Clinicopathological differences between familial colorectal cancer type X and sporadic cancer in an isolated area of spain.

AIM: Very few studies have compared the epidemiological characteristics of patients with familial colorectal cancer Type X (FCCTX) with those of sporadic colorectal cancer (S-CRC). The aim of this study was to compare clinicopathological characteristics and survival between FCCTX and S-CRC in patients from a historically isolated geographical region. METHOD: A retrospective study was carried out of patients with S-CRC and FCCTX treated in the Canary Islands. Family and personal history of colorectal cancer (CRC) were recorded, together with genetic (microsatellite instability), immunohistochemical and clinical variables. RESULTS: Forty-eight (10.6%) of 451 patients were classified as FCCTX and the remaining 403 (89.4%) as S-CRC. Age at the diagnosis of tumour was significantly lower in FCCTX than in S-CRC (64.06 ± 12.65 years vs 69.13 ± 10.80 years; P = 0.01; Z = -2.48). Patients with FCCTX had a larger number of synchronous tumours (P = 0.09). Recurrence was significantly higher in FCCTX than in S-CRC (18.7% vs 8.6%; P = 0.01). Survival correlated significantly with the number of first-degree and second-degree relatives with CRC (P = 0.04; OR: 1.368, 95% CI: 1.01-1.84, and P = 0.04; OR: 1.363, 95% CI: 1.08-1.65) and with the total number of cases of CRC in the immediate family (P < 0.01; OR: 1.377, 95% CI: 1.17-1.61). Recurrence-free time was significantly lower in patients with FCCTX (log-rank = 0.01). CONCLUSION: Significant differences were found in several demographic and clinicopathological variables between patients with FCCTX and patients with S-CRC. These included increased tumour presentation under the age of 50 years and a higher recurrence rate in patients with FCCTX, suggesting an increased risk of CRC in this group.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

Willingness to undergo colorectal cancer screening in first-degree relatives of hospitalized patients with colorectal cancer.

AIMS: To evaluate whether willingness to undergo colonoscopy screening is influenced by being a first-degree relative of hospitalized patients with or without colorectal cancer after briefing and surgeon recommendation. METHODS: We performed a cross-sectional study of 327 first-degree relatives of hospitalized patients aged higher than 40 years, divided into Group A (151 relatives of colorectal cancer patients) and Group B (176 relatives of non-cancer patients) at the University Hospital of the Canary Islands, Spain. All were personally briefed by a surgeon, aided by a colorectal cancer pamphlet, and encouraged to accept screening colonoscopy with sedation. RESULTS: Willingness to undergo colonoscopy screening was greater in Group A (66.9%) than in Group B (29.0%); (odds ratio: 11.1; 95% confidence interval = 4.27 to 29.14; P < 0.001). Pre-briefing awareness of screening colonoscopy was also significantly higher in Group A (76.8% vs. 33.5%; P < 0.001), the main source of information being a close relative with colorectal cancer. CONCLUSIONS: Being a close relative of a colorectal cancer patient is positively related with willingness to undergo colonoscopy screening in this study. This cross-sectional study outlines a strategy for increasing the level of willingness to undergo colorectal cancer screening in a group of people at risk.

[Mesenteric panniculitis: experience in our center]. / Paniculitis mesentérica: experiencia en nuestro centro.

Although several etiological factors have been associated with mesenteric panniculitis, the exact etiology in some cases remains unknown. Herein, we present a retrospective analysis of 8 patients affected with this disorder performed between May 2000 and December 2006. In our series the mean age at which patients presented was 63 years. The majority of the patients were male (with a male: female ratio of 3:1). The most common clinical manifestations were abdominal pain (n = 4) and asthenia (n = 4). Three cases presented with obstructive symptoms and three had a history of abdominal surgery. Notably, seven had a background of tobacco use (five smokers and two ex-smokers) and one patient developed follicular lymphoma. A literature research was carried out to analyze our results and formulate a new hypothesis. In our opinion, we believe that the study of causal factors such as tobacco and its components is required due to the strong association found in this study.

Laparoscopic repair of incarcerated low spigelian hernia with transperitoneal PTFE DualMesh.

There are different types of hernias that can develop at certain sites in the abdominal wall. Spigelian hernia (SH) is a protrusion of abdominal contents through a defect in the spigelian aponeurosis, in proximity to the external margin of the rectus muscle. Usually, abdominal wall hernia sac contains the omentum but may also contain small intestine that might become trapped in the hernia. When ischemia of herniated contents is suspected, urgent surgical treatment is advocated. Elective laparoscopic repair of SH is still under discussion. However, a recent randomized study comparing open and laparoscopic repair as elective treatment suggested that extraperitoneal laparoscopic repair is the technique that offers best results for the patients. Recent development of new biologic materials and technologies in laparoscopy has led to improved results. We report the successful repair of incarcerated low SH that was successfully managed by urgent laparoscopic intraperitoneal onlay polytetrafluoroethylene mesh hernioplasty.

Restorative proctocolectomy with an ileoanal pouch: the role of laparoscopy.

OBJECTIVES: The Aim of this retrospective study was to evaluate early experience with laparoscopic restorative proctocolectomy by analyzing the perioperative results of surgical treatment. PATIENTS AND METHODS: Seven major surgeries were performed in six patients with familial adenomatous polyposis and ulcerative colitis. All procedures were performed under laparoscopy at our third-level hospital from June 2003 to October 2004. RESULTS: Mean surgical time was 287.5 +/- 80.7 min, and median blood loss was 300 +/- 249.0 cc. There were no conversions; return of peristalsis began at 32 +/- 12.4 h; average time to first oral intake was 64.0 +/- 32.8 h, and mean duration of hospital stay was 9.3 +/- 1.2 days. There was one case of perineal sepsis due to ileal pouch-anal anastomotic leakage, which was successfully treated with oral intake restriction, parenteral nutrition, and intra-rectal drainage. The most common postoperative complication was postoperative ileus. CONCLUSIONS: We believe that the laparoscopic approach to restorative proctocolectomy may be considerably improved in our center. Particular aspects for improvement include efforts to achieve lower operating and hospitalization times to equate our results with those reported by multicenter studies for laparoscopic colon cancer surgery. In our opinion, learning and further training opportunities should be encouraged to improve surgeon experience in the field of laparoscopy, preferably at centers specializing in restorative proctocolectomy.

