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1.
Annals of the Academy of Medicine, Singapore ; : 892-902, 2021.
Artigo em Inglês | WPRIM | ID: wpr-921099

RESUMO

INTRODUCTION@#Prehabilitation may benefit older patients undergoing major surgeries. Currently, its efficacy has not been conclusively proven. This is a retrospective review of a multimodal prehabilitation programme.@*METHODS@#Patients aged 65 years and above undergoing major abdominal surgery between May 2015 and December 2019 in the National University Hospital were included in our institutional programme that incorporated aspects of multimodal prehabilitation and Enhanced Recovery After Surgery concepts as 1 holistic perioperative pathway to deal with issues specific to older patients. Physical therapy, nutritional advice and psychosocial support were provided as part of prehabilitation.@*RESULTS@#There were 335 patients in the prehabilitation cohort and 256 patients whose records were reviewed as control. No difference in postoperative length of stay (@*CONCLUSION@#The current study found no differences in traditional surgical outcome measures with and without prehabilitation. An increase in patient mobility in the immediate postoperative period was noted with prehabilitation, as well as an association between prehabilitation and increased adherence to postoperative adjuvant therapy. Larger prospective studies will be needed to validate the findings of this retrospective review.


Assuntos
Humanos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Exercício Pré-Operatório , Estudos Prospectivos , Estudos Retrospectivos
2.
Annals of the Academy of Medicine, Singapore ; : 773-781, 2021.
Artigo em Inglês | WPRIM | ID: wpr-921073

RESUMO

INTRODUCTION@#Surgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC.@*METHODS@#Three databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM.@*RESULTS@#From a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease.@*CONCLUSION@#The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC.


Assuntos
Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/cirurgia , Metastasectomia , Pneumonectomia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Taxa de Sobrevida
3.
Annals of Coloproctology ; : 119-121, 2020.
Artigo | WPRIM | ID: wpr-830367

RESUMO

Nasal metastases from colorectal cancer is rare. The presentation of nasal metastases is often very similar to primary nasal sinus adenocarcinoma. A high index of suspicion is required, especially in patients who have had a previous history of colorectal carcinoma. Histology is ultimately required for diagnosis. We describe 2 cases of nasal metastases from colorectal carcinoma, and discuss the presentation, diagnosis and management of the case. Such metastatic disease ultimately represents end-stage malignancy, and patients should be palliated.

4.
Annals of Coloproctology ; : 47-49, 2019.
Artigo em Inglês | WPRIM | ID: wpr-762290

RESUMO

PURPOSE: Perianal adenocarcinoma arising from a chronic anorectal fistula is a rare condition for which the natural history and optimal management are not well established. For that reason, we conducted a retrospective analysis of 5 consecutive patients with a perianal adenocarcinoma arising from a chronic anorectal fistula managed at our institution from January 2014 to December 2015. METHODS: The patients were identified from a prospectively collected colorectal cancer database that included all patients managed for colorectal cancer at our institution. RESULTS: The median age at diagnosis was 64 years (range, 55–72 years). Magnetic resonance imaging (MRI) was the initial investigation for all patients and showed a hyperintense T2-weighted image. One patient underwent an abdominoperineal resection following neoadjuvant chemoradiotherapy and remained disease free during the 12-month follow-up. Three patients received neoadjuvant therapy with intent for surgery, but did not undergo surgery due to either worsening health or metastatic spread. One patient declined intervention. The median overall survival was 10.5 months (range, 2–19 months). CONCLUSION: A high index of suspicion is required to make a clinical diagnosis of an anal adenocarcinoma arising from a chronic fistula. Histologic diagnosis must be achieved to confirm the diagnosis. Multimodal therapy with neoadjuvant chemoradiotherapy followed by abdominoperineal resection is the treatment of choice.


