ABSTRACT
Purpose@#Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. @*Methods@#Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. @*Results@#A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. @*Conclusion@#This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
ABSTRACT
Objective: to determine the reasons of referral/transfer of patients from other health facilities to a surgical unit of Lady Reading Hospital Peshawar
Methodology: this is a descriptive cross-sectional study conducted in surgical unit "C" Lady Reading Hospital [LRH] Peshawar from February 28 to September 14, 2014, using consecutive non-purposive sampling technique. All patients admitted in our unit living outside the catchment area of Peshawar were included. Age, gender, address, reason for referral and perception of the patients about Lady Reading Hospital Peshawar was recorded on a proforma. Data was analyzed using SPSS version 20. Mean and standard deviation was calculated for quantitative output responses and frequency and percentages for qualitative output responses. Chi-square test was applied on the variables when compared and p value of <0.05 was considered significant
Results: total patients received in the study period of [six and half months] were 195.Out of these 75.4% were male. The mean age of patients was 37.2+ 17.49 years. The percentage admitted via emergency was 88.7%. Out of 195 patients, 147[75.4%] attended a health facility before coming to LRH. The reasons given for referral was lack of equipment, lack of staff, lack of ICU, lack of specialty, lack of out of hours services and seropositivity given in 88[59.8%], 74[50.3%],71[48.2%], 70[47.6%], 70 [47.6%] and 04 [2.7%] patients respectively.Dissatisfaction towards the local health facilities was shown by 137 [70.3%]
Conclusion: the peripheral health care system is being underutilized resulting in excessive burden on tertiary care health facilities. It is therefore important to address the problems and to implement a structured referral system