ABSTRACT
BACKGROUND: Laparoscopy-assisted surgery (LAS) for colorectal cancer (CRC) was first described in 1991 and robotic-assisted surgery (RAS) for CRC was first reported in 2002; robotic-assisted colorectal surgery (RACS) is becoming increasingly popular. However, data comparing its outcomes to other established techniques remain limited to small case series. Our primary goal was to review the mortality outcome difference between laparoscopic versus robotic elective colon resection at a small, community hospital. STUDY DESIGN: We conducted a retrospective review of 2089 patients at the South Atlantic division for cases who underwent robotic and laparoscopic colectomies at our division in 2014-2018. All cases were elective surgeries and analysis was performed within these two subgroups. RESULTS: In this study, 306 patients underwent robotic colorectal surgery versus 1783 patients who underwent laparoscopic-assisted colorectal surgery. Readmission rate within 30 days of operation was significantly lower for laparoscopic-assisted colorectal resection (LACR) versus RACS (445.4% vs. 53.9%, p= 0.006). However, the length of hospital stay was significantly shorter for RACS with a median of three days (interquartile range {IQR}: 2-5) versus four days (IQR: 3-7) for LACR (p=0.0001). There were no significant differences between the two groups for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, or rate of conversion to an open procedure. CONCLUSION: Our study showed a similar outcome between LACR and RACS for post-operative incisional hernias, anastomotic leaks, post-operative pain control, surgical site infections, and rate of conversion to an open procedure. Also, our study showed a readmission rate within 30 days of operation was significantly lower for LACR versus RACS. However, the length of hospital stay was significantly shorter for RACS with a median of three days when compared to LACR. Future research should focus on surgeon-specific variables, such as comfort, ergonomics, distractibility, and ease of use, as other ways to potentially distinguish robotic from laparoscopic colorectal surgery.
ABSTRACT
OBJECTIVE: Diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Arteriovascular disease, metabolic syndromes, non-steroidal anti-inflammatory drugs (NSAIDs), anti-thrombotics, and anticoagulants have been suggested as risk factors. There is a paucity of studies addressing factors associated with diverticular re-bleeding, especially in the United States. The aim of this study is to evaluate factors associated with colonic diverticular bleeding and re-bleeding in a US community-based hospital. METHODS: We conducted a retrospective case-control study to analyze the factors associated with diverticular bleeding. Between January 2010 and July 2011, 93 patients were admitted to our hospital with a primary diagnosis of acute diverticular bleeding. We compared them to 152 patients who were admitted with a primary diagnosis of diverticulitis in the same period. We collected data from the medical records of each patient in relation to the demographics, comorbidities, medications, social habits, location of diverticulosis, length of stay in the hospital, and re-bleeding rate within 2 years of the first bleeding episode. RESULTS: Factors such as cerebrovascular accident (p=0.009), coronary artery disease (p=0.037), diabetes mellitus (p=0.046), obstructive sleep apnea (p=0.033), NSAIDs (p=0.038), use of anti-thrombotics (p=0.001), anticoagulants (p=0.002) or calcium channel blockers (p=0.009), and bilateral diverticulosis (p=0.001) were significantly associated with diverticular bleeding as compared to diverticulitis. Recurrence of bleeding was noted in 26 out of 93 patients (28%) within 2 years of the first bleeding episode (p=0.001). Bilateral colonic involvement, anticoagulants, and elderly age (≥65 years) were found to have a closer relationship to diverticular re-bleeding, although it was not statistically significant. CONCLUSION: This study reveals that arteriovascular disease, diabetes mellitus, NSAIDs, the use of anti-thrombotics, anticoagulants or calcium channel blockers, and obstructive sleep apnea are factors that are significantly associated with diverticular bleeding. It also shows that bilateral colonic involvement, elderly age, and anticoagulants have a closer relationship to diverticular re-bleeding. More prospective studies in patients with diverticular bleeding should be conducted to shed light on the causality of these factors and the prevalence of diverticulitis.
ABSTRACT
Renal cell carcinoma metastasis to the small intestine is a rare condition. It usually results in gastrointestinal bleeding and it could happen many years after the diagnosis with renal cell cancer. Treatment includes surgery as well as targeted agents such as tyrosine kinases. We report here the case of an 82-year-old man with a past medical history of high-grade renal cell carcinoma and right nephrectomy 6 years earlier, who presented with recurrent episodes of syncope and black stools. He underwent esophagogastroduodenoscopy (EGD) and colonoscopy without evident source of bleeding. Video capsule endoscopy (VCE) showed three bleeding lesions in the jejunum and ileum. Push enteroscopy revealed a proximal jejunum bleeding mass that was suspicious for malignancy. Histopathology demonstrated poorly differentiated carcinoma. Given the patient's history of high-grade renal cell carcinoma, and similarity of histologic changes to the old renal cell cancer specimen, metastatic renal cell carcinoma was felt to be the responsible etiology.
ABSTRACT
There is paucity in the literature on the use of endoscopic ultrasound (EUS) for evaluating the thyroid gland. We report the first case of primary papillary thyroid cancer diagnosed by using EUS and fine needle aspiration (FNA). A 66-year-old man underwent EUS for the evaluation of mediastinal lymphadenopathy. FNA of the lymph nodes showed benign findings. A hypoechoic mass was noted in the right lobe of the thyroid gland. Therefore, FNA was performed. The cytological results were consistent with primary papillary thyroid cancer.