Assuntos
Humanos , Adenocarcinoma , Povo Asiático , Quimiorradioterapia , Neoplasias Colorretais , Diagnóstico , Fístula , Seguimentos , Imageamento por Ressonância Magnética , História Natural , Terapia Neoadjuvante , Estudos Prospectivos , Fístula Retal , Estudos Retrospectivos
5.
Annals of Coloproctology ; : 175-179, 2018.
Artigo em Inglês | WPRIM | ID: wpr-716199

RESUMO

PURPOSE: Obstructive ileocolitis is an ulcero-inflammatory condition which typically occurs in the ileum or colon proximal to an obstructing colorectal lesion. If left unresolved, it often leads to intestinal perforation. We present a matched case control study of patients with obstructive ileocolitis caused by colorectal cancer to determine if any factors can predict this condition. METHODS: This is a retrospective review of 21 patients with obstructive colorectal cancer and histologically proven obstructive ileocolitis from 2005 to 2015 matched for age and sex with 21 controls with obstructing colorectal cancer without obstructive ileocolitis. RESULTS: The 21 patients with obstructive ileocolitis had a median age of 71 years (range, 52–86 years). The most common presenting symptom was abdominal pain (n = 16, 76.2%), followed by vomiting/nausea (n = 14, 66.7%) and abdominal distension (n = 12, 57.1%). Interestingly, the radiological feature of pneumatosis intestinalis was noted in only 1 case. No significant differences were observed in baseline comorbidities, clinical presentations, or tumor characteristics between the 2 groups. Patients with obstructive ileocolitis were found to have a significantly higher total leucocyte count (17.1 ± 9.4×109/L vs. 12.0 ± 6.8×109/L, P = 0.016), lower pCO2 (32.3 ± 8.2 mmHg vs. 34.8 ± 4.9 mmHg, P = 0.013), lower HCO3 (18.8 ± 4.5 mmol/L vs. 23.6 ± 2.7 mmol/L, P < 0.001), lower base excess (-6.53 ± 5.32 mmol/L vs. -0.57 ± 2.99 mmol/L, P < 0.001) and higher serum lactate levels (3.14 ± 2.19 mmol/L vs. 1.19 ± 0.91 mmol/L, P = 0.007) compared to controls. No radiological features were predictive of obstructive ileocolitis. CONCLUSION: Patients with obstructive ileocolitis tend to present with metabolic acidosis with respiratory compensation, raised lactate, and worse leucocytosis. Radiological features are not useful for predicting this condition.


Assuntos
Humanos , Dor Abdominal , Acidose , Estudos de Casos e Controles , Colo , Neoplasias Colorretais , Comorbidade , Compensação e Reparação , Doença de Crohn , Íleo , Obstrução Intestinal , Perfuração Intestinal , Ácido Láctico , Estudos Retrospectivos
6.
Annals of the Academy of Medicine, Singapore ; : 92-97, 2015.
Artigo em Inglês | WPRIM | ID: wpr-312196

RESUMO

<p><b>INTRODUCTION</b>The aim of the study was to determine if age at the creation of an ileal pouchanal anastomosis (IPAA) has an impact on the outcomes in patients with ulcerative colitis (UC).</p><p><b>MATERIALS AND METHODS</b>A retrospective review of all patients who underwent IPAA for UC from 1999 to 2011 was performed. Long-term functional outcome was assessed using both the Cleveland Clinic and St Mark's incontinence scores.</p><p><b>RESULTS</b>Eighty-nine patients, with a median age of 46 (range, 16 to 71) years, formed the study group. The median duration of disease prior to their pouch surgery was 7 (0.5 to 39) years. There were 57 (64%) patients who were aged ≤50 years old and 32 (36%) who were >50 years old. Fifty-seven (64%) patients developed perioperative complications of which 51 (89.5%) were minor. High ileostomy output (n = 21, 23.6%) and urinary symptoms (n = 13, 14.6%) were the most commonly encountered complications. The older patients were more likely to have an ASA score ≥3 and a longer length of stay. Although there was a higher incidence of complications in the older group of patients, the difference was not statistically significant. There were no significant differences in the incidence of severe complications. Forty-nine (55%) patients completed our questionnaire on the evaluation of their functional outcomes. There were no significant differences in the Cleveland Clinic and St Mark's incontinence scores between the older (n = 19, 38.8%) and younger (n = 30, 61.2%) patients. There were also no significant differences in the frequency of bowel movements during the day or overnight after sleep between the 2 groups.</p><p><b>CONCLUSION</b>IPAA procedure for patients with UC can be safely performed. Long-term functional outcome is not significantly influenced by the age at which the IPAA was created.</p>


