotide repeats, one mononucleotide repeat). Microsatellite instability phenotype was defined as alterations in one or more loci.RESULTS:Median follow‐up period was 74 months, and the median number of colonoscopies was 4.6. The percentage of microsatellite instability‐positive cases was 26.4 percent (72/272). Seventeen metachronous colorectal carcinomas were detected during the follow‐up period. Incidences of metachronous colorectal carcinomas in microsatellite instability‐positive and microsatellite instability‐negative cases were 15.3 and 3 percent, respectively (P< 0.001). The cumulative five‐year incidence of metachronous colorectal carcinomas was significantly higher in microsatellite instability‐positive cases than in microsatellite instability‐negative cases (12.5vs. 2.5 percent,P< 0.0001). Logistic regression analysis of the relationship between incidence of metachronous colorectal carcinomas and possible risk factors (namely, coexistence of adenoma at the time of surgery, family history of colorectal carcinoma, history of extracolonic malignancy, and microsatellite instability status) showed that microsatellite instability and coexistence of adenoma were significant independent risk factors for the occurrence of metachronous colorectal carcinomas, with values ofP= 0.001 and 0.02, respectively.CONCLUSION:These data indicate that microsatellite instability can be regarded as a novel independent and important marker for predicting the development of metachronous colorectal carcinoma after surgery.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The purpose of this study was to examine whether a hyaluronan‐based membrane (Seprafilm® Adhesion Barrier) could affect growth and metastasis of colon cancer in a human xenograft/nude mouse model.METHODS:Male athymic (nude) mice underwent a midline abdominal incision followed by an intraperitoneal inoculation of KM12‐L4 human colon cancer cells. Seprafilm® membrane was placed under the incision or on the right lateral abdominal wall; control groups received no Seprafilm® membrane. In another group, Vicryl™ mesh was placed on the right lateral abdominal wall and removed after 1 minute to control for surgical trauma associated with biomaterial placement.RESULTS:Intraperitoneal Seprafilm® did not affect human colon cancer tumor metastasis, including the liver, spleen, and mesenteric lymph nodes. The application of a biomaterial such as Seprafilm® or Vicryl™ mesh to the peritoneal sidewall away from the midline wound was associated with an increased rate of local tumor growth. This was likely because of the local trauma of biomaterial placement in the nude mouse model and not because of the presence of a foreign material.CONCLUSIONS:Our study suggests that Seprafilm® does not affect tumor metastasis. Additionally, placement of biomaterials may cause local trauma that stimulates the formation of localized sidewall tumors in the nude mouse model. Further studies in other animal models and ultimately, in humans are required to unambiguously understand the safety of Seprafilm® and other biomaterials in cancer patients.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:This study reviews the long‐term outcome of overlapping anal sphincteroplasty for acquired anal incontinence.METHODS:Seventy‐one consecutive patients underwent overlapping sphincteroplasty from 1989 to 1996. Current degree of continence and associated quality of life were determined by telephone interview using the Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life Scale, as validated by The American Society of Colon and Rectal Surgeons. Both the patient‐rated and the surgeon‐rated Fecal Incontinence Severity Index scores were recorded. Demographic and perioperative data were obtained from patient charts.RESULTS:Forty‐nine (69 percent) of the 71 patients, with a median age of 38.5 (range, 22‐80) years, could be contacted at a median of 69 (range, 48‐141) months after sphincter repair. Four patients were diverted at the time of follow‐up. Twenty‐four (54 percent) patients were incontinent to liquid or solid stool, and only six patients (14 percent) were totally continent. Fifteen patients (34 percent) had the best possible Fecal Incontinence Quality of Life score of 16. The median patient‐rated and surgeon‐rated Fecal Incontinence Severity Index scores were 20 (range, 0‐61) and 20 (range, 0‐57), respectively. The patient‐rated score correlated to the surgeon‐rated score (r= 0.98,P< 0.001) and the Fecal Incontinence Quality of Life score (r= 0.64,P< 0.001).CONCLUSION:Years after sphincter repair surgery more than half of the patients are incontinent to liquid or solid stool. The American Society of Colon and Rectal Surgeons‐validated Fecal Incontinence Severity Index and Fecal Incontinence Quality of Life scores are useful and complementary tools for evaluation of fecal incontinence.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The purpose of this study was to use the Fecal Incontinence Severity Index to assess fecal incontinence after fistulotomy and to correlate the Fecal Incontinence Severity Index score with quality‐of‐life measures.METHODS:A retrospective chart review was performed on consecutive patients undergoing fistulotomy by a single colon and rectal surgeon at a university hospital from 1991 to 1999. Demographics, fistula anatomy, surgical technique, and length of follow‐up were recorded. Mailed questionnaires and telephone interviews were conducted to determine the Fecal Incontinence Severity Index score, pad usage, lifestyle restriction, and psychosocial factors. A linear regression model was used to determine the relationship of clinical factors with Fecal Incontinence Severity Index. One‐way ANOVA was used to correlate Fecal Incontinence Severity Index with quality‐of‐life measures.RESULTS:Of 110 patients who underwent fistulotomy, 96 (88 percent) had complete follow‐up. Mean age was 48 (range, 17‐84) years, and 68 percent were male. Follow‐up was less than two years in 26 percent, two to five years in 39 percent, and more than five years in 35 percent. Of these patients, 41 percent had intersphincteric fistulas, whereas 59 percent had transsphincteric fistulas. Median Fecal Incontinence Severity Index score was 6, with a mean of 13 (maximum Fecal Incontinence Severity Index = 61); 36 percent had a Fecal Incontinence Severity Index score of zero. Linear regression revealed that only the amount of external sphincter divided correlated with Fecal Incontinence Severity Index score (P= 0.05). Quality‐of‐life measures strongly correlated with Fecal Incontinence Severity Index by analysis of variance (P< 0.01 for pad usage, lifestyle restriction, depression, and embarrassment), with substantial quality‐of‐life drop‐off documented with Fecal Incontinence Severity Index >30.CONCLUSION:The Fecal Incontinence Severity Index is an excellent tool to gauge quality of life after fistulotomy. Fecal Incontinence Severity Index scores >30 predict a detrimental effect on quality of life.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to evaluate the incidence of postoperative complications after Harmonic Scalpel® hemorrhoidectomy and to identify any predisposing factors leading to postoperative complications.METHODS:Five hundred consecutive cases of Harmonic Scalpel® hemorrhoidectomy were studied in a prospective manner. Postoperative complications were recorded, and any predisposing factors were evaluated.RESULTS:Three hundred fifty‐five patients (71 percent) underwent Harmonic Scalpel® hemorrhoidectomy alone. One hundred twenty patients (24 percent) underwent additional fissurectomy/sphincterotomy for fissure‐in‐ano, and 25 patients (5 percent) underwent additional fistulotomy. A total of 24 (4.8 percent) patients experienced some form of postoperative complication. Three patients (0.6 percent) experienced a secondary postoperative hemorrhage requiring reexploration under anesthesia. Two of the three patients were taking postoperative oral Toradol®, and both had undergone an “open” hemorrhoidectomy technique. The third patient required suture ligation of multiple bleeding sites on two separate occasions at 7 and 14 days postoperatively. The patient was subsequently diagnosed as having Ehlers‐Danlos syndrome. One patient experienced postoperative incontinence to flatus and stool. The patient had large, Grade IV postpartum hemorrhoids and had undergone a three‐quadrant closed hemorrhoidectomy. The sphincter mechanism was intact on postoperative ultrasound, and an underlying pudendal neuropathy likely contributed to the sphincter dysfunction. Postoperative urinary retention was noted in 10 (2 percent) patients, postoperative fissure in 5 (1 percent), and abscess/fistula in 4 (0.8 percent). One patient (0.2 percent) required readmission for colonic pseudo‐obstruction.CONCLUSION:Harmonic Scalpel® hemorrhoidectomy is a safe surgical modality, and postoperative complication rates compare favorably with previously published studies. The combination of an “open” hemorrhoidectomy technique and prolonged oral Toradol® administration may result in a higher incidence of postoperative hemorrhage.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

