Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: A significant proportion of patients undergoing rectal cancer surgery receive a temporary ileostomy because of its benefits in case of anastomotic dehiscence. However, the best timing for closure remains unclear. METHODS: Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared in a single-center randomized controlled trial conducted at National Cancer Institute (Vilnius, Lithuania). Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other serious complications were randomized to early or standard ileostomy closure groups. Thirty days postoperative morbidity following ileostomy closure was the primary outcome of the study. RESULTS: The trial was prematurely terminated due to the safety reason after 86 patients were randomized to EC (43 patients) and SC (43 patients) groups. The overall 30 days postoperative morbidity rate was dramatically higher in the EC group (27.9% vs 7.9%; P = 0.024). Moreover, severe complications (Clavien-Dindo ≥3) were present only after EC of ileostomy in five (11.6%) patients. CONCULSION: Early closure of ileostomy at 30 days after radical rectal resection is not safe and should not be performed.

[Laparoscopic surgery for malignancies of the colon, rectum, and anus in Lithuania in 2008]. / Laparoskopines storosios zarnos ir isanges piktybiniu naviku operacijos Lietuvoje 2008 m.

UNLABELLED: THE OBJECTIVE OF THIS STUDY: was to analyze data on laparoscopic surgery for malignant diseases of the colon, rectum, and anus in Lithuania during the period of January 1, 2005, to February 15, 2008. MATERIAL AND METHODS: During the above-mentioned period in Lithuania, 130 laparoscopic surgeries for malignancies of colon, rectum, and anus were performed in seven different hospitals. There were 73 males and 57 females with a mean age of 68 years (range, 35-85 years). Laparoscopic procedures were attempted in 140 cases. Out of them, 130 were completed laparoscopically; 10 operations were converted to open, and conversion rate was 7.1%. Twenty-seven (20.8%) patients had stage I, 45 (34.6%) stage II, 45 (34.6%) stage III, and 13 (10%) stage IV disease. Ninety-two (70.8%) patients underwent straight laparoscopic surgery and 38 (29.2%) - hand-assisted laparoscopic surgery. Time in surgery was from 50 to 365 min, with a mean of 183 min. During 130 operations, in 11 (8.5%) cases, blood vessels were ligated through specimen retrieval site. Out of 104 operations, where anastomosis was performed (23 abdominoperineal resections and 3 Hartmann's procedures), in 68 (65.4%) cases it was done laparoscopically and in 36 (34.6%) cases using conventional extracorporal suturing. RESULTS: Hospital stay ranged from 7 to 59 days, with a mean of 12 days. One (0.8%) patient died. Postoperative complications occurred in 27 (20.8%) cases. Reoperation rate was 4.6% (6 cases). Complications were as follows: suture insufficiency (3 cases), eventration (3 cases), wound infection (7 cases), intraperitoneal abscess (1 case), abdominal wall phlegmon (1 case), intra-abdominal infiltrate (1 case), perineal hematoma (1 case), proctovaginal fistula (2 case), intraoperative bleeding from uterus (1 case), urinary retention (4 cases), cystitis (1 case), pneumonia (1 case), acute cardiovascular insufficiently (1 case). In histological specimens, 10 lymph nodes were found on the average (range, 2 to 27). CONCLUSIONS: Laparoscopic surgery for malignant diseases of the colon, rectum, and anus is dominating among laparoscopic surgeries for colorectum. Complication rate is similar to other authors. To evaluate disease relapse and outcomes, observation time is not sufficient yet.

The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment.

BACKGROUND: the purpose of study was to evaluate the impact of age on outcomes in colorectal cancer surgery. METHODS: patients on hospital database treated for colorectal cancer during the period 1995 - 2002 were divided into two groups: Group 1--patients of 75 years or older (n = 154), and Group 2--those younger than 75 years (n = 532). RESULTS: In Group 1, for colon cancers, proximal tumors were significantly more common (23% vs. 13.5%, p < 0.05), complicated cases were more frequent (46 % vs. 33%, p = 0.002), bowel obstruction more common at presentation (40% vs. 26.5%, p = 0.001), and more frequent emergency surgery required (24% vs. 14%, p = 0.003). Postoperative overall morbidity was higher in the elderly group, but with no differences in surgical complications rate. Overall 5 year survival was 39% vs. 55% (p = 0.0006) and cancer related 5 year survival was 44% vs. 62% (p = 0.0006). Multivariate Cox analysis showed that age was not an independent risk factor for postoperative mortality. CONCLUSION: Preoperative complications and co-morbidities, more advanced disease, and higher postoperative nonsurgical complication rates adversely affect postoperative outcomes after surgery for colorectal cancer in the elderly.

