An updated review of the methods, guidelines of, and controversies on screening for colorectal cancer.

BACKGROUND: Screening for early detection of colorectal cancer (CRC), adenomatous polyps, and precancerous lesions can reduce mortality. This review aimed to illustrate methods, guidelines, and clinical utility of CRC screening programs. METHODS: Literature search of PubMed and Scopus electronic databases was independently performed by two authors in September 2021. Articles discussing CRC screening methods and updated guidelines were reviewed. RESULTS: After reviewing the full text of 55 studies, it was found that the screening tests for CRC are divided into stool-based, endoscopic, and molecular. All CRC screening guidelines recommend screening starting at age 45-50, but vary regarding screening methods, frequency, and timing of screening discontinuation. Controversies include clinical benefits of screening the elderly and discontinuation of screening. Effective screening barriers involve patient- and healthcare-related factors. CONCLUSION: Overall, screening should start at age 45-50 for average-risk individuals. Colonoscopy and FIT tests are standard modalities recommended for regular screening. Increasing public awareness of the importance of screening and implementing mass national screening programs can detect early CRC and decrease related mortality.

Comprehensive literature review of the outcome, modifications, and alternatives to double-stapled low pelvic colorectal anastomosis.

BACKGROUND: The double-stapled technique is widely used for creation of colorectal anastomosis after anterior resection of the rectum. Anastomotic leak has been recognized as one of the serious complications of low pelvic colorectal anastomosis. The present review aimed to illustrate the collective outcome of double-stapled technique, risk factors for anastomotic leak, and the modifications and alternatives of double-stapled technique. METHODS: A comprehensive review of PubMed/Medline, Scopus, and Web of Science was conducted to search articles that entailed patients who underwent low anterior resection with double-stapled low pelvic anastomosis. The main outcome measures were anastomotic leak and complication rates of double-stapled technique and its technical modifications. RESULTS: Overall, the median anastomotic leak rate across 25 studies was 7.3% (range: 0.7%-24.5%). The most commonly reported predictors of anastomotic leak after double-stapled technique were low tumor location, multiple stapler firings, male sex, longer operation time, and perioperative blood transfusion. Several modifications of the double-stapled technique were described and include hand-sewn colonic J-pouch, vertical division of the rectum, transanal reinforcement of anastomosis, transanal pull-through with single stapling technique, elimination of dog-ears using sutures, the natural orifice intracorporeal anastomosis with extraction of specimen procedure, and transanal transection and single-stapled. CONCLUSION: The median rate of anastomotic leak after double-stapled technique was less than 8%; however, it showed a wide range from less than 1% to approximately 25%. This wide variation might be related to additional risk factors of anastomotic leak, namely low tumor location and multiple stapler firings. Several techniques were described to modify the double-stapled technique to try to reduce the incidence of anastomotic leak.

Systematic review and meta-analysis of the outcome of puborectalis division in the treatment of anismus.

AIM: Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM) division in the treatment of anismus. METHOD: PubMed, Scopus, Web of Science and the Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in the Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI). RESULTS: Ten studies (204 patients, 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomized trials was 97.6% (95% CI 94%-100%) and across nonrandomized studies it was 63.1 (95% CI 39.3%-87%). The weighted mean rate of 12-month improvement across randomized trials was 64.9% (95% CI 53.3%-76.4%) and across nonrandomized studies it was 55.9% (95% CI 30.8%-81%). The weighted mean rate of FI across randomized trials was 12.1% (95% CI 4.2%-20%) and across nonrandomized studies it was 10.4% (95% CI 1.6%-19.3%). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division and concomitant sphincterotomy were significantly associated with FI after PRM division. CONCLUSIONS: The use of PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to <60% 12 months after PRM division. The mean rate of FI after PRM division, namely 10%-12%, is a limitation of the technique. Further well-designed trials are needed to verify the outcome of PRM division in the treatment of anismus.

Karydakis procedure versus Limberg flap for treatment of pilonidal sinus: an updated meta-analysis of randomized controlled trials.

BACKGROUND: The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF. METHODS: Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction. RESULTS: Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of -0.788 (95%CI: -11.55 to -4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9-2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76-1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15-3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39-3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= -0.182; 95%CI: -3.58 to -0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65-3.77, p = 0.01). CONCLUSIONS: KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.

Accuracy of pre-operative parameters in predicting severe cholecystitis-A systematic review.

INTRODUCTION: Severity of cholecystitis can be defined by the presence of histopathological changes such as gangrene, perforation, and empyema. Severe cholecystitis correlates with higher morbidity and longer hospital stay. The present review aimed to identify the predictors of severe cholecystitis. METHODS: Electronic databases including PubMed, Scopus, and Cochrane library were searched in the period of January 1980 to March 2019. The main outcome of this review was to assess the predictability of pre-operative parameters such as Leukocytosis, fever, tachycardia, gallbladder wall edema, gallbladder distension, serum platelet count, and gallbladder mural striation. The role of patients' characteristics including age, gender, and diabetes mellitus in predicting severe cholecystitis was also assessed. RESULTS: A total of 8823 patients were analysed. The mean age of patients was 67.14 ± 4.17. The parameters that had the highest Odds ratio in predicting severe cholecystitis were all findings on CT scanning and included attenuation of arterial phase, mural striation of the gallbladder, and decreased gallbladder wall enhancement. CONCLUSION: We conclude that CT findings were the most significant predictors of severe cholecystitis. Patients with clinical and laboratory predictors of severe cholecystitis should be urgently evaluated with contrast CT scan to rule out any severe complications.

Development of the 'PREDICT' score through a systematic review and meta-analysis of the predictive parameters for locoregional recurrence after total mesorectal excision.

BACKGROUND: Despite robust management techniques, locoregional recurrence rates of rectal cancer are still significant. Although offering intensive follow-up has been shown to be beneficial in the early detection, it can be resource consuming. Having a robust knowledge of risk factors of locoregional recurrence will help in identification of patients who actually need intensive follow-up programs. This review aimed to identify the factors that can predict locoregional recurrence after Total mesorectal excision (TME). METHODS: We systematically reviewed PubMed, Scopus and Cochrane for relevant articles with no date restrictions while language was restricted to English. We only included articles that had either provided Hazards ratio (HR)/odds ratio (OR) or provided enough data that allowed calculation of HR/OR specifically for rectal cancer. Articles were deemed eligible if they included patients undergoing (TME). RESULTS: Seventeen studies (18,605 patients) published between 2002 and 2019 were included. A total of 699 patients developed locoregional recurrence at a median time of 25.2 months after surgery. There were eight significant predictors evaluated by more than one study; T3-T4 stage, circumferential resection margin, lymphovascular invasion, mucinous histology, N1-N2 stage, positive distal resection margin, Tumor < 5 cm from anal verge, and lack of neoadjuvant radiotherapy. A scoring system was developed based on the weight and pooled OR/HR of each predictor. CONCLUSION: Using predictive factors identified in our review in context of scoring system may help in the early detection of locoregional recurrence after TME. This may help in tailoring the application of intensive follow-up programs.