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fatores Etários , Colite Ulcerativa , Cirurgia Geral , Bolsas Cólicas , Incontinência Fecal , Diagnóstico , Epidemiologia , Seguimentos , Incidência , Complicações Pós-Operatórias , Diagnóstico , Epidemiologia , Proctocolectomia Restauradora , Estudos Retrospectivos , Resultado do Tratamento
7.
Annals of Coloproctology ; : 83-87, 2014.
Artigo em Inglês | WPRIM | ID: wpr-128115

RESUMO

PURPOSE: Malnutrition is associated with an increased risk of developing complications following gastrointestinal surgery, especially following radical surgeries such as pelvic exenteration. This study aims to determine if preoperative body mass index (BMI) is associated with 30-day morbidity, length of hospital stay and/or quality of life (QoL) in patients undergoing pelvic exenteration surgery for recurrent and locally-advanced rectal cancer prior to a prospective trial. METHODS: A review of all patients who underwent pelvic exenteration surgery prior to 2008 was performed. Patients were included if they had a documented BMI as well as a QoL measurement (Functional Assessment Cancer Therapy - Colorectal questionnaire). RESULTS: Thirty-one patients, with a mean age of 56 years, had preoperative height and weight data, as well as measures of postoperative QoL, and formed the study group. The numbers of patients with recurrent (n = 17) or locally-advanced rectal cancer (n = 14) were similar. The mean length of stay was 21 days while the mean BMI of the patients was 24.3 (+/- 5.9) kg/m2. The majority of the patients were either of normal weight (n = 15) or overweight/obese (n = 11). The average length of hospital stay was significantly longer in patients who were underweight compared to those who were of normal weight (F = 6.508, P = 0.006) and those who were overweight and obese (F = 6.508, P = 0.007). CONCLUSION: This study suggests that a lower body mass index preoperatively is associated with a longer length of hospital stay. BMI is not associated with long-term QoL in this patient group. However, further prospective research is required.


Assuntos
Humanos , Índice de Massa Corporal , Tempo de Internação , Desnutrição , Sobrepeso , Exenteração Pélvica , Qualidade de Vida , Neoplasias Retais , Magreza , Resultado do Tratamento
8.
Annals of Coloproctology ; : 55-59, 2013.
Artigo em Inglês | WPRIM | ID: wpr-122835

RESUMO

PURPOSE: Managing deep postanal (DPA) sepsis often involves multiple procedures over a long time. An intersphincteric approach allows adequate drainage to be performed while tackling the primary pathology at the same sitting. The aim of our study was to evaluate this novel technique in managing DPA sepsis. METHODS: A retrospective review of all patients who underwent this intersphincteric technique in managing DPA sepsis from February 2008 to October 2010 was performed. All surgeries were performed by the same surgeon. RESULTS: Seventeen patients with a median age of 43 years (range, 32 to 71 years) and comprised of 94.1% (n = 16) males formed the study group. In all patients, an internal opening in the posterior midline with a tract leading to the deep postanal space was identified. This intersphincteric approach operation was adopted as the primary procedure in 12 patients (70.6%) and was successful in 11 (91.7%). In the only failure, the sepsis recurred, and a successful advancement flap procedure was eventually performed. Five other patients (29.4%) underwent this same procedure as a secondary procedure after an initial drainage operation. Only one was successful. In the remaining four patients, one had a recurrent abscess that required drainage while the other three patients had a tract between the internal opening and the intersphincteric incision. They subsequently underwent a drainage procedure with seton insertion and advancement flap procedures. CONCLUSION: Managing DPA space sepsis via an intersphincteric approach is successful in 70.6% of patients. This single-staged technique allows for effective drainage of the sepsis and removal of the primary pathology in the intersphincteric space.


