Baseline mortality-adjusted survival in colon cancer patients.

BACKGROUND: This investigation assessed the baseline mortality-adjusted survival after colon cancer resection. MATERIAL AND METHODS: In total, 523 patients with adenocarcinoma of the colon who underwent primary colon resection at Kantonsspital St. Gallen, Switzerland, between 1996 and 2008 were included. RESULTS: The median follow-up was 25 months for all patients and 39 months for those who survived until the end of the follow-up. The 5-year relative survival rate was 63.2 % (95 % CI 57.3-69.6 %), and the overall survival rate was 52 % (95 % CI 47.6-57.7 %). After curative resection of stage I-III colon cancer, 40 % of the observed deaths were cancer-related and 60 % reflected the baseline mortality. In stage I, the 5-year relative survival was 103.2 % (95 % CI 91.4-116.5 %) and was not different from a matched population (p = 0.820). In multivariate analysis, good general health and less advanced cancer stages were associated with better relative and overall survival rates. A more advanced age was associated with better relative survival, but worse overall survival. CONCLUSIONS: The analysis of relative survival of patients exclusively with colon cancer revealed that prognosis of patients suffering from stage I colon cancer does not differ significantly from that of the general population. In more advanced stages, a relevant fraction of deaths is not cancer-related. As the stage determines a patient's survival, early diagnosis is crucial for prognosis.

New kid on the block: perineal stapled prolapse resection (PSP) is it worthwhile in the long-term?

PURPOSE: Perineal stapled prolapse resection (PSP) has been described as a new surgical treatment for external rectal prolapse in 2008. Short-term and midterm results acknowledged PSP as a safe, fast and simple procedure for high-risk patients. This study aims to assess long-term results after PSP. METHODS: All patients who underwent PSP from 2007 to 2015 were analyzed retrospectively. Data was gathered from medical records and operative reports and by interviews with the general practitioner or the patient. RESULTS: Indication for PSP was provided in 64 cases. One procedure had to be changed to an Altemeier's and another to a laparoscopic rectopexy. The median age was 79.9 years (range 25.9-97.5). Spinal anaesthesia was used in 19 patients. The median operation time was 32.5 min (range 25-51.2). There was no mortality. One patient had to be reoperated. All other complications were minor. The median hospital stay was 6.0 days (range 2-23). Median follow-up of patients alive was 6.0 years (range 0.2-8.4). The 5-year recurrence-free survival rate for primary prolapse was 70.1 % compared to 34.3 % for recurrent prolapses (p = 0.048). Further positive prognostic factors were specimen length over 8 cm and lack of preoperative obstructed defecation syndrome. Faecal incontinence was remedied in 18, and new onset was recorded in 6 patients (significant incontinence rate reduction (p = 0.025)). CONCLUSION: Due to low morbidity and the possibility of spinal anaesthesia, PSP is suitable for frail patients. The recurrence rate for primary prolapse is similar to alternative perineal procedures like Delorme's and Altemeier's, but inferior to the laparoscopic techniques.

IPMN: surgical treatment.

PURPOSE: Cystic pancreatic tumors are being detected more frequently, and particularly, intraductal papillary mucinous neoplasia (IPMN) has recently attracted increased attention. The detection rate of IPMN has increased over the last decade; however, management of this neoplasm remains controversial. METHODS: Based on a review of the relevant literature and the international guidelines, we discuss the diagnostic evaluation of IPMN, its treatment, and prognosis. RESULTS: While IPMN represents only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. It may not be possible to differentiate main duct disease from branch duct disease (MD-IPMN vs. BD-IPMN) prior to surgery. This distinction has not only an impact on treatment but also on prognosis, as MD-IPMN is more often malignant. IPMN has updated consensus guideline indications for conservative and surgical resection. CONCLUSIONS: Since patients with IPMN of the pancreas are at risk of developing recurrent IPMN and pancreatic ductal adenocarcinoma in the remnant pancreas and extrapancreatic malignancies, early recognition, treatment, and systemic surveillance are of great importance. No conclusions can be drawn from the available evidence with respect to the efficacy of surveillance and follow-up treatment programs. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is mandatory to enable further diagnostic and treatment improvements.

[Surgical treatment of fistula-in-ano--a journey between Skylla and Charybdis]. / Die Therapie der Analfistel - Wahl zwischen Skylla und Charybdis.

This review discusses the pathogenesis, symptomatology, diagnostic work-up, and treatment options for fistula-in-ano, which is a common condition that affects ~ 20 in 100,000 per year with a predominance for young males. Fistula-in-ano normally presents as an acute anorectal abscess that subsequently becomes established as a chronic discharging fistula. The illness is characterized by chronic perianal discharge and intermittent pain. The aim of surgical treatment is permanent cure of the fistula whilst maintaining patient continence. This principle forms the basis of surgical decision-making and means that treatment options often have to be individualized for each patient. Low, simple fistulae may be treated by fistulotomy because of the low risk of incontinence. In contrast, high fistulae that contain a greater proportion of sphincter muscle demand more complex operations. Traditional reconstructive techniques (transanal advancement flap, primary sphincter reconstruction) aim to eradicate the fistula whilst leaving the sphincter muscle intact or readapted, whilst newer techniques (biosynthetic plugs) provide a scaffold to encourage normal tissue ingrowth with fistula occlusion. The newer procedures preserve the sphincter ideally. On the other hand success rates of these techniques are somewhat disappointing.