Overall Survival of Elderly Patients Having Surgery for Colorectal Cancer Is Comparable to Younger Patients: Results from a South Asian Population.

INTRODUCTION: There has been a continuous debate on whether elderly patients with colorectal cancer (CRC) fair worse. The aim of this study is to assess the thirty-day mortality (TDM) and overall survival (OS) of elderly patients undergoing surgery for CRC. METHOD: OS between two groups (≥70 versus <70 years) having surgery for CRC was analyzed. Demographics, tumour characteristics, and serological markers were considered as independent factors. Multivariable analysis was done using the Cox proportional hazard model. We also compared overall survival in the elderly versus those <60 and <50 years. RESULTS: 477 patients, 160 elderly (55% male; median age 75, range 70-89) and 317 younger patients (49% male; median age 55, range 16 to 69), were studied. Overall survival in CRC patients ≥70 is comparable to <70 (P = 0.45) and <60 years (P = 0.08). Poor OS was observed in the ≥70 versus <50 years (P = 0.03). TDM in the elderly was poor (P < 0.05). Postoperative cardiac complication was the only determinant affecting survival in the elderly (P = 0.01). CONCLUSION: OS in elderly CRC patients having surgery is not worse compared to <70 and <60 years although the TDM was higher. Postoperative cardiac complications significantly affected OS in those ≥70 compared to those <50 years. Chronological age alone should not negatively influence surgical decision-making in the elderly.

Novel use of Absorbable Modified Polymer (AMP®); EndoClot™ as an adjunct in the management of bleeding from the liver bed during laparoscopic cholecystectomy.

Absorbable modified polymer (AMP) is a novel local haemostatic agent derived from a natural polysaccharide. Its safety and efficacy has been evaluated in upper and lower gastrointestinal bleeding without reported side effects. We report the safe use of AMP as an adjunct in the management of serious bleeding during laparoscopic cholecystectomy.

Laparoscopically detected and nonsurgically managed ileal perforation by an ingested fish bone: a case report.

INTRODUCTION: Ileal perforation due to fish bone is a rare event. The condition is difficult to diagnose due to lack of specific clinical features and low sensitivity of imaging techniques. We report a case of ileal perforation by a fish bone that was detected laparoscopically and managed nonsurgically. CASE PRESENTATION: A 45-year-old Sinhalese man presented with acute onset right iliac fossa pain and fever for three days. On examination, he had significant right iliac fossa tenderness and guarding. His white cell count and C-reactive protein level were elevated and an ultrasound scan was indicative of a bowel mass formation. A clinical diagnosis of acute appendicitis was made and laparoscopic appendicectomy was scheduled. At initial survey, a thin spike-like structure was retrieved from the bowel mass, which was revealed to be a fish bone. Our patient was managed with antibiotics only and did not develop any complications. CONCLUSIONS: Ileal perforation due to fish bone is a rare condition that can mimic common conditions like appendicitis. Preoperative diagnosis is rarely made. The slow process of fish bone migration results in concomitant sealing of the perforation, reducing contamination. Use of laparoscopy may be useful in diagnosing this condition and preventing the morbidity of laparotomy in these patients.

Congenital hypertrophy of retinal pigment epithelium (CHRPE) in patients with familial adenomatous polyposis (FAP); a polyposis registry experience.

BACKGROUND: Familial Adenomatous Polyposis (FAP) is an autosomal dominant condition giving rise to multiple adenomatous polyps in the colon which invariably become malignant by the fourth decade. Congenital hypertrophy of retinal pigment epithelium (CHRPE) is one of its extra intestinal manifestations early in childhood seen, present in 90% of FAP population and is easy to detect. FINDINGS: Patients diagnosed with FAP and at risk first degree family members were screened for CHRPE using a slit lamp and indirect ophthalmoscopy. The retina of 17 diagnosed FAP patients and 13 individuals at risk were examined. The site and size of CHRPE lesions were documented. Thirteen (76%) of 17 FAP patients (male-10, female - 7, median age - 30 years; range 15-55 years) had CHRPE lesions; seven (54%) had bilateral CHRPE lesions and six (46%) had unilateral lesions. A single lesion was detected in 6 (46%) while 7 (54%) patients had multiple lesions. Of 13 at risk individuals (7- male, female-6 ; median age 34; range 16-52 years), one was positive for CHRPE and 12 were free of retinal lesions. The sensitivity of the presence of a CHRPE lesion in association with colonic polyps in FAP was 76%, specificity 92%, positive predictive value 93%, and negative predictive value 75%. CONCLUSIONS: This study found a high sensitivity and specificity for a CHRPE lesion to be associated with colonic polyps of FAP and hence a useful screening method in a burdened health-care system. The method is minimally invasive and simple and would be of particular value in screening children at risk for FAP.

Total number of lymph nodes harvested is associated with better survival in stages II and III colorectal cancer.

BACKGROUND: Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II CRC. Inadequate node sampling may result in inaccurate staging. METHOD: Records of 131 patients with stages II and III CRC who underwent curative resection, having five or more lymph nodes harvested from the specimen, were prospectively followed up and analyzed. The Kaplan-Meier method was used to analyze survival, based on groups of serially ascending values of lymph nodes harvested. Regression analysis was performed by Cox proportional hazards ratio model with right-censored CRC survival data at a 10 % significance level. The effect of nodal harvest on survival was adjusted for age, sex, preoperative carcinoembryonic antigen (CEA) level, neoadjuvant chemoradiation, pathological tumor stage, histological type, differentiation, margin positivity, angioinvasion, perineural invasion, and lymphovascular infiltration. RESULTS: The total population showed improved survival with 14 or more nodes harvested (p= 0.005). For both rectal (n= 83; p= 0.03) and colon cancers (n= 46; p= 0.08), most significant survival benefits were seen with over 14 nodes harvested, irrespective of the stage. With multiple regression analysis, advanced age (p= 0.003), male sex (p= 0.017), lymphovascular infiltration (p= 0.015), and preoperative CEA levels (p= 0.096) were found to be other significant factors. The lymph node effect remained significant (HR = 0.19, p= 0.004) after adjusting for the above factors. CONCLUSION: A lymph node harvest of 14 or more resulted in better survival outcome from CRC in this population. Staging of the disease could be accurate with increased nodal harvesting.