Fall of another myth for colon cancer: Duration of symptoms does not differ between right- or left-sided colon cancers.

BACKGROUND/AIMS: Patients with colorectal cancer continue to present with relatively advanced tumors that are associated with poor oncological outcomes. The aim of the present study was to assess the association between localization, symptom duration, and tumor stage. MATERIALS AND METHODS: A prospective, multicenter cohort study was conducted on patients newly diagnosed with a histologically proven colorectal adenocarcinoma. Standardized questionnaire-interviews were performed. Data were collected on principal presenting symptoms, duration of symptoms (time to first presentation to a doctor and time to diagnosis) and treatment, diagnostic procedures, tumor site, and stage of the tumor (tumor, node, and metastasis (TNM)). RESULTS: A total of 1795 patients with colorectal cancer were interviewed (mean age: 60.76±13.50 years, male patients: 1057, patients aged >50 years: 1444, colon/rectal cancer: 899/850, right side/left side: 383/1250, stage 0-1-2/stage 3-4: 746/923). No statistically significant correlations were found between duration of symptoms and either tumor site or stage. Principal presenting symptoms were significantly associated with left colon cancer. Patients who had "anemia," "change in bowel habits," "anal pruritus or discharge," "weight loss," and "tumor in right colon" had a significantly longer symptom time. CONCLUSION: Symptom duration is not associated with localization, nor is the tumor stage. Diagnosis of colorectal cancer at an earlier stage may be best achieved by screening of the population.

Phenol Injection Versus Excision With Open Healing in Pilonidal Disease: A Prospective Randomized Trial.

BACKGROUND: Minimally invasive procedures may be an alternative to surgical excisions for pilonidal disease. OBJECTIVE: The aim of the study was to compare phenol injection versus excision with open healing technique. DESIGN: This is a prospective randomized study (ACTRN12612000868886). SETTINGS: This study was conducted at the Ankara University and Ufuk University Departments of Surgery. PATIENTS: One hundred forty patients were randomly assigned to phenol injection (n = 70) or excision with open healing (n = 70). MAIN OUTCOME MEASURES: The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale pain score, painkiller intake, time to resume daily activities, recurrence rate, Short Form 36 Health Survey, and Nottingham Health Profile at 3 weeks after surgery. RESULTS: Time to complete wound healing (16.2 ± 8.7 versus 40.1 ± 9.7 days) was significantly in favor of the phenol injection group (p < 0.001). The median operation time was 14.0 ± 3.8 minutes in the phenol group versus 49.0 ± 24.2 minutes in the excision with open healing group (p < 0.001). The time to resume daily activities (pain-free mobilization and defecation) was 0.8 ± 2.8 and 16.2 ± 12.6 hours after phenol injection and 9.3 ± 10.0 and 22.5 ± 15.1 hours after the excision with open healing treatment (p < 0.001, p = 0.008). Visual analog pain score at 48 hours and painkiller intake within 48 hours were significantly in favor of the phenol injection group. At the mean follow-up of 39.2 ± 9.0 months after surgery, no differences were seen in the recurrence rate between the treatment arms (13 recurrences in phenol vs 9 in excision with open healing; p = not significant). Short Form 36 and Nottingham Health Profile scores at 3 weeks after surgery were also in favor of phenol injection. LIMITATIONS: The present study was not double blinded, and a history of abscess drainage was significantly higher in the surgery group. CONCLUSIONS: Based on the results, we conclude that phenol injection is as effective as the excision with open healing technique.

Morbidity and mortality after the closure of a protective loop ileostomy: analysis of possible predictors.

BACKGROUND/AIMS: A diverting loop ileostomy is often created to protect distal colorectal, coloanal and ileoanal anastomoses. Ileostomy closure is associated with somewhat morbidity and mortality. The aim of this study was to determine the morbidity and morbidity related factors of ileostomy closure. METHODOLOGY: Prospectively recorded data of 255 patients who underwent diverting loop ileostomy between October 2000 and May 2011 were analyzed retrospectively. RESULTS: The study consisted of 139 male and 116 female patients with a median age of 54 years (range 17-79) who underwent ileostomy closure. The morbidity rate of ileostomy closure was 18.4% (47 patients) and the mortality rate was 1.2% (3 patients). When patients with morbidity and without morbidity were compared in terms of gender; age, American Society of Anesthesiology Score, primary pathology, surgeon factor; setting of ileostomy creation and time to stoma closure, only American Society of Anesthesiology Score was found as a predictor for morbidities. CONCLUSIONS: Closure of loop ileostomy is a simple procedure with low morbidity and a small but significant risk of mortality. Surgeons must consider the known risks in conjunction with the overall benefit/risk analysis before deciding between a temporary fecal diversion and a discontinuous colonic resection.

Subsite distribution of colorectal carcinoma and implications for screening; a retrospective audit of 1771 cases.