Assuntos
Humanos , Masculino , Abscesso , Canal Anal , Drenagem , Fístula , Estudos Retrospectivos , Sepse , Resultado do Tratamento
9.
Annals of Coloproctology ; : 12-16, 2013.
Artigo em Inglês | WPRIM | ID: wpr-120589

RESUMO

PURPOSE: Laparoscopy continues to be increasingly adopted for elective colorectal resections. However, its role in an emergency setting remains controversial. The aim of this study was to compare the outcomes between laparoscopic and open colectomies performed for emergency colorectal conditions. METHODS: A retrospective review of all patients who underwent emergency laparoscopic colectomies for various surgical conditions was performed. These patients were matched for age, gender, surgical diagnosis and type of surgery with patients who underwent emergency open colectomies. RESULTS: Twenty-three emergency laparoscopic colectomies were performed from April 2006 to October 2011 for patients with lower gastrointestinal tract bleeding (6), colonic obstruction (4) and colonic perforation (13). The hand-assisted laparoscopic technique was utilized in 15 cases (65.2%). There were 4 (17.4%) conversions to the open technique. The operative time was longer in the laparoscopic group (175 minutes vs. 145 minutes, P = 0.04), and the duration of hospitalization was shorter in the laparoscopic group (6 days vs. 7 days, P = 0.15). The overall postoperative morbidity rates were similar between the two groups (P = 0.93), with only 3 patients in each group requiring postoperative surgical intensive-care-unit stays or reoperations. There were no mortalities. The cost analysis did not demonstrate any significant differences in the procedural (P = 0.57) and the nonprocedural costs (P = 0.48) between the two groups. CONCLUSION: Emergency laparoscopic colectomy in a carefully-selected patient group is safe. Although the operative times were longer, the postoperative outcomes were comparable to those of the open technique. The laparoscopic group did not incur a higher cost.


Assuntos
Humanos , Estudos de Casos e Controles , Colectomia , Colo , Custos e Análise de Custo , Emergências , Hemorragia , Hospitalização , Laparoscopia , Trato Gastrointestinal Inferior , Duração da Cirurgia , Estudos Retrospectivos
10.
Annals of Coloproctology ; : 205-208, 2013.
Artigo em Inglês | WPRIM | ID: wpr-135301

RESUMO

PURPOSE: Mesenteric embolization is an integral part in the management of acute lower gastrointestinal (GI) bleeding. The aim of this study was to highlight our experience after adopting mesenteric embolization in the management of acute lower GI hemorrhage. METHODS: A retrospective review of all cases of mesenteric embolization for acute lower GI bleeding from October 2007 to August 2012 was performed. RESULTS: Twenty-seven patients with a median age of 73 years (range, 31 to 86 years) formed the study group. More than half (n = 16, 59.3%) of the patients were on either antiplatelet and/or anticoagulant therapy. The underlying etiology included diverticular disease (n = 9), neoplasms (n = 5) and postprocedural complications (n = 6). The colon was the most common bleeding site and was seen in 21 patients (left, 10; right, 11). The median hemoglobin prior to the embolization was 8.6 g/dL (6.1 to 12.6 g/dL). A 100% technical success rate with immediate cessation of hemorrhage at the end of the session was achieved. There were three clinical failures (11.1%) in our series. Two patients re-bled, and both underwent a successful repeat embolization. The only patient who developed an infarcted bowel following embolization underwent an emergency operation and died one week later. There were no factors that predicted clinical failure. CONCLUSION: Mesenteric embolization for acute lower GI bleeding can be safely performed and is associated with a high clinical success rate in most patients. A repeat embolization can be considered in selected cases, but postembolization ischemia is associated with bad outcomes.


