ABSTRACT
BACKGROUND: Long-course neoadjuvant chemoradiotherapy (NCRT), followed by surgery after an interval of 6-8 weeks, represents standard of care for patients with locally advanced rectal cancer (LARC). Increasing this interval may improve rates of complete pathological response (pCR) and tumour downstaging. We performed a meta-analysis comparing standard (SI, within 8 weeks) versus longer (LI, after 8 weeks) interval from NCRT to surgery. METHODS: PubMed, Embase, and Cochrane databases were searched up to 31 August 2022. Randomized controlled trials (RCTs) comparing SI with LI after NCRT for LARC were included. The primary endpoint was pCR rate. Secondary endpoints included rates of R0 resection, circumferential resection margin positivity (+CRM), TME completeness, lymph node yield (LNY), operative duration, tumour downstaging (TD), sphincter preservation, mortality, postoperative complications, surgical site infection (SSI) and anastomotic leak (AL). Random effects models were used to calculate pooled effect size estimates. RESULTS: Four RCTs encompassing 867 patients were included. There were 539 males (62.1%). LI was associated with a higher pCR rate (OR 0.61, 95%CI â= â0.39-0.95, p â= â0.03), and more TD (OR 0.60, 95%CI â= â0.37-0.97, p â= â0.04) compared to SI. However, there was no difference in rates of R0 resection (p â= â0.87), +CRM (p â= â0.66), sphincter preservation (p â= â0.26), incomplete TME (p â= â0.49), LNY (p â= â0.55), SSI (p â= â0.33), AL (p â= â0.20), operative duration (p â= â0.07), mortality (p â= â0.89) or any surgical complication (p â= â0.91). CONCLUSIONS: A LI to surgery after NCRT for LARC increases pCR and TD rates. Local recurrence or survival were not assessed due to unavailable data. We recommend deferring TME until after an interval of 8 weeks following completion of NCRT.
Subject(s)
Neoadjuvant Therapy , Randomized Controlled Trials as Topic , Rectal Neoplasms , Humans , Rectal Neoplasms/therapy , Rectal Neoplasms/pathology , Rectal Neoplasms/mortality , Time-to-Treatment , ChemoradiotherapyABSTRACT
Cancers of the colon and kidney are common malignancies, however, the occurrence of primary synchronous neoplasms of these two organs is uncommon. To the best of our knowledge, this is the first case report of a laparoscopic radical left nephrectomy and extended right complete mesocolic excision (CME) for a patient with synchronous renal and colon cancers. While a radical nephrectomy has long been the standard of care for a renal malignancy, CME has only recently been used. Combined surgeries provide the patient with various benefits such as decreased hospital stay, less postoperative pain and morbidity, early return to work and better cosmoses.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Renal Cell/surgery , Colonic Neoplasms/surgery , Kidney Neoplasms/surgery , Neoplasms, Multiple Primary/surgery , Adenocarcinoma/pathology , Aged , Carcinoma, Renal Cell/pathology , Colectomy , Colonic Neoplasms/pathology , Humans , Imaging, Three-Dimensional , Kidney Neoplasms/pathology , Laparoscopy , Lymph Node Excision , Male , Mesocolon/surgery , Neoplasms, Multiple Primary/economics , Nephrectomy , Radiography, Abdominal , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Enterobius vermicularis is an often unexpected finding in appendectomy specimen, most commonly seen in paediatric cases. Predicting the presence of E. vermicularis in the setting of appendectomy is important to avoid unnecessary appendectomy and associated morbidity. We sought to identify the incidence of E. vermicularis in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify predictive factors for E. vermicularis. METHODS: This study was performed in an 800-bed University Teaching Hospital, in the Republic of Ireland. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. RESULTS: In total 182 paediatric appendectomies were performed during the year 2012 for clinically suspected acute appendicitis. Demographics included: Mean age 11.14 years (3-16), gender 1M: 1F. 58.8% of procedures were completed laparoscopically, 39% open and 2.2% were converted. The negative appendectomy rate was 22.5%. The annual incidence of E. vermicularis in acute appendicitis specimen from a paediatric cohort at our institute was 7% (1 in 14). In specimen containing E. vermicularis, 69% had no evidence of appendicitis and of those that had, no gangrene or perforation was seen. The presence of E. vermicularis in paediatric patients with RIF pain may be predicted by Eosinophilia (p = 0.016), normal WCC (p = 0.034) and normal Neutrophil count (p = 0.014). CONCLUSIONS: E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity.
Subject(s)
Appendectomy , Appendicitis/parasitology , Appendix/parasitology , Cecal Diseases/epidemiology , Enterobiasis/epidemiology , Acute Disease , Adolescent , Animals , Appendectomy/statistics & numerical data , Appendicitis/surgery , Cecal Diseases/diagnosis , Child , Child, Preschool , Enterobiasis/diagnosis , Enterobius , Female , Humans , Incidence , Ireland/epidemiology , Laparoscopy/statistics & numerical data , Leukocyte Count , Male , Neutrophils/pathology , Retrospective StudiesABSTRACT
INTRODUCTION: Fournier's gangrene is a rare severe necrotising fasciitis of the genitalia. CASE: A case of Fournier's gangrene caused by perforated sigmoid diverticulitis in a patient with systemic lupus erythematosus is presented along with a review of the relevant literature.
