Prognostic roles and survival benefits of endoscopic resection versus surgical resection in the management of malignant colon polyps

Background: Due to few sufficient data regarding the comparison between endoscopic and surgical resection of malignant colorectal polyps regarding outcomes and survival benefits, there are no clear guidelines of management strategies of malignant colorectal polyps. The aims of the present study were to compare endoscopic resection alone and surgical resection in patients with malignant polyps in the colon (T1N0M0) readings advantages, disadvantages, recurrence risks, survival benefits, and long-term prognosis to detect how management strategy affects outcome. Patients and methods: we included 350 patients. All included patients were divided into 2 groups; the first group included 100 patients who underwent only endoscopic polypectomy and the second group included 250 patients who underwent endoscopic polypectomy followed by definitive surgical resection after histopathological diagnosis. We followed all patients for about 5 years, ranging from 18 to 55 months. The primarily evaluated parameters are surgical consequences and patients' morbidity. The secondary evaluated parameters are recurrence risks, recurrence free survival, and overall survival rates. Results: The age of patients who underwent polypectomy is usually younger than the surgical group, males have more liability to polypectomy in comparison with females. Patients with tumors in the left colon have more liability to polypectomy in comparison with the right colon (p< 0.0001). Tumor factors associated with more liability to surgical resection are presence of lymphovascular invasion, high grade, and poor tumor differentiation (p< 0.0001). The management strategy was the most significant predictor of overall and recurrence free survival rates in patients with malignant colon polyps (p< 0.001). Conclusions: We found that survival benefits and lower incidence of recurrence are detected in the surgical resection group more than in the polypectomy group. (AU)

Bilateral sphenopalatine ganglion block versus intravenous clonidine premedication for surgical field improvement and postoperative pain relief in endoscopic sino-nasal surgery

ackground: Bilateral sphenopalatine ganglion block (SPGB) and IV clonidine premedication could provide better hemodynamic parameters, surgical field, postoperative pain control during endoscopic sino-nasal surgery. Design: prospectiverandomized controlled comparative study. Methods: A total of 69 patients of ASA grade I or II scheduled for endoscopic sino-nasal surgery were equally divided into three groups (23 patients each): control group; block group; and clonidine group. The sphenopalatine ganglion block technique done by lateral infra-zygomatic approach guided by x-ray fluoroscopy. Iv clonidine premedication was given 15 min before general anesthesia induction with dose 2 µg/kg as singe bolus. Surgical field quality assessment done by average category scale (ACS), hemodynamic profile and consumption of anesthetics were recorded. Postoperative pain evaluated by VAS. The time to first request for analgesia, analgesic requirement for 24 h postoperatively and any complications were recorded. Results: MAP and HR readings at most of intra and postoperative times, Average category scale score, intraoperative blood loss, average consumption of fentanyl and propofol and hypotensive agent (labetalol) were significantly high in control group when compared with block and clonidine groups and were significantly low in block group when compared with clonidine group except for postoperative HR.VASscore postoperatively, Time of first request of analgesia, Total pethidine consumption was significantly high in control group C when compared with block and clonidine groups. Conclusion: SPGB is effective for better hemodynamic control, surgical field and postoperative analgesia in endoscopic sino-nasal surgery when compared with IV clonidine premedication