Assuntos
Humanos , Colo , Emergências , Hemorragia Gastrointestinal , Hemoglobinas , Hemorragia , Isquemia , Estudos Retrospectivos
11.
Annals of Coloproctology ; : 205-208, 2013.
Artigo em Inglês | WPRIM | ID: wpr-135300

RESUMO

PURPOSE: Mesenteric embolization is an integral part in the management of acute lower gastrointestinal (GI) bleeding. The aim of this study was to highlight our experience after adopting mesenteric embolization in the management of acute lower GI hemorrhage. METHODS: A retrospective review of all cases of mesenteric embolization for acute lower GI bleeding from October 2007 to August 2012 was performed. RESULTS: Twenty-seven patients with a median age of 73 years (range, 31 to 86 years) formed the study group. More than half (n = 16, 59.3%) of the patients were on either antiplatelet and/or anticoagulant therapy. The underlying etiology included diverticular disease (n = 9), neoplasms (n = 5) and postprocedural complications (n = 6). The colon was the most common bleeding site and was seen in 21 patients (left, 10; right, 11). The median hemoglobin prior to the embolization was 8.6 g/dL (6.1 to 12.6 g/dL). A 100% technical success rate with immediate cessation of hemorrhage at the end of the session was achieved. There were three clinical failures (11.1%) in our series. Two patients re-bled, and both underwent a successful repeat embolization. The only patient who developed an infarcted bowel following embolization underwent an emergency operation and died one week later. There were no factors that predicted clinical failure. CONCLUSION: Mesenteric embolization for acute lower GI bleeding can be safely performed and is associated with a high clinical success rate in most patients. A repeat embolization can be considered in selected cases, but postembolization ischemia is associated with bad outcomes.


Assuntos
Humanos , Colo , Emergências , Hemorragia Gastrointestinal , Hemoglobinas , Hemorragia , Isquemia , Estudos Retrospectivos
12.
Singapore medical journal ; : e83-4, 2013.
Artigo em Inglês | WPRIM | ID: wpr-359118

RESUMO

This report highlights the rare occurrence of a huge gangrenous Meckel's diverticulum in an adult, which was managed successfully with laparoscopic resection. A 45-year-old woman presented with a one-day history of right iliac fossa pain with fever and vomiting. Computed tomography showed a huge gangrenous Meckel's diverticulum. The patient underwent laparoscopic exploration and extracorporeal stapled resection of the Meckel's diverticulum. This case serves to highlight the safety and feasibility of performing a laparoscopic resection of a huge gangrenous Meckel's diverticulum in an adult.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Gangrena , Diagnóstico por Imagem , Cirurgia Geral , Laparoscopia , Divertículo Ileal , Diagnóstico por Imagem , Cirurgia Geral , Tomografia Computadorizada por Raios X , Resultado do Tratamento
13.
Annals of the Academy of Medicine, Singapore ; : 451-456, 2012.
Artigo em Inglês | WPRIM | ID: wpr-299604

