[Clinical analysis of patients with stage IV ( colorectal cancer after palliative resection of primary tumor].

OBJECTIVE: To investigate the independent predictors of postoperative mortality, morbidity, and long-term survival in patients with stage IV ( colorectal cancer. METHODS: Clinical data of 189 patients with stage IV( colorectal cancer undergoing palliative resection of primary tumor in the presence of unresectable synchronous metastases were analyzed retrospectively. RESULTS: Eighty-six (45.5%)patients developed postoperative complications. Preoperative predictors of medical complications included age(≥65, P=0.039) and emergency operations (P=0.001). Preoperative predictors of surgical complications included advanced local disease (T4, P=0.022) and lymph node spread (N2, P=0.009). Seventeen (9.0%) patients died in the postoperative period. Mortality was independently associated with age(P=0.013), peritoneal dissemination(P=0.010), emergency operations(P=0.001) and medical complications(P=0.008). The survival rates at 1-, 2-, and 3- year of 172 patients admitted in survival analysis were 41.2%, 22.7% and 7.7% respectively. Independent factors associated with poor overall survival included lymph node spread(N2, P=0.015) and poor tumor differentiation(P=0.038). CONCLUSIONS: Emergency operations should be avoid when palliative resection of primary tumor is considered for stage IV( colorectal cancer patients, especially for elderly patients and those with peritoneal dissemination. The significance of palliative resection is limited for stage IV ( colorectal cancer patients with lymph node spread and poor tumor differentiation.

Laparoscopic splenectomy in goats.

OBJECTIVE: To report laparoscopic splenectomy in goats. STUDY DESIGN: Experimental study. ANIMALS: Healthy female goats (n=9); aged, 10-18 months; weighing, 22-30 kg. METHODS: Food was withheld for 24 hours and water for 10 hours. Anesthetized right laterally recumbent goats had a laparoscopic portal and 3 instrumental portals created in the left flank. Splenic attachments were dissected with monopolar electrocautery and blunt dissection through 2 instrument portals. Exposure and isolation of splenic vessels was performed with laparoscopic "right-angle" preparation forceps. Vessels were ligated with a medium-titanium clip and 2 silk sutures and then transected between the silk sutures. The detached spleen was manipulated into a specimen retrieval bag, morcellated, and the bag retrieved through an enlarged portal. Repeat laparoscopic examination was performed at 1 month. RESULTS: Laparoscopic splenectomy required 70 minutes (range, 52-88 minutes) and was successful without major intraoperative and postoperative complications. Postoperatively, all goats had signs of mild abdominal discomfort. On repeat laparoscopy, with the exception of 1 goat that had a focal omental adhesion to the enlarged portal site, no other abnormalities were identified. CONCLUSIONS: Laparoscopic splenectomy can be accomplished in goats using 4 portals in the left flank and a combination of monopolar cautery dissection of splenic attachments, ligation of vessels using metal clips and intracorporeal ligatures, and intra-abdominal morcellation of the detached spleen in a specimen retrieval bag. CLINICAL RELEVANCE: Laparoscopic splenectomy is an effective and safe technique in goats.