ABSTRACT
Background: Mechanical bowel preparation (MBP) before elective resection of left colon cancer remains controversial. We propose that the protective effect of MBP is dependent on its combination with chemical preparation by oral antibiotics.Methods: Medical data of adult patients with left colon cancer who underwent elective resection at Sohag University Hospital (August 2016-March 2019) were reviewed. Anastomotic leak (AL), surgical site infections (SSI), postoperative morbidity and mortality were compared among patients who preoperatively received MBP followed by chemical preparation with oral antibiotics (MBP and OABx group) versus another group of preoperative MPB alone (MBP group).Results: Forty-two patients with left colon adenocarcinoma were enrolled, 21 per group. Overall, sigmoid colon was the most common site of left sided colon cancer (76%). Malignant lesions were found in proximal sigmoid in 19 (45%), rectosigmoid in 13 (31%), descending colon in 8 (19%) and splenic flexure in 2 (5%) patients. Dukes’ classification was A in 6 (14%), B in 19 (45%) and C in 17 (41%) patients. Compared with MBP, MBP and OABx group showed significantly lower rates of anastomotic leak (3 patients (14%) versus 1 (5%) respectively, p<0.05) and surgical site and intraabdominal infections (7 patients (33%) versus 2 (10%), p<0.05). MBP and OABx group exhibited lesser grades of postoperative complications (p<0.05) and shorter hospital stay (p<0.05). Postoperative mortality occurred only in the MBP group.Conclusions: Combined mechanical-chemical bowel preparation prior to elective resection of left colon cancer confers superior clinical outcome regarding anastomotic leak, surgical site infections and overall postoperative complications.
ABSTRACT
Background: Combined liver-visceral resections (CLVRs) may impose increased risk of postoperative complications. The clinical outcome of CLVRs versus sole liver resection (SLR) has not been adequately reported from upper Egypt cancer surgery programs.Methods: Medical records of adult non-cirrhotic patients who electively underwent liver resection from February 2015 to April 2018 at Sohag University Hospital, Egypt, were retrospectively reviewed. Indications for liver resection comprised definitively malignant tumors and those with equivocal radiologic features. The severity of surgical complications, including mortality, was compared among patients who underwent CLVRs versus SLR control group with matching age, gender, number of resected liver segments, method of hepatic inflow occlusion and parenchyma transection techniques.Results: Twenty-six patients were enrolled, including 13 with CLVRs group and their 13 SLR control group. Histopathologic examination of resected specimens confirmed malignancy in 17 patients (10 in CLVR group and 7 in SLR group). Major liver resection (≥3 segments) was carried out in 14 (54%) patients, 7 per each group. The complication score was significantly higher in CLVRs (p<0.05). Similarly, the length of hospital and intensive care unit stays was significantly prolonged in CLVRs group (p<0.05). Overall, 2 patients died (8%), exclusively in the CLVRs. Elderly patients (>65 years) who underwent CLVRs exhibited increased complications compared with their matching controls.Conclusions: CLVR predisposes to increased morbidity rates and mortality. It should be carried out in carefully selected patients to avoid worse clinical outcome.