Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer

PURPOSE: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome. METHODS: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors. RESULTS: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class. CONCLUSION: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

Feasibility of Gasless Endoscopic Thyroid Surgery through a Single Infraclavicular Approach / 대한내분비외과학회지

PURPOSE: Several approaches in endoscopic thyroid surgery have been developed to avoid large scars on the anterior neck. We assessed the feasibility and cosmetic benefit of performing gasless endoscopic thyroid surgery through a single infraclavicular approach. METHODS: Thirty-one patients with a benign thyroid mass on sonography received gasless endoscopic thyroidectomy through a single infraclavicular approach. A 5-cm infraclavicular incision was created laterally, depending on the distance from the clavicle to the thyroid mass, but which would be completely hidden by a V-shaped shirt collar. In some cases, hand-assisted vessel ligation was performed through this incision. RESULTS: The study included 26 female patients (out of 31), and the mean age was 38.2 years old (range, 14 to 70). All patients received a unilateral thyroid lobectomy, with or without isthmectomy, and tumors were benign (follicular adenoma in 12 and adenomatous hyperplasia in 19). A recurrent laryngeal nerve was identified in all cases. The mean operation time was 162.5 min (range, 100 to 300 min). No patients required conversion to conventional open surgery or showed postoperative bleeding, even without drainage. Hoarseness occurred in 1 patient with injury of the recurrent laryngeal nerve, which was repaired through the same incision and recovered within 6 months. Temporary hoarseness occurred in another 3 patients, but recovered within 3 months. CONCLUSION: Gasless endoscopic thyroidectomy through a single infraclavicular approach improved cosmetic outcomes and allowed for bleeding control through hand-assisted ligation of vessels. Therefore, the technique is suitable for surgeons inexperienced in endoscopic thyroidectomy.