Risk factors for clinical anastomotic leakage following the resection of sigmoid and rectal cancer.

UNLABELLED: The aim of the study was to determine the risk factors for the leakage after sigmoid and rectal cancer resections depending on the height of anastomoses. MATERIAL AND METHODS: Data of 269 patients, who underwent primary resection of colorectal cancer, were analyzed retrospectively: 21 patients underwent proctectomy with Parks coloanal anastomosis, 78--low anterior resection of rectum, 67--high anterior resection of rectum and 103--resection of sigmoid colon with colorectal anastomosis. Preoperative radiotherapy was performed on 61 patients. RESULTS: Anastomotic leakage occurred in 20 (7.4%) patients. Multivariate analysis of the overall population showed that the risk of anastomotic leakage was 3.9 times higher for males (p=0.02) and 3.5 times higher for anastomoses situated at or below 10 cm from the anal verge (p=0.01). Multivariate analysis of low colorectal and coloanal anastomoses (n=99) showed that only male sex was an independent factor. Multivariate analysis of patients with anastomosis situated higher than 10 cm from the anal verge (n=170) showed that the preoperative condition of the patient was as independent factor for the development of anastomotic leakage. CONCLUSIONS: Low rectal anastomoses are at risk for anastomotic leakage, especially in males and in generally unfit patients.

[Coloanal anastomosis in rectal cancer surgery]. / Koloanaline anastomoze gydant tiesiosios zarnos vezi.

PURPOSE: To determine the efficacy of proctectomy with coloanal anastomosis for adenocarcinoma of the lower third of the rectum, and to compare quality of life after colonal anatomosis with low anterior rectal resection. MATERIAL AND METHODS: Twenty coloanal anatomosies were performed on 1996-2001 in Kaunas Medical University Hospital. Coloanal anatomosis was performed due to 1 villous adenoma and 19 adenocarcinomas. Postoperative functional results and quality of life were assessed by questionnaire, which was sent by mail to 17 patients after coloanal anatomosis and randomly assigned to 35 patients after low anterior rectal resection. Questionnaire was answered by 10 patients (59%) after coloanal anatomosis and 23 patients (66%) after low anterior rectal resection. RESULTS: Four general and 7 surgical complications occurred after coloanal anatomosis. Postoperative mortality was 15% (3 cases). Symptomatic anastomotic strictures revealed in 2 patients. The frequency of defecation 6 and more times per day after coloanal anatomosis were in 2 cases (20%) and after low anterior rectal resection in 3 cases (13%). In coloanal anatomosis group normal continence occurred in 40% of cases and after low anterior rectal resection--in 65%. One patient had incontinence of solids after low anterior rectal resection. In 4 cases after low anterior rectal resection occurred stable urine dysfunction. In coloanal anatomosis group sexual dysfunction occurred in 30% of cases, after low anterior rectal resection--in 22%. After both operations about 50% patients felt better. Hard social, emotional problems had only one patient with incontinence of solids. In other aspects quality of life was similar in both groups. CONCLUSIONS: Proctectomy with coloanal anastomosis is suitable and safe procedure to treat lower third rectal cancer, with functional results and quality of life similar to low anterior rectal resection.

[Staging of rectal cancer by endorectal ultrasound]. / Endorektalinio ultragarso tyrimo reiksme nustatant tiesiosios zarnos vezio stadija.

The aim of the present study was to compare the accuracy of transrectal ultrasound in staging rectal carcinoma. 30 consecutive patients with rectal carcinoma proven pathomorphological were staged transrectal ultrasound and computed tomography imaging, and then underwent radical surgery. The data of preoperative staging were compared with pathomorphological findings of the specimens according to Surgical excised the TNM classification system. Transrectal ultrasound showed better results than computed tomography in evaluating N (sensitivity 45.2%, specificity 45.2%), because the parameters of sensitivity and specificity were high enough (76.6%). Computed tomography has limited usefulness in staging rectal tumors because the layers of the rectal wall are not resolved by computed tomography. In T staging transrectal ultrasound sensitivity and specificity ranges 87.54% and 94.82% respectively and that enables to perform adequate surgical procedure.