Colorectal cancer in younger adults from a Bi-National Colorectal Cancer Audit registry.

BACKGROUND: The incidence of colorectal cancer (CRC) in younger adults (<50 years old) is rising worldwide, at a rate of 1% per annum since mid-1980s. The clinical concern is that younger adults may have more advanced disease leading to poorer prognosis compared to their older cohort due to lack of screening. Therefore, the aim of this study is to assess the incidence and short-term outcomes of colorectal cancer in younger adults. METHODS: This is a retrospective study from a prospectively maintained bi-national database from 2007 to 2018. RESULTS: There were 1540 younger adults diagnosed with CRC, with a rise from 5.8% in 2007 to 8.4% in 2018. Majority had lower American Society of Anaesthesiologists (ASA) scores (89%), rectal cancers (46.1%) and higher tumour stage (65.4%). As a consequence, they were likely to have higher circumferential resection margin positivity (6%, P = 0.02) and to receive adjuvant chemotherapy (57.1%, P < 0.001) compared to their older cohort. Multivariate analysis showed disadvantaged socioeconomic status (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.37-7.94, P < 0.001) and increasing tumour stage (OR 14.9, 95% CI 1.89-116.9, P < 0.001) were independent predictors for circumferential resection margin positivity whereas being female (OR 0.71, 95% CI 0.53-0.95, P = 0.02), higher ASA score (OR 175.3, 95% CI 26.7-1035.5, P < 0.001), urgent surgery (OR 2.75, 95% CI 1.84-4.11, P < 0.001) and anastomotic leak (OR 5.02, 95% CI 3.32-7.58, P < 0.001) were predictors of inpatient mortality. CONCLUSION: There is a steady rise in the incidence of colorectal cancer in younger adults. Both physicians and younger adults should be aware of the potential risk of colorectal cancer (CRC) and appropriate investigations performed so not to delay the diagnosis.

Rate of anastomotic leak following right hemicolectomy by general surgical trainees.

PURPOSE: Performing a right hemicolectomy (RH) is a core technical competency for general surgical trainees. There is a concern that anastomotic leaks occur more frequently when patients are operated on by trainees rather than by surgeons. This study aims to analyse the quality of care outcomes after RH, stratified by the experience level of the operator. METHODS: Patients were retrospectively recruited from the Bi-National Colorectal Cancer Audit (BCCA) Registry, from 2007 to 2018. All patients who underwent a RH for colorectal cancer were eligible. The primary outcome measure was anastomotic leak rate. RESULTS: A total of 6548 eligible right hemicolectomies were identified, with 74% being performed by consultants, 12% by fellows, and 14% by surgical trainees. The overall incidence of an anastomotic leak was 2.1%, with the highest rate of 3.7% noted among supervised registrars. Positive resection margin rate was the highest among unsupervised trainees at 10.5%, as compared with 4.3% among consultants. Anastomotic leak, anastomotic bleeding, prolonged ileus, and pneumonia occurred significantly less frequently with consultant surgeons, as compared with trainees. Independent risk factors for anastomotic leak were urgent surgery, extended right hemicolectomy, conversion to open surgery, and a lower level of operator seniority. Two independent risk factors were identified for inpatient mortality-a high ASA score (III and above) and urgent surgery. CONCLUSION: RH is a common operative procedure in general surgical training. Data from this study may assist with the structuring of surgical training programmes, aimed at maximising both patient safety and trainee professional development and education.

Appendicorectal fistula with a novel solution: First case report and review of the literature.

Appendicorectal fistula can be a cause of chronic abdominal pain, forming years after an occult episode of appendicitis. It can be diagnosed with Colonoscopy and Magnetic Resonance Imaging, and successfully treated surgically with laparoscopic appendicectomy and stapled segmental cuff resection of the rectum.

Safety of laparoscopic appendicectomy during pregnancy: a systematic review and meta-analysis.

BACKGROUND: Acute appendicitis is the most common non-obstetric surgical presentation during pregnancy. There were concerns that laparoscopic appendicectomy increases the risk of foetal loss compared to an open approach. Therefore, with recent advances in perioperative care, it is likely the risk has changed. Here, we performed an updated meta-analysis assessing the safety of laparoscopic appendicectomy in pregnant women. METHODS: A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was undertaken between 2000 and 2017 on Ovid Medline and Embase. The primary outcome measures were foetal loss and preterm delivery, whereas secondary outcome measures were operative time and hospital length of stay. A random-effect model was performed to pool odds ratio (OR) and standardized mean difference (SMD). RESULTS: Seventeen observational studies were included, with 1886 patients in the laparoscopic and 4261 patients in the open group. Comparing laparoscopic versus open appendicectomy, there were 54 (5.96%) and 136 (3.73%) foetal losses, respectively. However, preterm delivery was much higher in the open approach (8.99%) compared to laparoscopic approach (2.84%). Pooled OR for foetal loss was 1.84 (95% confidence interval (CI) 1.31-2.58, P < 0.001), whereas OR for preterm delivery was 0.39 (95% CI 0.27-0.55, P < 0.001). There was no significant difference between both approaches for operative time (SMD -0.07; 95% CI -0.43 to 0.30, P = 0.71) or hospital length of stay (SMD -0.34; 95% CI -0.83 to 0.16, P = 0.18). CONCLUSION: In a pooled analysis of level III evidence, laparoscopic appendicectomy posed a higher risk of foetal loss but lower risk of preterm delivery. Caution and informed consent are crucial when offering a laparoscopic approach.