INTRODUCTION:We report the early results of patients treated with stapled hemorrhoidectomy, which has recently been introduced into the United States.METHODS:Sixty‐eight patients with symptomatic hemorrhoids were treated at two institutions with the Proximate® HCS Hemorrhoidal Circular Stapler supplied by Ethicon Endo‐Surgery. Patients were prospectively evaluated for functional recovery and postoperative pain on a 1 to 10 scale.RESULTS:There were 45 (66 percent) males and 23 (34 percent) females with a mean age of 56 years and median duration of symptoms of 5 years. The mean operative time was 22.2 minutes. The operation was performed with spinal (50 percent), local (40 percent), or general (10 percent) anesthesia and as an outpatient (56 percent) or overnight admission (44 percent). Ninety‐three percent of patients remained asymptomatic with a mean follow‐up of 34 weeks, whereas the remaining 7 percent required either surgical excision or rubber band ligation for persistent symptoms. There was no mortality, new incontinence, fecal impaction, or persistent pain. The total morbidity was 19 percent, with urinary retention as the most common complication (12 percent). The mean pain score decreased from 3.6 on postoperative Day 1 to 1.4 at postoperative Day 7. Ninety‐nine percent of patients made a complete functional recovery by postoperative Day 7.CONCLUSIONS:Stapled hemorrhoidectomy is safe, effective, and can be performed as an outpatient procedure with local or regional anesthesia. There seems to be minimal postoperative pain and early recovery, although a benefit over traditional hemorrhoidectomy needs to be proven in a randomized trial.

ISSN:0012-3706    

出版商:OVID    

年代:2002

数据来源: OVID