Minimally invasive resection for colorectal cancer: perioperative and medium-term results in an unselected patient group at a single institution.

BACKGROUND: The use of laparoscopy for colorectal cancer resection is still controversial. METHODS: We prospectively analyzed the outcome of minimally invasive resection for colorectal cancer, performed at our institution from 1998, when laparoscopic surgery became the treatment of choice for colorectal cancer, until 2004. All patients undergoing elective resection were assessed in terms of perioperative results (duration of surgery, number of lymph nodes removed, length of specimen, rate of conversion, complications) and survival. Patients were assessed yearly with follow-up visits and telephone interviews. RESULTS: In the study period, 302 patients (mean age 66.1 years; range, 32-93 years) underwent 114 left hemicolectomies, 108 low anterior resections, 61 right hemicolectomies, 12 Miles procedures, 4 subtotal colectomies, and 3 transverse colon resections. Surgery took an average of 226 minutes (SD=71 min). The number of lymph nodes removed was 14+/-8. The conversion rate was 10%; most of the conversions were due to locally advanced cancer (15 cases) and bowel distension (7 cases). Fifteen anastomotic leaks were observed (5%). Twenty patients needed reoperation and two died: one of septic shock due to an anastomotic leak; the other of electrolyte imbalance and dehydration after peritonitis due to a bowel loop injury. Follow-up was available for 91% of patients. Cancer-related survival curves showed a 90% survival for stage II, 85% for stage III, and 10% for stage IV disease, 30 months after surgery. CONCLUSIONS: Minimally invasive laparoscopic resection for colorectal cancer enables an oncologically adequate resection with complication and survival rates that are no worse than are to be expected after traditional open surgery. Locally advanced tumor and bowel distension are the most frequent reasons for conversion to open surgery.

An experimental swine model of small bowel cross transplantation.

AIM: In this study we evaluated the possibility of performing a cross small bowel transplantation (CrSBTx) in which, at the same time, 2 pigs were both donors and later recipients of intestinal grafts. The hemodynamic and metabolic impact of this original transplantation model on the animals was determined. METHODS: Ten large White adult female pigs underwent a 2 stage procedure. The principal intraoperative hemodynamic and metabolic parameters were measured at different times during the operation. In the 3 days that followed the operation, renal function, liver and pancreatic damage were investigated. RESULTS: Our surgical model permits us to keep excellent hemodynamic and metabolic stability with low mortality. CONCLUSION: The need of half of animals with respect to conventional models represents an ethical and economic advantage of CrSBTx and we propose it for intestinal transplant studies in large animals.

Clinical indications for echocardiography.

Echocardiography is an important adjunct to clinical diagnosis. Evaluation of chamber size, estimation of left ventricular function, valvular defects, and tricuspid atresia or stenosis are among the many disorders in which it can be helpful.

Echocardiographic and electrocardiographic criteria for diagnosing left atrial enlargement.

Electrocardiographic criteria for left atrial enlargement (LAE) were evaluated in a group of 100 patients with a wide spectrum of cardiovascular diseases and compared with the echocardiographic measurement of left atrial dimension (LAD). Data analysis showed a high degree of correlation between the echocardiographic measurement of LAD and the EKG criteria for LAE. The magnitude of the P terminal force in lead V1 was the most specific of the EKG criteria evaluated, while the P/P-R segment ratio was least specific. Concordance between the two methods of measuring left atrial size increased when multiple positive EKG criteria were present.