Systematic review: the burden of post-operative complications following colectomy for ulcerative colitis

Background: Ulcerative colitis [UC] patients failing medical management require colectomy

Methods: Literature search in MEDLINE , CINAHL and Embase, targeting studies reporting the outcomes of colorectal procedures [from 2002 to 2016 with total and subtotal colectomy postoperative complications in adults with ulcerative colitis as an endpoint. Texts and authoritative Web sites were also reviewed then identification of papers according to the inclusion and exclusion criteria and data extraction were performed by two independent researchers

Results: Following data extraction and synthesis, we identified 24 articles for review. Reporting outcomes from procedures conducted from 2002-2016. Most frequent short-term complications: infectious complications and ileus [mean incidence 21% and 19%], while most frequent long-term complications: pouchitis, fecal incontinence and small bowel obstruction [mean incidence 31%, 22% and 18%]. Post-operative early complications [

Conclusion: Although Colectomy remains an appropriate therapeutic strategy for specific groups of patients- it is not the optimal cure for UC. Clinicians need to fully understand the various postoperative complications and comorbidities that are highly prevalent with over a third of patients expected to experience long-term or late arising post-operative complications. Thus, while surgical procedures are recommended as an appropriate therapeutic strategy for a specific group of patients, the post-operative complications associated with these surgical procedures should not be underestimated

systematic review of the safety of nipple sparing mastectomy

Background: Breast cancer is a complex disease, and local recurrence and cancer-related death is likely multifactorial. Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy [NSM]. However, oncological safety remains unproven, and the benefits and indications have not been clearly identified

Methods: A Systematic search in the scientific database [Medline, EMBASE, Google Scholer and Ovid] from 1980 to 2016 was conducted for all relevant retrospective studies including; randomized controlled trials, cohort studies and case-studies involving women undergoing either NSM were analyzed and included based on the preset inclusion criteria

Results: The search yielded 1193 articles, of which 55 studies with 9053 patients met our selection criteria. After a mean follow up of 41 months [range, 7.1-78 months], the overall pooled locoregional recurrence rate [LRR] was 3.25%, the overall complication rate was 21.8% [1309 of 6003], and the overall incidence of nipple necrosis, either partial or total, was 6.6 % [561 of 8438]. Significant heterogeneity was found among the published studies and patient selection was affected by tumor characteristics

Conclusion: There is growing evidence that NSM has been marked as oncologically safe in women with small, peripherally located tumors, without multicentricity, or when performed as a prophylactic mastectomy. Hence, NSM has been recommended only if carefully selected for a particular group of patients