Enhanced recovery after surgery efficacy in an older patients and high-risk population affected by colorectal cancer: a more than 1000 patients experience.

AIM: Enhanced recovery after surgery programs aims to standardize care, improving colorectal surgery outcomes. Older patients are a challenge population for these programs. The aim of this manuscript is to explore the effect of application Enhanced recovery after surgery protocol among older patients and high-risk patients undergone colorectal surgery for cancer. METHOD: Since January 2005, until September 2016, 1189 consecutive patients underwent elective Colorectal Surgery and treated according to our Enhanced recovery after surgery protocol. Patients are divided in three groups according to age: Group1 under 69 y-o (control group), Group2 70 to 79 y-o and Group3 over 80 y-o. Primary end point was Time to Readiness to Discharge. RESULTS: Median Time to Readiness to Discharge was 4 days (3-30) in Group 1, 5 (3-47) in Group 2 and 5 (3-19) in Group 3. Length of stay in Group 1 had a median length of 6 days (3-58), in Group 2 of 8 days (3-70) and in Group 3 of 8 days (3-53). CONCLUSIONS: Once more Enhanced recovery after surgery program has showed its efficacy in colorectal surgery field. Moreover, our experience has underlined the need to concentrate efforts mainly on older and high-risk patients.

[Feasibility and effectiveness of laparoscopic right colectomy with extracorporeal anastomosis]. / Emicolectomia destra laparoscopia con anastomosi intracorporea: fattibilità ed efficacia.

AIM: Despite the laparoscopic right hemicolectomy has been validated by many randomized prospective trials, clear evidences on the validity of the totally mini-invasive technique, namely, through intracorporeal anastomosis, are still lacking. The aim of this study was the assessment of short-term outcome within three months from laparoscopic right colectomy with intra- or extra-corporeal anastomosis. METHODS: With no exclusion, all patients undergoing laparoscopic right hemicolectomy at our institution have been enrolled in this study. Group A included patients undergoing laparoscopic right hemicolectomy with extracorporeal anastomosis (LAC) and Group B, included patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (TLC). Patients' data, surgery details, results of postoperative period and histological tests have been prospectively recorded in a database and analysed. RESULTS: Between December 2006 and December 2008, 45 patients underwent right hemicolectomy, 21 with extracorporeal anastomosis and 24 had intracorporeal ones. As to patients' characteristics and histopathological results there are no difference between the groups. Anastomotic dehiscence occurred one in group A and one in group B (P>0.05). Both patients underwent reoperation. We recorded 6 postoperative ileus with vomiting in the LAC group and only 1 in the TLC group (P<0.05). The incidence of Non-Surgical Site Complications (NSSC) was of 4.54% in LAC group and 8.33% in TLC group (P>0.05). Hospitalization was of 5 days for both groups. CONCLUSION: In conclusion, we believe that this technique is feasible in terms of safety; it doesn't significatively affect the length of surgical procedure and guarantees maintenance of oncological radicality standards of reference. Besides it significatively improves quality of the post-operative period.

[Treatment of the pancreatic stump after pancreaticoduodenectomy. Wirsung duct occlusion versus pancreaticojejunostomy]. / Trattamento del moncone pancreatico dopo duodenocefalopancreasectomia.Occlusione del Wirsung vs anastomosi pancreatico-digiunale.

AIM: The aim of the study is to compare the results obtained using two different techniques of reconstruction after pancreaticoduodenectomy: pancreaticojejunostomy and pancreatic remnant duct occlusion. METHODS: The authors describe a retrospective study performed in 44 nonselected patients submitted to pancreaticoduodenectomy from 2000 to 2004. They have been divided into 2 groups. Patient characteristics were comparable in both groups. The first group (22 patients) received pancreaticojejunostomy. The second group (22 patients) received duct occlusion with sclerosing glue. Intraoperative finding (operative time, estimated blood loss) and postoperative morbidity and mortality were evaluated. Endocrine and exocrine function were analyzed at 3 and 12 months after surgery. RESULTS: Results showed no differences in median blood loss, duration operation and hospital day. Morbidity and mortality were higher in duct occlusion group; pancreatic fistula was more frequent after duct occlusion, but less dangerous than one from pancreaticojejeunostomy. Also exocrine function was better in anastomosis group and the incidence of diabetes mellitus was higher in patients with duct occlusion. CONCLUSION: Pacreaticojejunostomy is the procedure of choice, while duct occlusion should be performed in friable stump with small pancreatic duct (higher risk of pancreatic fistula).