BACKGROUND/AIMS: Recent epidemiologic studies mentioned a shift from left to right in colorectal cancer. We searched our hospital database to try to give an insight into the patient characteristics and also optimize the screening programs in our country. METHODOLOGY: A total of 1771 colorectal cancer patients were identified and analyzed. Patients' gender, age, operation dates, tumor localization, resectability and T stage of the lesions, were recorded and comparisons were made. Second step of the study consisted of a questionnaire including 6 questions that were asked to 278 physicians to document current physician attitudes and practices regarding colorectal cancer screening, and to formulate appropriate interventions. RESULTS: Most of our patients were older than 51 in our study and a higher percentage of cases had sigmoid and rectal cancer (67%). The chronological trends in anatomic subsite distribution of colorectal cancer showed that by changing years when left colon cancer percentage was increasing, rectum cancer percentage was decreasing. There was no age-dependent variation in the topographical distribution of colorectal cancer by changing years. Also there was no relation between sex differences and subsite distribution when the whole group was taken into consideration. Specialist physicians had a poor understanding of colorectal cancer screening and lacked the responsibility of the screening programs. CONCLUSIONS: Data presented in this article do not support a progressive left to right shift in the distribution of colorectal carcinoma. Screening with fecal occult blood testing and sigmoidoscopy seems appropriate. Physician education may be an important step in screening before public awareness.

Recurrence after transanal excision of T1 rectal cancer: should we be concerned?

PURPOSE: Transanal excision is an appealing treatment for low rectal cancers because of its low morbidity, mortality, and better functional results than transabdominal procedures. However, controversy exists about whether it compromises the potential for cure. Several, recent reports of high recurrence rates after local excision prompted us to review our results of transanal excision alone in patients with T1 rectal cancers. METHODS: All patients with T1 low rectal cancer undergoing local excision alone between 1980 through 1998 were reviewed for local recurrence, distant metastasis, disease-free interval, results of salvage surgery, and overall and disease-free survival. Demographics, tumor size, distance from anal verge, and preoperative endoluminal ultrasound results also were recorded. Patients with poorly differentiated tumors, perineural or lymphovascular invasion, or with mucinous component were excluded. RESULTS: Fifty-two patients underwent transanal excision during the study period. Five-year recurrence was estimated to be 29.38 percent (95 percent confidence interval, 15.39-43.48). For 52 patients, five-year, cancer-specific and overall survival rates were 89 and 75 percent respectively. Fourteen of 15 patients with recurrence underwent salvage treatment with 56.2 percent (95 percent confidence interval, 35.2-90) five-year survival rate. Gender, preoperative staging by endorectal ultrasound, distance from the anal verge, tumor size, location, and T1 status discovered after transanal excision of a villous adenoma did not influence local recurrence or tumor-specific survival. CONCLUSIONS: Transanal excision for T1 rectal tumors with low-grade malignancy has a high rate of recurrence. Although overall cancer survival rates might be regarded as satisfactory, this high recurrence and low salvage rate raises the issue about the role of transanal excision alone for early rectal cancer and the possible need for adjuvant therapy or increased role of resective surgery.

Enteral and intraluminal short-chain fatty acids improves ischemic left colonic anastomotic healing in the rat.

BACKGROUND AND AIMS: This study assessed the effect of short-chain fatty acids (SCFAs) on the healing of ischemic colonic anastomosis and compared the enteral and intraluminal (transrectal) forms of SCFAs in the same study. MATERIAL AND METHODS: Left colonic ischemia was induced and a 1-cm left colon resection 2-4 cm above the peritoneal reflection was performed through a midline incision. In all, 160 rats were divided into eight groups: a control group, an ischemia group, a transrectal SCFAs group, an ischemia + transrectal SCFAs group, an enteral guar gum group, an ischemia + enteral guar gum group, an ischemia + enteral sham group, and a control + enteral sham group. The animals in each group were anesthetized again on day 4 or 7 after the operation for in vivo analytic procedures. Wound complications, intestinal obstructions, and anastomotic complications were recorded. Periperitoneal adhesions were graded. The strength of each anastomosis was assessed by measuring its bursting pressure. RESULTS: There were significantly more dense intra-abdominal adhesions in the ischemic group and ischemia + enteral sham group. Five animals in the ischemia group, six in the ischemia + enteral sham group, and one in each of the control and ischemia + transrectal SCFA groups developed anastomotic dehiscence. The median bursting pressures were significantly lower in the ischemic group and in the ischemia + enteral sham group on the 4 day and 7 days. CONCLUSION: Deleterious effects of ischemia on left colonic anastomotic healing were significantly prevented by the administration of either 7 days' pretreatment with enteral guar gum or the intraluminal instillation of SCFAs. There were no significant differences between enteral and intraluminal SCFA groups.