Clinical outcome of open and laparoscopic surgery in Dukes' B and C rectal cancer: experience from a regional hospital in Hong Kong.

OBJECTIVE: To compare the long-term outcome of open and laparoscopic surgery for Dukes' B and C rectal cancer in a regional hospital in Hong Kong. DESIGN: Retrospective study. SETTING: A regional hospital in Hong Kong. MAIN OUTCOME MEASURES: Survival and local recurrence rates. PATIENTS: Patients with Dukes' B and C rectal cancers underwent elective curative open or laparoscopic surgery during the period December 2000 to December 2006. RESULTS: A total of 222 patients (open surgery, n=133; laparoscopic surgery, n=89) were assessed. The overall 3- and 5-year survival rates for all patients were 72% and 58%, respectively. Local recurrence rates were similar in both groups. Laparoscopic group had better overall survival (P=0.014), however. The overall 3-year survival rates were 79% and 68% in the laparoscopic and open groups, respectively. The corresponding 5-year rates were 75% and 52%. Multivariate analysis also demonstrated that laparoscopic surgery was a significant independent factor for better survival. Chemotherapy, local recurrence, lymph node metastasis, and poorly differentiated tumour were significantly associated with survival. CONCLUSION: Laparoscopic surgery for Dukes' B and C rectal cancer was associated with more favourable survival than with open surgery.

Efficacy of multidisciplinary approach in treatment of constipation: a pilot study.

OBJECTIVE: To evaluate a multidisciplinary Hong Kong treatment programme for patients with constipation. DESIGN: Pilot study. SETTING: A joint collaboration among the departments of surgery, physiotherapy, and dietetics in a regional hospital in Hong Kong. PATIENTS: Thirty-one constipated patients with normal colonic transit and pelvic floor dyssynergia. INTERVENTION: Multidisciplinary treatment including dietary modification, bowel habit adjustment, and physiotherapy. MAIN OUTCOME MEASURES: Anorectal manometry, fibre intake, subjective improvement, bowel frequency, Bristol score, and straining time and effort. RESULTS: Significant improvement was found in mean fibre intake, straining time and effort, but not in anal manometric results. A total of 78% of patients demonstrated more than 50% improvement in subjective symptoms, whereas 70% of the patients enjoyed objective improvement in pelvic floor dyssynergia documented by electromyography and anal pressure during a push effort. CONCLUSION: The multidisciplinary rehabilitative programme for constipated patients significantly improved symptoms. Electromyography and anal pressure during a push effort are useful tools for objective assessment of the treatment effect.

Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study.

OBJECTIVE: To compare stapled haemorrhoidectomy with open diathermy haemorrhoidectomy in Chinese patients with respect to the postoperative pain, symptom control, and manometric alterations. DESIGN: Prospective randomised controlled trial. SETTING: A regional general surgical unit, Hong Kong. PATIENTS: Twenty-four patients with second- or third-degree haemorrhoids or who have had failed medical treatment. INTERVENTION: Open diathermy haemorrhoidectomy or stapled haemorrhoidectomy. MAIN OUTCOME MEASURES: Structured questionnaire for symptoms, anorectal manometry, transrectal ultrasound, and postoperative pain. RESULTS: Stapled haemorrhoidectomy compared with open diathermy haemorrhoidectomy resulted in similar postoperative pain and drug requirements. Postoperative control of prolapse symptoms was significantly better with open diathermy haemorrhoidectomy than with stapled. The control of other symptoms was similar with regard to bleeding, pain, pruritus, and incontinence scores. Anorectal manometry showed a decrease in the maximum resting pressure and maximum squeeze pressure in both groups, but the decrease was only significant in the stapled haemorrhoidectomy group. CONCLUSIONS: Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy for the treatment of haemorrhoids, but with the exception of skin tag prolapse. There is a need for long-term follow-up for the changes in manometric parameters after haemorrhoidectomy.

Treatment of early rectal tumours by transanal endoscopic microsurgery in Hong Kong: prospective study.

OBJECTIVE: To summarise the results of transanal endoscopic microsurgery for the treatment of rectal villous adenoma and early rectal tumours. DESIGN: Prospective study. SETTING: Regional hospital, Hong Kong. PATIENTS: Consecutive patients between November 1995 and January 2003. INTERVENTION: Transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Intra-operative morbidity and mortality, complication rate, operating time, postoperative morbidity and mortality, recurrence rate and correlation between preoperative ultrasonography staging and postoperative pathological staging. RESULTS: Thirty-two patients with rectal villous adenoma and early rectal carcinoma were registered, 31 of whom (14 men and 17 women) were included in the study. The median tumour size was 2.5 (range, 1-8) cm and the median operating time was 95 (45-220) minutes. The median follow-up period was 23 (2-92) months, and there was no local recurrence. There was no operation-related mortality and the resection margins were all clear. Complications included temporary flatus incontinence (n=2), acute retention of urine (n=1), exacerbation of chronic obstructive airway disease (n=1), and secondary haemorrhage in a patient on aspirin. CONCLUSIONS: Transanal endoscopic microsurgery is a safe procedure and can achieve good local tumour control. It is ideal in the management of rectal villous adenomas at stages pT0 and pTis. Its application is now extended to the treatment of early rectal carcinoma at stage pT1 with curative intent. For tumours at stage pT2 or later, it can also serve as a good option for local palliation.