Efficacy of a local anesthetic gel infusion kit for pain relief after minimally invasive colorectal surgery: an open-label, randomized clinical trial.

Continuous wound infusion with local anesthesia is an effective method for reducing postoperative pain after laparoscopic colorectal surgery. However, most subcutaneous local anesthesia is delivered through continuous injection, which can be inconvenient for patients. This study compared the effectiveness of postoperative pain relief from the application of a local poloxamer 407-based ropivacaine hydrogel (Gel) to the incision site with continuous infusion-type ropivacaine administration (On-Q) in patients undergoing laparoscopic colorectal surgery. This prospective, randomized, non-inferiority study included 61 patients who underwent laparoscopic colorectal surgery with an incision length of 3-6 cm. All 61 patients were randomly assigned to the Gel group (poloxamer 407-based 0.75% ropivacaine, 22.5 mg) or the On-Q group (0.2% ropivacaine, 4 mg/hour for two days). Postoperative analgesia was induced in all patients with intravenous patient-controlled analgesia (IV-PCA). The outcome measures, which were assessed for 72 h after surgery, included the total amount of fentanyl consumed via IV-PCA (primary endpoint), and the amount of rescue analgesia (pethidine) and postoperative pain intensity assessed using a numeric rating scale (NRS) [secondary endpoints]. The Gel was administered to 31 patients and On-Q was used for 30 patients. There was no significant difference in the total usage of fentanyl between the two groups (Gel group, 1623.98 mcg; On-Q group, 1595.12 mcg; P = 0.806). There was also no significant difference in the frequency of analgesic rescue medication use (P = 0.213) or NRS scores (postoperative 6 h, P = 0.860; 24 h, P = 0.333; 48 h, P = 0.168; and 72 h, P = 0.655) between the two groups. The Gel, which continuously delivers a local anesthetic to operative sites, can thus be considered an effective device for analgesia and pain relief for midline incisions in laparoscopic colorectal surgery.

Prognostic factors associated with primary cancer in curatively resected stage IV colorectal cancer.

PURPOSE: The aim of this study is to evaluate the prognostic factors associated with primary cancer in patients with curatively resected stage IV colorectal cancer, based on lymph node status. METHODS: A total of 468 consecutive patients with curatively resected stage IV colorectal cancer from October 1994 to December 2010 were prospectively enrolled. Survival curves were constructed using the Kaplan-Meier method, and multivariate analysis assessed independent prognostic factors. RESULTS: During the median follow-up period of this study, which was 37 months (range 1-177), the 3- and 5-year overall survival rates were 66.5 and 52.1%, respectively, and the 3- and 5-year disease-free survival rates were 43.0 and 38.2%, respectively. According to multivariate analysis, adjuvant chemotherapy and the preoperative serum carcinoembryonic antigen (CEA) level were independent prognostic factors for overall survival, and primary tumor location and preoperative serum CEA level were independent variables for disease-free survival. For the patients with N0 and N1 tumors, the overall survival curves in the preoperative CEA groups differed significantly (P = 0.046 and P < 0.013, respectively). However, for patients with pN2 tumors, the overall survival did not differ significantly according to the preoperative CEA (P = 0.948). CONCLUSION: The preoperative serum CEA level is a reliable predictor of recurrence and survival after curative surgery in patients with metastatic colorectal cancer. A multidisciplinary approach that combines both complete resection and adjuvant chemotherapy may achieve improved overall survival in these patients.

Prognostic value of perineural invasion in patients with stage II colorectal cancer.

BACKGROUND: Perineural invasion (PNI) may influence the prognosis after resection of colorectal cancer (CRC); whether this is a definite prognostic factor remains controversial. This study determined the clinicopathologic factors associated with oncologic outcome after radical resection of stage II CRC, focusing on PNI. MATERIALS AND METHODS: We retrospectively reviewed 341 consecutive patients who underwent curative surgery for stage II CRC between January 2001 and December 2006. Of these, 278 patients (81.5%) received postoperative 5-fluorouracil-based chemotherapy. The oncologic outcomes and the risk factors for recurrence were analyzed. RESULTS: PNI was detected in 57 of 341 patients (16.7%) and was significantly associated with depth of tumor invasion (P = .035) and positive lymphovascular invasion (P < .001). Multivariate analyses revealed that PNI was a significant independent prognostic factor for disease-free survival, not for overall survival. With a median follow-up period of 57.6 months, the 5-year disease-free and overall survival rates of the patients were 80.2 and 82.6%, respectively. The 5-year disease-free survival of the PNI-negative group was significantly higher than that of the PNI-positive group (P < .001). Within the PNI-positive patients, those receiving chemotherapy had significantly higher 5-year disease-free survival than the others (P = .023). CONCLUSION: This study illustrates the value of PNI as a prognostic factor for stage II CRC. Moreover, PNI-positive patients should be considered for postoperative chemotherapy.

Postoperative chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer: is it essential for patients with ypT0-2N0?

BACKGROUND: The potential advantage of adjuvant chemotherapy in patients with ypT0-2N0 rectal cancer remains unclear. The purpose of this study was to evaluate whether this therapy has an impact on survival. MATERIALS AND METHODS: Patients who underwent curative surgery after preoperative chemoradiation for locally advanced low rectal cancer were retrospectively reviewed. A total of 41 consecutive patients with pathological stage 0 (ypT0N0) or I (ypT1-2N0) were enrolled. Of the 41 patients, 17 (41.5%) received postoperative 5-fluorouracil (5-FU)-based chemotherapy, while 24 were followed without postoperative therapy. Oncologic outcomes were compared between the two groups. RESULTS: The median follow-up period was 47.6 months. The overall postoperative complication rates did not differ significantly between the patients who received chemotherapy and those who did not (17.6% vs. 20.8%, P = 0.799). The 5-year overall and disease-free survival rates for patients who received chemotherapy were 88.9% and 84.7%, which were not significantly different from the rates for those who did not (85.9%; P = 0.644 and 73.4%; P = 0.599, respectively). CONCLUSIONS: Postoperative adjuvant chemotherapy for patients with good responses after preoperative chemoradiation and curative surgery did not significantly improve the survival. However, this should be validated in prospective randomized trials with larger sample sizes.