The outcome of laparoscopic colorectal resection in T4 cancer.

AIM: Laparoscopic surgery for locally advanced tumours with extramural involvement is still controversial. It is believed that laparoscopic excision of T4 cancers is technically difficult and may result in prolonged operative time, increased conversion rate, added postoperative morbidity, and suboptimal oncological clearance. METHOD: Our unit has been practising laparoscopic colorectal surgery since 1992, and all data are entered into a database prospectively. Since 1999 we have routinely used the laparoscopic approach for colorectal cancer resections. Data regarding patients with a histologically T4 cancer operated on between 1999 and 2008 were analysed. Outcomes included operating time, conversion rate, postoperative complications and oncological outcome. RESULTS: Over a 10-year period, 146 patients (male 75) with a T4 cancer underwent laparoscopic resection. The median operating time was 125 (range, 46-285) min and the median blood loss was 50 (0-1800) ml. The conversion rate was 16%. Six (4.1%) patients experienced anastomotic leakage. The median number of lymph nodes harvested was 13 (2-40). One hundred and two (70%) patients underwent curative resection. The recurrence rates were 41% and 53% for stage II and III patients, respectively. Four (3.9%) patients had local recurrence. At a median follow up of 18 (1-118) months, the overall survival was 25 months, with median overall survival for patients with stage II, III and IV disease being 63, 36 and 12 months, respectively. CONCLUSION: Laparoscopic colectomy in histologically T4 cancer is safe. Oncological outcomes remain satisfactory. Based on our data, provided expertise is available, patients with locally advanced tumours should not be excluded from a laparoscopic approach.

A case report of small bowel perforation at colonoscopy.

The most dreaded complication of a colonoscopy is colonic perforation. Perforation of the small bowel following colonoscopy is extremely rare, especially if the procedure was performed without any therapeutic intervention. Herein we report a case of jejunal perforation following a routine surveillance colonoscopy. A literature review focusing on the proposed mechanism of perforation is included.

Evaluation of common bile duct diameter using high resolution computed tomography.

The visibility rate and mean diameter of the common bile duct (CBD) were determined in 172 patients scanned with a routine abdominal technique on a GE CT/T 9800. Ninety-two (53%) had visible CBDs with the mean diameter measuring 5.3 mm. The visibility rate varied from 45 to 66% in healthy and ill patients, although the CBD diameters were similar (4.5 and 5.1 mm). The CBD was visualized more often in patients after cholecystectomy (87%), and the mean diameter was larger (8.2 mm). Using high resolution CT it seemed that the CBD could be demonstrated more frequently than the previously reported 30%.

Gelatin gel beads as an embolic agent.

Gelatin gel beads (GGB) is a compound of a long-chain polypeptide cross-linked with glutaraldehyde. It has been produced exclusively for embolic purposes. The object of the tests reported here was to determine the efficacy of GGB as an embolic agent in dogs as initial studies with rats had shown no acute toxic reaction. Eight dogs were used as subjects. Transcatheter embolization of one kidney in each animal was performed with a suspension of 500 mg of GGB and contrast material. The embolized kidneys were re-examined after one to five weeks. Embolized vessels remained occluded up to five weeks after the procedure. There was mild granulomatous reaction which started to organize at about the third week. The availability of GGB in various sizes when mixed in an isotonic solution makes it unique when compared with other forms of embolic agents. As this agent has now been shown to be a safe and reliable agent in dogs, it can now be used for testing in human subjects.

Urinary uric acid excretion in patients with carcinoma of the cervix undergoing intracavitary radium therapy.

An attempt is made here to determine the pattern of urinary uric acid excretion in patients with carcinoma of the cervix undergoing intracavitary radium therapy. Eight patients from the Philippine General Hospital were studied using 24-hour urine collection method to study the uric acid level. Result showed a proportionate increased in uric acid excretion with increasing dose of radiation up to 4,800-5,400 rads, after which, uric acid excretion produced an unexpected downtrend even with continued radiation. Maximum uric acid excretion ranged from 680-1,500 mg% with a mean of 1,005 +/- 100 mg%.