Radiation proctopathy.

Radiation therapy is a widely utilized treatment modality for pelvic malignancies, including prostate cancer, rectal cancer, and cervical cancer. Given its fixed position in the pelvis, the rectum is at a high risk for injury secondary to ionizing radiation. Despite advances made in radiation science, up to 75% of the patients will suffer from acute radiation proctitis and up to 20% may experience chronic symptoms. Symptoms can be variable and include diarrhea, bleeding, incontinence, and fistulization. A multitude of treatment options exist. This article summarizes the latest knowledge relating to radiation proctopathy focusing on the vast array of treatment options.

Risk factors for anastomotic leak and mortality in diabetic patients undergoing colectomy: analysis from a statewide surgical quality collaborative.

OBJECTIVES: To determine the risk factors in diabetic patients that are associated with increased postcolectomy mortality and anastomotic leak. DESIGN: A prospectively acquired statewide database of patients who underwent colectomy was reviewed. Primary risk factors were diabetes mellitus, hyperglycemia (glucose level ≥ 140 mg/dL), steroid use, and emergency surgery. Categorical analysis, univariate logistic regression, and multivariate regression were used to evaluate the effects of these risk factors on outcomes. SETTING: Participating hospitals within the Michigan Surgical Quality Collaborative. PATIENTS: Database review of patients from hospitals within the Michigan Surgical Quality Collaborative. MAIN OUTCOME MEASURES: Anastomotic leak and 30- day mortality rate. RESULTS: Of 5123 patients, 153 (3.0%) had leaks and 153 (3.0%) died. Preoperative hyperglycemia occurred in 15.6% of patients, only 54% of whom were known to have diabetes. Multivariate analysis showed that the risk of leak for patients with and without diabetes increased only by preoperative steroid use (P<.05). Mortality among diabetic patients was associated with emergency surgery (P<.01) and anastomotic leak (P<.05); it was not associated with hyperglycemia. Mortality among nondiabetic patients was associated with hyperglycemia (P<.005). The presence of an anastomotic leak was associated with increased mortality among diabetic patients (26.3% vs 4.5%; P<.001) compared with nondiabetic patients (6.0% vs 2.5%; P<.05). CONCLUSIONS: The presence of diabetes did not have an effect on the presence of an anastomotic leak, but diabetic patients who had a leak had more than a 4-fold higher mortality compared with nondiabetic patients. Preoperative steroid use led to increased rates of anastomotic leak in diabetic patients. Mortality was associated with hyperglycemia for nondiabetic patients only. Improved screening may identify high-risk patients who would benefit from perioperative intervention.

Evaluating the age distribution of patients with colorectal cancer: are the United States Preventative Services Task Force guidelines for colorectal cancer screening appropriate?

PURPOSE: Evaluate the appropriateness of the 2008 United States Preventative Services Task Force screening recommendations for colorectal cancer. METHODS: Ages at diagnosis data were collected on patients with colorectal cancer from the William Beaumont Tumor Registry. The database identified 6,925 patients treated for colorectal cancer between January 1973 and December 2007. Patients were divided into 3 age groups at diagnosis categories (younger than 50 years old, those 50 to 75 years old, and those older than 75 years old) to evaluate whether there were changes in the age distribution, pathologic stage, or tumor location during the 35-year period. RESULTS: The percent of patients with colorectal cancer older than age 75 years increased from 29% to 40% (P < .0001). The combined percentage of patients younger than age 50 years and older than age 75 years has increased from 36% (1973-1978) to 49% (2003-2007). The combined percentages of stage III and IV disease in patients younger than 50 years and older than 75 years were 51% and 34%, respectively (P < .0001). Rectal or left-sided lesions occurred in 68%, 64%, and 50% of patients younger than 50 years old, those 50 to 75 years old, and those older than 75 years old, respectively (P < .0001). Right-sided lesions occurred in 22%, 25%, and 37% of those younger than 50 years old, those 50 to 75 years old, and those older than 75 years old, respectively (P < .0001). CONCLUSIONS: There has been a significant increase in the percentage of colorectal cancer patients older than age 75 years. Failing to screen patients younger than 50 years and older than the age of 75 years would miss 49% of patients treated at our institution from 2003 to 2007.