RESUMO
AIM: To assess the impact of multi-disciplinary teams (MDTs) management in optimising the outcome for rectal cancers. METHODS: We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers (defined as tumours ≤ 15 cm from anal verge) discussed at our MDT between Jan 2008 and Jan 2011. The data was validated against the national database to ensure completeness of dataset. The clinical course and follow-up data was validated using the institution's electronic patient records. The data was analysed in terms of frequencies and percentages. Significance of any differences were analysed using χ2 test. A Kaplan-Meier analysis was performed for overall survival and disease free survival. RESULTS: Following appropriate staging, one hundred and thirty-three patients were suitable for potentially curative resections. Seventy two (54%) were upper rectal cancer (URC) - tumour was > 6 cm from the anal verge and 61 (46%) were lower rectal cancers (LRC) - lower extent of the tumour was palpable ≤ 6 cm. Circumferential resection margin (CRM) appeared threatened on pre-operative MRI in 19/61 (31%) patients with LRC requiring neo-adjuvant therapy (NAT). Of the 133 resections, 118 (89%) were attempted laparoscopically (5% conversion rate). CRM was positive in 9 (6.7%) patients; Median lymph node harvest was 12 (2-37). Major complications occurred in 8 (6%) patients. Median follow-up was 53 mo (0-82). The 90-d mortality was 2 (1.5%). Over the follow-up period, disease related mortality was 11 (8.2%) and overall mortality was 39 (29.3%). Four (3%) patients had local recurrence and 22 (16.5%) patients had distant metastases. CONCLUSION: Management of rectal cancers can be optimized with multi-disciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.
RESUMO
PURPOSE: The incidence of incisional hernia varies considerably in the literature. The aim of our study was to calculate the incidence of various types of the occult iatrogenic hernias following colorectal surgery, both laparoscopic and open, using CT scan. METHODS: The study included all patients who underwent colorectal resection procedures in a colorectal surgery department over an 11 year period between 2001 and 2012 who went on to have a CT scan post surgery. The term iatrogenic hernia included all postoperative hernias at laparotomy incision site in the open colorectal subgroup, hernias at the site of specimen extraction or port site hernias in the laparoscopic colorectal subgroup, and parastomal hernias in both subgroups. RESULTS: The total number of diagnosed iatrogenic hernias was 74 (61 detected on CT scan and 13 repaired on clinical grounds). Out of the 74 diagnosed iatrogenic hernias, 23 (31.1%) required surgical repair; 11 in the LCR (6 incisional, 2 parastomal and 2 port site hernias) and 12 in the OCR (9 incisional and 3 parastomal). CONCLUSION: The incidence of iatrogenic hernias is underestimated. The use of CT will increase the number detected. There is no significant difference in the incidence of iatrogenic hernias between laparoscopic and open colorectal procedures.
