Quality of life and functional outcomes after transanal total mesorectal excision for rectal cancer-results from the implementation period in Denmark.

BACKGROUND: The standard operation for mid- and low rectal cancer total mesorectal excision (TME) is routinely performed as minimally invasive surgery. TME is associated with temporary or permanent functional impairment of pelvic organs, causing reduced quality of life (QoL). Concerns have been raised that the newest minimally invasive approach, transanal TME (TaTME), may further reduce urogenital and anorectal functions. OBJECTIVE: To determine if functional outcomes affecting QoL are altered after TaTME. Primary end-point is the impact of TaTME on QoL and functional outcomes. Secondary end-point is assessing differences in QoL and functional outcomes after TME surgery from below (TaTME) or above (transabdominal TME). DESIGN, SETTING, AND PARTICIPANTS: Observational study consisting of prospectively registered self-reported questionnaire data collected at baseline and follow-ups after TaTME. All patients who underwent TaTME during the Danish national implementation phase were included. Central surveillance of the implementation included questionnaires concerning QoL and functional outcomes. Analyses of functional results from the Danish cohort of the ROLARR trial (Jayne et al. in JAMA 318:1569-1580, (2017) are reported separately for perspective, representing the transabdominal approach to TME, i.e., laparoscopic- or robotic-assisted TME (LaTME/RoTME). Applied questionnaires include EORTC QLQ-C30, SF-36, LARS, ICIQ-MLUTS, ICIQ-FLUTS, IPSS, IIEF, SVQ, and FSFI. RESULTS: A total of 115 TaTME procedures were registered August 2016 to April 2019. LaTME/RoTME patients (n = 92) were operated on January 2011 to September 2014. A temporary postoperative decrease of QoL (global health status and functional scales) was observed, yet long-term results were unaffected by surgery in both groups. In TaTME patients, the anorectal dysfunction increased significantly (p < 0.001) from preoperative baseline to 13.5 months follow-up, where 67.5% (n = 52) reported major LARS symptoms. Urinary function was not significantly impaired after TME regardless of technique. The paucity of responses concerning sexual function precludes conclusions. CONCLUSIONS: Although an initial reduction in QoL after TME occurs, it normalizes within the first year postoperatively. In concurrence with international results, we found that significant anorectal dysfunction is common after TaTME. No data on anorectal function was available for LaTME/RoTME patients for comparison. We found no indications that transanal TME is inferior to transabdominal TME surgery concerning urogenital functions or health-related QoL.

Gene expression signatures for colorectal cancer microsatellite status and HNPCC.

The majority of microsatellite instable (MSI) colorectal cancers are sporadic, but a subset belongs to the syndrome hereditary non-polyposis colorectal cancer (HNPCC). Microsatellite instability is caused by dysfunction of the mismatch repair (MMR) system that leads to a mutator phenotype, and MSI is correlated to prognosis and response to chemotherapy. Gene expression signatures as predictive markers are being developed for many cancers, and the identification of a signature for MMR deficiency would be of interest both clinically and biologically. To address this issue, we profiled the gene expression of 101 stage II and III colorectal cancers (34 MSI, 67 microsatellite stable (MSS)) using high-density oligonucleotide microarrays. From these data, we constructed a nine-gene signature capable of separating the mismatch repair proficient and deficient tumours. Subsequently, we demonstrated the robustness of the signature by transferring it to a real-time RT-PCR platform. Using this platform, the signature was validated on an independent test set consisting of 47 tumours (10 MSI, 37 MSS), of which 45 were correctly classified. In a second step, we constructed a signature capable of separating MMR-deficient tumours into sporadic MSI and HNPCC cases, and validated this by a mathematical cross-validation approach. The demonstration that this two-step classification approach can identify MSI as well as HNPCC cases merits further gene expression studies to identify prognostic signatures.

[Tension-free hernioplasty with a plug and a patch. A prospective long-term study of 483 cases of inguinal or femoral hernia]. / Tensionsfri hernioplastik med "plug" og plade. Prospektiv langtidsopgørelse af 483 ingvinal- og femoralhernier.

INTRODUCTION: The aim of this study was to assess the introduction of mesh plug and patch for hernia repair. MATERIALS AND METHODS: A prospective study was carried out on 483 consecutive cases of inguinal or femoral hernia treated at a county hospital in the period November 1993 to April 1997. The final follow-up was done by questionnaire. RESULTS: The operation was performed as a day-in procedure in 59% of the patients, and 35% stayed in the ward overnight. Normal daily activities were resumed within three (2-7) days (median [interquartile range]), and the sick leave was 7 (4-14) days. There were few postoperative complications, and reoperation was done in two cases. The overall recurrence rate was 5%, and for primary hernias 4%. There were no recurrences after operation for femoral hernia. Chronic pain was reported in 17% of the patients, 12% felt pain only during strenuous exercise. The observation at time was 46 (36-56) months (median [interquartile range]). DISCUSSION: Patients operated on with the mesh plug and patch technique had a short hospital stay and a short convalescence. The recurrence rate was acceptable.

Exulceratio simplex dieulafoy.

During a three year period, 18 patients with the Exulceratio Simplex Dieulafoy lesion of the stomach were treated (nine males and nine females). Because of intermittent bleeding episodes, lack of chronic ulceration of the gastric mucosa and the location of the lesion (most common in the upper part of the stomach), the lesion is easily overlooked at endoscopy and even at laparotomy with gastrotomy. Our treatment includes repeated endoscopies, attempted hemostasis with a combination of injection sclerotherapy and electrocoagulation and, if this is not successful, emergency surgical treatment with wedge resection using a technique with the TA 90 (U. S. Surgical Corp.) linear stapler. The diagnostic and therapeutic problems are discussed on the basis of patient profiles.