Influence of the Enhanced Recovery After Surgery Protocol on Postoperative Inflammation and Short-term Postoperative Surgical Outcomes After Colorectal Cancer Surgery

Purpose@#Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes. @*Methods@#Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database. @*Results@#The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the duration required for leukocytes to normalize were reduced in patients following the ERAS protocol (P ≤ 0.001). Other inflammatory markers, such as lymphocyte count (P = 0.008), neutrophil/lymphocyte ratio (P = 0.032), and C-reactive protein level (P ≤ 0.001), were lower in the ERAS protocol group. High compliance ( ≥ 70%) was strongly associated with the complication rate and the LOS (P = 0.008 and P ≤ 0.001, respectively). @*Conclusion@#ERAS protocols decrease early postoperative inflammation and improves short-term postoperative recovery outcomes such as complication rate and the LOS. High compliance ( ≥ 70%) with the ERAS protocol elements accelerates the positive effects of ERAS on surgical outcomes; however, the effect on inflammation was very small.

Comparative study between transanal tube and loop ileostomy in low anterior resection for mid rectal cancer: a retrospective single center trial

PURPOSE: To investigate the efficacy and safety of the transanal tube (TAT) in preventing anastomotic leak (AL) in rectal cancer surgery. METHODS: Clinical data of the patients who underwent curative surgery for mid rectal cancer from February 2010 to February 2014 were reviewed retrospectively. Rectal cancers arising 5 to 10 cm above the anal verge were selected. Patients were divided into the ileostomy, TAT, or no-protection groups. Postoperative complications including AL and postoperative course were compared. RESULTS: We included 137 patients: 67, 35, and 35 patients were included in the ileostomy, TAT, and no-protection groups, respectively. Operation time was longer in the ileostomy group (P = 0.029), and more estimated blood loss was observed (P = 0.018). AL occurred in 5 patients (7.5%) in the ileostomy group, 1 patients (2.9%) in the TAT group, and 6 patients (17.1%) in the no-protection group (P = 0.125). Patients in the ileostomy group resumed diet more than 1 day earlier than those in the other groups (P = 0.000). Patients in the no-protection group had about 1 or 2 days longer postoperative hospital stay (P = 0.048). The ileostomy group showed higher late complication rates than the other groups as complications associated with the stoma itself or repair operation developed (P = 0.019). CONCLUSION: For mid rectal cancer surgery, the TAT supports anastomotic site protection and diverts ileostomy-related complications. Further large scale randomized controlled studies are needed to gain more evidence and expand the range of TAT usage.

Efficacy of a Patient's Own Blood as Colonic Localization Agent

No abstract available.

Analysis of Prognosis in Colorectal Mucinous Adenocarcinoma: A Retrospective Analysis with Peritoneal Fluid

PURPOSE: Although many papers have reported poor prognosis of colorectal mucinous adenocarcinoma, the underlying cause for its unfavorable outcome is yet to be elucidated. In the peritoneal fluid studies, we observed that peritoneal recurrences and cytology positive cases were many times mucinous cancers. On the basis of these observations, mucinous and non-mucinous adenocarcinomas were compared and prognostic factors were studied. METHODS: Five hundred and forty-six patients who underwent surgery for colorectal adenocarcinomas from January 2004 to December 2008 were included. RESULTS: Among the 546 patients, mucinous adenocarcinomas were 30 (5.5%) and non-mucinous adenocarcinomas were 516 (94.5%). Mean age was 55.0 years, which was younger than 63.2 years in non-mucinous colon cancers. They tend to develop in the right colon. Mucinous adenocarcinomas were more advanced in depth of invasion and distant metastasis, but no significant difference in lymph node (LN) metastasis. Peritoneal CEA, CA19-9, and positive cytology were more apparent. Liver and peritoneal metastasis did not show significant increases. Five year survival rates were 82.9% and 91.7% and cancer free survival rates were 42.7% and 68.5% each, respectively, for mucinous and non-mucinous cancers. According to stage, only stage III and IV patients showed differences in cancer free survival and overall survival (P=0.001, 0.040). CONCLUSION: Mucinous adenocarcinomas showed worse prognoses and significant differences in recurrences, but had similar prognoses in early cancers. Although no significant differences were in LN metastasis, dissimilarities were in infiltration depth. Infiltrations led to the increase in free cancer cells and peritoneal fluid tumor markers: ultimately cancer recurrences developed.

Chemotherapeutic Responsibility according to Polymorphism of ERCC1, XRCC1 and GSTP1 in Gastric Cancer Patients Receiving Oxaliplatin Based Chemotherapy

PURPOSE: The platinum-based modified FOLFOX-6 has been reported as an acceptable chemotherapeutic regimen in treatment of advanced gastric cancer patients. The response rate and drug-induced toxicity of platinum-based chemoagents is different according to several gene polymorphism such as ERCC1, XRCC1 and GSTP1 genes, which were related with therapeutic mechanisms. We aimed to evaluate the effect of gene polymorphism and determine the possibility as prediction factor for responsibility in advanced and recurrent gastric cancer patients treated with modified FOLFOX-6 regimen. METHODS: This study was conducted with 55 patients. We sampled 20 ml of peripheral blood to isolate DNA from lymphocytes, and identified genotypes of 3 genes (ERCC1, XRCC1, GSTP1) by PCR-RFL of extracted DNA. Based on medical records, retrospective analysis was made on the patients' clinical characteristics. RESULTS: The overall response rate to modified FOLFOX-6 was 40.0% (22/55). In polymorphism of ERCC1 C8092A, the wild type (CC) showed a statistically significantly lower response rates to chemoagents than the mutant type (CA/AA). In the subtypes of ERCC1 C118T, however, the wild type (CC) showed statistically significantly lower hematological toxicity than the mutant type (CA/AA). But, there was no statistically significance in survival analysis. CONCLUSION: We suggest that ERCC1 gene polymorphism is clinically more adequate as a feasible factor for predicting the response rate and toxicity of modified FOLFOX-6 regimen in gastric cancer patients.

Perineal Reconstructive Surgery of a Cloaca-Like Perineal Defect: A Case Report

Retrorectal or presacral tumors are rare, with incidences of approximately 0.01%. Generally, these tumors have no specific symptoms and are likely to be found incidentally on CT or MRI scans. Most of them are benign masses, but malignant masses are reported on occasion. The modality of treatment is a resection in cases of a benign mass, but chemotherapy or radiation therapy can be done in cases of malignancy. Like our case, a matured cystic teratoma in the retrorectal area is very rare. In addition, no laparoscopic resection of a retrorecal teratoma was reported until 2008. Thus, we report the case of a 31-yr-old female patient who underwent a total laparoscopic excision for a matured cystic teratoma in the retrorectal space.