Paniculitis mesentérica: experiencia en nuestro centro / Mesenteric panniculitis: experience in our center

A pesar de que se han reconocido distintos factores precipitantes en la paniculitis mesentérica, su etiología en determinados casos es incierta. Presentamos un análisis retrospectivo de 8 pacientes afectados de paniculitis mesentérica en un periodo comprendido entre mayo 2000 hasta diciembre 2006. En nuestra serie la edad media de presentación fue 63 años, siendo la mayoría de pacientes varones (proporción 3:1). Las manifestaciones clínicas más frecuentes fueron el dolor abdominal (n = 4) y la astenia (n = 4). Tres casos se presentaron como cuadro de obstrucción y tres casos presentaron antecedentes de cirugía abdominal. El antecedente más común fue el tabaquismo (5 casos eran fumadores activos y 2 exfumadores) y hubo un paciente que desarrolló un linfoma folicular en el seguimiento. Revisamos la literatura para analizar nuestros resultados y formular una hipótesis. En nuestra opinión, pensamos que debe ser analizada de forma más exhaustiva la relación entre el tabaco y sus componentes con la aparición de la enfermedad debido a la fuerte asociación encontrada en este estudio

Although several etiological factors have been associated with mesenteric panniculitis, the exact etiology in some cases remains unknown. Herein, we present a retrospective analysis of 8 patients affected with this disorder performed between May 2000 and December 2006. In our series the mean age at which patients presented was 63 years. The majority of the patients were male (with a male: female ratio of 3:1). The most common clinical manifestations were abdominal pain (n = 4) and asthenia (n = 4). Three cases presented with obstructive symptoms and three had a history of abdominal surgery. Notably, seven had a background of tobacco use (five smokers and two ex-smokers) and one patient developed follicular lymphoma. A literature research was carried out to analyze our results and formulate a new hypothesis. In our opinion, we believe that the study of causal factors such as tobacco and its components is required due to the strong association found in this study

Proctocolectomía restauradora con reservorio ileoanal: el papel de la laparoscopia / Restorative proctocolectomy with an ileoanal pouch: the role of laparoscopy

Objetivos: el objetivo de este estudio restrospectivo es evaluarla experiencia inicial en la proctocolectomía restauradora laparoscópica,analizando los resultados perioperatorios obtenidos durantela fase de introducción de la técnica.Pacientes y métodos: entre junio de 2003 y octubre 2004,realizamos siete intervenciones mayores en seis pacientes afectosde poliposis colónica familiar y colitis ulcerosa mediante abordajelaparoscópico.Resultados: el tiempo medio quirúrgico fue: 287,5 ± 80,7min y las pérdidas hemáticas: 300 ± 249,0 cc. No hubo conversiones;el inicio del peristaltismo fue: 32 ± 12,4 h; el tiempo mediode reintroducción de la alimentación: 64,0 ± 32,8 h; el tiempomedio de estancia hospitalaria: 9,3 ± 1,2 días. Hubo un casode dehiscencia del reservorio ileoanal con sepsis perineal tratadasatisfactoriamente con dieta absoluta, nutrición parenteral y drenajedel mismo mediante punción intrarrectal. La complicaciónpostoperatoria más frecuente fue la presencia de íleo postoperatorio.Conclusiones: creemos que la proctocolectomía restauradoralaparoscópica aún debe mejorar. Estas mejoras deberían reducirlos tiempos operatorios y la estancia hospitalaria para que la laparoscopiaen este campo iguale los resultados tan favorables obte-nidos en estudios multicéntricos en la cirugía oncológica del colon.En nuestra opinión, estos cambios deberían producirse con elaprendizaje y formación de los cirujanos en laparoscopia colorrectaly siempre en centros dedicados especialmente a este tipo de cirugía

Objectives: the aim of this retrospective study was to evaluateearly experience with laparoscopic restorative proctocolectomy byanalyzing the perioperative results of surgical treatment.Patients and methods: seven major surgeries were performedin six patients with familial adenomatous polyposis and ulcerativecolitis. All procedures were performed under laparoscopyat our third-level hospital from June 2003 to October 2004.Results: mean surgical time was 287.5 ± 80.7 min, and medianblood loss was 300 ± 249.0 cc. There were no conversions;return of peristalsis began at 32 ± 12.4 h; average time to firstoral intake was 64.0 ± 32.8 h, and mean duration of hospital staywas 9.3 ± 1.2 days. There was one case of perineal sepsis due toileal pouch-anal anastomotic leakage, which was successfullytreated with oral intake restriction, parenteral nutrition, and intrarectaldrainage. The most common postoperative complicationwas postoperative ileus.Conclusions: we believe that the laparoscopic approach torestorative proctocolectomy may be considerably improved in ourcenter. Particular aspects for improvement include efforts toachieve lower operating and hospitalization times to equate ourresults with those reported by multicenter studies for laparoscopiccolon cancer surgery. In our opinion, learning and further trainingopportunities should be encouraged to improve surgeon experiencein the field of laparoscopy, preferably at centers specializingin restorative proctocolectomy