Preoperative versus postoperative 5 FU-based chemoradiation in the management of resectable rectal carcinoma

Forty-eight patients with resectable rectal carcinoma [stages II and III] were randomized to receive either preoperative concomitant 2 cycles of 5-FU/LV and pelvic radiation followed 4-6 weeks later by surgery then additional 4 cycles of the same chemotherapy [group A = 23 patients] or the standard surgical procedure to be followed by 6 cycles of 5-FU/LV and concomitant pelvic irradiation during cycle 3 and 4 [group B = 25 patients]. In preoperative group, objective response was seen in 47.8% of patients 4 weeks after chemoradiation. The remaining patients had stable disease. Ten patients [43.5%] and 16 patients [64%] in preoperative group and postoperative group, respectively, underwent abdominoperineal resection [APR]; while 13 patients [56.5%] in preoperative group and 9 patients [36%] in postoperative group underwent sphincter saving surgery. Seven out of 17 patients [41%] in preoperative group who were initially candidates for APR saved their anal sphincter after preoperative chemoradiation, 85.7% of these patients had excellent to good sphincter function. No pathologic complete response had been recorded. Hematologic grade 3+ toxicity was recorded in 17.4% of patients in preoperative group and in 28% in postoperative group. Grade 3+ diarrhea was recorded in 17.4% in preoperative group and in 20% of patients in postoperative group. The differences were not statistically significant. Eight patients [34.8%] in preoperative group and 9 patients [36%] in postoperative group had one or more components of failure. The difference was not statistically significant. The 2-year overall survival was 69.6% in preoperative group and 72% in postoperative group. The 2-year disease free survival was 65.2% in preoperative group and 64% in postoperative group. The differences in survival and disease free survival between the two groups were not statistically significant. The study concluded that treatment with preoperative combined modality therapy, followed by surgery and postoperative chemotherapy in resectable rectal carcinoma is an attractive alternative to the standard postoperative combined modality therapy. The local control, survival rates and toxicity are comparable to postoperative combined modality therapy. Preoperative chemoradiation offers an additional potential advantage of sphincter preservation. This work needs to be confirmed on a larger number of patients with longer follow up

Laparoscopic examination of contralateral internal inguinal ring via the neck of hernia sac in children with unilateral inguinal hernia

The purpose of this study was to evaluate the technique of intra- operative laparoscopic examination of contralateral internal inguinal via the hernia sac in children with unilateral inguinal hernia. Seventeen children with unilateral inguinal hernia were subjected to trans-inguinal diagnostic laparoscopy of the contralateral internal inguinal rings. A patent contralateral processus vaginalis was identified in 3 [17.6%] cases. There was a significantly higher incidence in patients with left inguinal hernia. The mean time to do the procedure was 11.3 minutes