Retrospective analysis of resected primary colorectal cancer revealed no correlation between node harvest and node involvement.

OBJECTIVE: To analyze the correlation between lymph nodes harvest (LNH) and lymph nodes involvement (LNI). METHODS: A retrospective analysis was done from January 2002 - August 2008 (6.5 years). The data was obtained from medical records, pathology and radiology. The patients with primary colorectal carcinoma (CRC) including synchronous or metachronous cancer, were included. These patients were treated with curative or palliative intent. Exclusion criteria was recurrent colorectal cancer, cancer not operated, cancer not resected (stoma-only, open-close) and endomucosal resection. LNH and LNI were obtained. The data was analyzed and also compared with the literature and the national audit. RESULTS: There were 177 resections (mean=28 +/- 3 per annum). Male to female ratio was 0.9:1 and median age was 71 years. There were 112 (63.3%) colonic and 65 (36.7%) rectal cancers. There were 14 Anterio-posterior resections (APRs) (21.5% of all rectal resections). Eighty four percent of resections were elective (OR=2.2 p=0.003 compared to the national audit). Metastasis was found in 14.6% at presentation. Adenocarcinoma (not otherwise specified) NOS constituted 94% of all histology results. Median lymph node harvest was 12 (mean=13.4 p=0.08). There was no significant LNH-LNI correlation (r=0.17 p=0.02). Survival figures for stages I-III CRC revealed 3-year disease-free survival of 82% (all-stage=69%). CONCLUSION: LNI as a function of tumour and host behaviour is of prognostic significance whereas LNH may be a quality assurance (QA) tool.

Castleman's disease-A case report.

Castleman's disease is a rare clinicopathological entity characterized by non-neoplastic lymph node hypertrophy. Its incidence and etiology is unknown. It has been found in association with Kaposi's sarcoma thus necessitating investigations for HIV. Although its localized variety is benign other types can be multifocal with adverse systemic manifestations. A case report of a 42 yrs old female with a slowly enlarging highly vascular mass in the left iliac fossa is presented which lead to a histological diagnosis of this rare condition (see picture). Furthermore its clinical features, its types, relevant investigations and current treatment modalities are discussed.

Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia.

BACKGROUND: Recurrence and reflux are 2 most important remote complications of lap-paraesophageal hernia (PEH) repair. However, the extent of recurrence remains unknown. We sought to determine the true incidence of recurrence after lap-PEH repair. METHODS: A meta-analysis was carried out. PubMed, EMBASE, Cochrane Library, hand search, and personal communication were used to access and appraise studies. The inclusion criteria were full-text papers published from 1991 to date that describe lap-PEH repair in >25 patients, have at least a 6-month follow-up, and address the issue of recurrence. "Wrap migration" papers were excluded. Papers were appraised and the data were isolated on summary sheets. MS Office Excel 2003 was used to plot the results and represent it in graphs. RESULTS: Thirteen studies were eligible (all retrospective case series). A total of 965 patients with 99 recurrences were noted. The overall recurrence rate (in all patients) was 10.2% and was 14% if only the followed up patients (n=658/965) were considered. However, when patients with objective evidence (follow-up Ba esophagogram) were used (301/965), the "true" recurrence rate was 25.5% (ie, 1 in 4 recurred). The learning curve did not appear to be an issue (P=0.27). The studies revealed broad 95 CI and touched the line-of-no-effect, thereby increasing the "chance factor." When an alternate model was applied, esophageal lengthening (by Collis-Nissen gastroplasty) revealed a significant protective influence (P<0.0001). CONCLUSION: The true incidence of lap-PEH recurrence is 25.5%. The learning curve is not an adequate explanation. Mandatory (protocol) follow-up esophagograms at 1 year are essential. Two emphasis points in the repair have emerged: hiatoplasty and (superadded) esophageal lengthening.