RESUMO

<p><b>INTRODUCTION</b>Emergency gastrectomy has been shown to be associated with poor morbidity and mortality rates. The aims of this study were to review the outcomes of emergency gastrectomy in our institution and to determine any factors that were associated with worse perioperative outcomes.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of all patients who underwent emergency gastrectomy for various indications from October 2003 to April 2009 was performed. All the complications were graded according to the classification proposed by Clavien and group.</p><p><b>RESULTS</b>Eighty-fi ve patients, median age 70 (range, 27 to 90 years), underwent emergency gastrectomy. The indications for the surgery included perforation, bleeding and obstruction in 45 (52.9%), 32 (37.6%) and 8 (9.4%) patients, respectively. The majority of the patients (n = 46, 54.1%) had an American Society of Anesthesiologists (ASA) score of 3. Partial or subtotal, and total gastrectomy were performed in 75 (88.2%) and 10 (11.8%) patients, respectively. Malignancy was the underlying pathology in 33 (38.8%) patients. The perioperative mortality rate was 21.2% (n = 18) with another 27 (31.8%) patients having severe complications. Twelve (14.1%) patients had a duodenal stump leak. The independent factors predicting worse perioperative complications included high ASA score and in perforation cases. Other factors such as malignancy, age and extent of surgery were not signifi cantly related. The presence of a duodenal stump leak was the only independent factor predicting mortality.</p><p><b>CONCLUSION</b>Emergency gastrectomy is associated with dismal morbidity and mortality rates. Patients with high ASA scores and perforations fared worse, and duodenal stump leak increases the risk of mortality.</p>


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Emergências , Gastrectomia , Mortalidade , Modelos Logísticos , Análise Multivariada , Complicações Pós-Operatórias , Epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Gastropatias , Mortalidade , Cirurgia Geral , Resultado do Tratamento
14.
Annals of the Academy of Medicine, Singapore ; : 136-142, 2010.
Artigo em Inglês | WPRIM | ID: wpr-253613

RESUMO

<p><b>INTRODUCTION</b>Laparoscopic common bile duct exploration (CBDE) is becoming more popular in the management of choledocholithiasis due to improved laparoscopic expertise and advancement in endoscopic technology and equipment. This study aimed to evaluate the safety and short-term outcome of laparoscopic CBDE in a single institution over a 3-year period.</p><p><b>MATERIALS AND METHODS</b>A retrospective review of the records of all patients who underwent laparoscopic CBDE in Tan Tock Seng Hospital between January 2006 and September 2008 was conducted.</p><p><b>RESULTS</b>Fifty consecutive patients, with a median age of 60 years (range, 27 to 85) underwent laparoscopic CBDE for choledocholithiasis during the study period. About half of our patients presented as an emergency with acute cholangitis (32.0%) accounting for the majority. A total of 22 (44.0%) patients underwent laparoscopic CBDE as their primary procedure while the remaining 28 (56.0%) were subjected to preoperative ERCP initially. Of the latter group, documented stone clearance was only documented in 5 (17.9%) patients. Laparoscopic CBDE via the transcystic route was performed in 27 (54.0%) patients while another 18 patients (36.0%) had laparoscopic choledochotomy and 1 patient (2.0%) had laparoscopic choledocho-duodenostomy. There were 4 (8.0%) conversions in our series. The median operative time for laparoscopic CBDE via the transcystic route and the laparoscopic choledochotomy were 170 (75-465) and 250 (160-415) minutes, respectively. For the 18 patients who underwent a laparoscopic choledochotomy, T-tube was inserted in 8 (44.4%) patients while an internal biliary stent was placed in 4 (22.2%) with the remaining 6 patients (33.3%) undergoing primary closure of the choledochotomy. The median length of hospital stay was 2 days (range, 1 to 15) with no associated mortality. The main complications (n = 4, 8.0%) included retained CBD stones and biliary leakage. These were treated successfully with postoperative endoscopic retrograde cholangiopancreatography (ERCP) with/without percutaneous drainage with no further surgery required.</p><p><b>CONCLUSION</b>Laparoscopic CBDE is a safe operation with good outcome in managing choledocholithasis. Its dividends include the numerous benefits of minimally invasive surgery. If possible, transcystic extraction is preferred to choledochotomy, as this obviates the need for biliary diversion. ERCP will still hold an important role in certain instances in the management of choledocholithiasis.</p>


Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ducto Colédoco , Cirurgia Geral , Cálculos Biliares , Diagnóstico , Cirurgia Geral , Laparoscopia , Métodos , Auditoria Médica , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Singapura
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