Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases.

INTRODUCTION: In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. SUBJECTS AND METHODS: Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008. RESULTS: A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68-1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the out-lying hospitals was found (P = 0.553). CONCLUSIONS: Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.

Fibrin glue for fistula-in-ano: the evidence reviewed.

Fibrin glue is increasingly used in the treatment of anal fistulae. This review aims to establish its longterm efficacy and clarify its role in this setting. A search of Medline and Pubmed databases was performed from 1966 to 2004. Data were collated regarding the type of study, fistula aetiology and complexity, technical aspects of glue application, and short- and long-term healing rates. The majority of studies comprised prospective series with fistulae of mixed aetiology. The overall healing rate was 53% with a wide variation between studies (10%-78%). The only factor that could account for this diversity was fistula complexity, with series including a high proportion of complex fistulae reporting worse outcomes. The quality of data to assess the efficacy of fibrin glue in the treatment of anal fistulae is poor and further clinical trials are needed. Fistula complexity is the main factor that adversely influences long-term healing rates.