Long-term results after elective laparoscopic surgery for colorectal cancer in octogenarians.

BACKGROUND: The aim of this study was to investigate the short- and long-term outcomes after elective laparoscopic surgery (LPS) for colorectal cancer patients over 80 years of age. METHODS: This was a retrospective study of all patients of 80 and above, who underwent elective colorectal resection, between January 2007 and January 2016. Data were analysed from a prospectively collected cancer database and cross checked with patient records. Determinants of survival were analysed using log-rank test and Kaplan-Meier curves. RESULTS: We identified 293 patients; 110 underwent LPS. LPS had significantly better overall survival (p = 0.0065) and disease-free survival (DFS) (p = 0.006). The LPS group also had a shorter length of stay (LOS)-9 vs 11 days (p < 0.00001), 90-day mortality-5.5 vs 13.7% (p = 0.03) and required fewer blood transfusions 22.7 vs 40.4% (p = 0.002), when compared to open surgery (OPS). There was no difference in 30-day mortality 1.8 vs 4.9% (p = 0.22), anastomotic leakage 2.3 vs 6% (p = 0.20) or post-operative complication rates 44.5 vs 50.8% (p = 0.30). CONCLUSIONS: LPS for patients in their 80s is characterised by better overall and DFS compared to open procedures and is associated with shorter post-operative LOS, and significantly lower 90-day mortality. Patients operated on laparoscopically also required fewer post-operative blood transfusions.

Blood pressure self-monitoring in pregnancy: examining feasibility in a prospective cohort study.

BACKGROUND: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. METHODS: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 and 16 weeks of pregnancy and were asked to take two BP readings twice daily three times a week through their pregnancy. Primary outcomes were recruitment, retention and persistence of self-monitoring. Study recruitment and retention were analysed with descriptive statistics. Survival analysis was used to evaluate the persistence of self-monitoring and the performance of self-monitoring in the early detection of gestational hypertension, compared to clinic BP monitoring. Secondary outcomes were the mean clinic and self-monitored BP readings and the performance of self-monitoring in the detection of gestational hypertension and pre-eclampsia compared to clinic BP. RESULTS: Of 201 women recruited, 161 (80%) remained in the study at 36 weeks or to the end of their pregnancy, 162 (81%) provided any home readings suitable for analysis, 148 (74%) continued to self-monitor at 20 weeks and 107 (66%) at 36 weeks. Self-monitored readings were similar in value to contemporaneous matched clinic readings for both systolic and diastolic BP. Of the 23 who developed gestational hypertension or pre-eclampsia and self-monitored, 9 (39%) had a raised home BP prior to a raised clinic BP. CONCLUSIONS: Self-monitoring of BP in pregnancy is feasible and has potential to be useful in the early detection of gestational hypertensive disorders but maintaining self-monitoring throughout pregnancy requires support and probably enhanced training.