Risk factors in reoperations in colorectal surgery.

BACKGROUND: Reoperations in colorectal surgery are usually a consequence of major surgical complications. Recently, the rate of reoperation has been proposed as a marker of surgical performance. Yet, the incidence of re-intervention varies significantly in literature, ranging from 5.2% to 13%. Therefore, in this study we investigated 30-day reoperation rates and made an attempt to identify risk factors of re-intervention following colorectal resection at our institution. METHODS: This is a retrospective study of patients who had undergone colorectal resection at a single institution from 2013 to 2017. Univariate and multivariate analysis of predicting factors were performed. RESULTS: Out of 464 patients included, 51 required reoperations (11%). The most common causes of reoperations were anastomotic leakage, postoperative bleeding, and wound dehiscence. In univariate analysis the age of the patient and location of the tumor were related to an increased rate of reoperation. In multivariate analysis patients older than 75 (OR = 2.1; 95%CI = 1.1-3.9) and tumors sited in the rectum (OR = 2.66; 95%CI = 1.4-5) were associated with an increased risk of re-intervention. Patients who required postoperative re-intervention stayed in hospital longer (14 vs. 6 days, P < 0.0001) and had higher mortality (9.8% vs. 1.2%, P = 0.002). CONCLUSIONS: Our study shows that reoperation rates that follow colorectal surgery are frequently undervalued. In our series, 11% of patients required an unplanned return to the operative room. Patient's age and rectal tumors were the two independent factors that affect the rate of reoperation. Novel aspect: Data concerning reoperation rates in colorectal surgery is varying and most reports have shown the incidence of re-intervention to be as low as 5-7%. Our study demonstrates that reoperations after curative surgery for colorectal cancer are more frequent and may occur in over a tenth of total patients operated on.

Colorectal surgery in elderly population.

INTRODUCTION: With the rising number of elderly patients and increasing incidence of colorectal cancer, management of geriatric patients has become the forefront of colorectal surgery. OBJECTIVES: This study aimed to investigate the short-term surgical outcomes following colorectal resection in elderly patients. MATERIALS AND METHODS: A total of 464 patients who underwent surgical resection for colorectal tumor between 2013 and 2017 were included. The patients were divided into elderly (≥75 years) and young (<75 years) group. The clinicopathological data of the patients were reviewed retrospectively. RESULTS: The elderly group constituted 30% of study population. More patients in elderly group underwent Hartmann procedure (p=0.02) and right hemicolectomy (p=0.029), and younger patients more often received low anterior resection (p=0.027). The surgical procedure took a shorter time in elderly group (p<0.01) but they stayed in the hospital one day longer (p=0.023). Postoperative complications and mortality tended to be higher in seniors (p=0.088). The younger patients showed a tendency towards a higher rate of distant metastases (p=0.053). Seniors received fewer preoperative chemoradiation than the young group (p=0.014). CONCLUSION: Older persons constitute one-third of patients treated electively in colorectal departments. Colorectal surgery in geriatric patients is associated with a prolonged hospital stay and a higher potential for complications and mortality.

Introduction of Robotic Surgery into a Community Hospital Setting: A Prospective Comparison of Robotic and Open Colorectal Resection for Cancer.

PURPOSE: The aim of this study was to compare robotic colorectal surgery (RCS) performed by a team having limited expertise in robotic surgery with open colorectal surgery (OCS) performed by experienced colorectal surgeons. METHODS: This was a prospective comparative nonrandomized study. RESULTS: Between March 2013 and June 2015, 79 patients with colon and rectal adenocarcinoma were enrolled into the study. Of these, 41 patients underwent OCS and 38 underwent RCS. The groups were comparable in terms of demographics and type of procedure. The RCS took significantly longer in the operating room than the OCS (222 vs. 141 min, p < 0.001). The rate of major complications was similar for both RCS and OCS (5.3 vs. 9.8%, p = 0.454). Wound infections were less frequent in the RCS group (10.5 vs. 29.3%, p = 0.039). The mean hospital stay was 1 day shorter in the RCS group than in the OCS group (5.7 vs. 6.7 days, p = 0.176). The lymph nodes harvested was comparable (14.7 RCS vs. 15.5 OCS, p = 0.596). CONCLUSIONS: This study confirmed that the surgical team with limited expertise in minimally invasive surgery can still safely introduce robotic surgery into their colorectal practice. When compared to the open approach, the robotic approach reduces hospital stay, as well as the rate of surgical site infection.

C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections - a prospective study.

INTRODUCTION: Early safe discharge is paramount for the success of ERAS following colorectal cancer resections. Anastomotic leakage (AL) has high morbidity, particularly if the patient has been discharged to the community. AIM: To evaluate whether C-reactive protein (CRP) and procalcitonin (PCT) can predict AL before early discharge. MATERIAL AND METHODS: Fifty-five consecutive patients undergoing open and robotic colorectal cancer resections were included. C-reactive protein and PCT were measured pre-operatively, 8 h after incision, and on the first and third postoperative day. Thirty-day readmissions, re-operations and mortality were recorded. RESULTS: Twenty-nine patients underwent robotic and the remainder open (n = 26) resections. Five patients had AL. The mean CRP and PCT increased on postoperative day 1 (POD 1) and POD 3 in all patients. On POD 3, mean CRP was 114 mg/l in non-AL patients and 321 mg/l in AL patients (p = 0.0001). Mean PCT on POD 3 was 0.56 ng/ml in the non-AL group and 10.4 ng/ml in AL patients (p = 0.017). On analysis of ROC and AUC curves, the cut-off for CRP on POD 3 was 245.64 mg/l, with 100% sensitivity and 98% specificity for AL. The cut-off for PCT on POD 3 was 3.83 ng/ml, with 75% sensitivity and 100% specificity for AL. CONCLUSIONS: C-reactive protein and PCT measurement on POD 3 following colorectal cancer resection can positively identify patients at low risk of anastomotic leakage.

Cryosurgery in the treatment of women with breast cancer-a review.

Cryoablation could be an alternative to surgical excision of breast cancer. The cytotoxic potential of cryosurgery has been shown in both animal models and studies conducted on humans. There are several advantages to be gained from ablation performed at very low temperatures and these include the method's simplicity, lack of pain, low morbidity, cost-effectiveness, and potential for positive cryo-immunologic effects. This manuscript reviews data concerning the use of cryoablation in the treatment of breast cancer.

Beginning robotic assisted colorectal surgery - it's harder than it looks!

INTRODUCTION: Laparoscopy has been introduced into the field of colorectal surgery with the aim of reducing morbidity. One of the major barriers to overcome is the steep learning curve. Robotic surgery offers substantial advantages over traditional laparoscopy, which make the whole procedure more user friendly. AIM: To present our initial experiences with robotic assisted colorectal surgery. MATERIAL AND METHODS: Thirty-five patients with colorectal cancer underwent robotic assisted procedures between 2011 and 2013. RESULTS: In total we performed 16 low anterior resections, 14 right colectomies, 3 abdominosacral resections and 2 left colectomies. There were 22 males and 13 females. The mean operative time was 315 ±65 min for a low anterior resection. The mean length of hospital stay was 6.4 ±1 days. There were 4 conversions to open procedures, 2 anastomotic leaks, and 1 colovaginal fistula. The mean lymph node yield was 12.7 ±4.3. The resection margin was negative in all but 1 patient. CONCLUSIONS: We agree with the opinion that robotic surgery brings many advantages in pelvic dissections. In order to facilitate safe acquisition of robotic total mesorectal excision skills, surgeons should begin with female patients, and less advanced rectal cancer. In some instances robotic assistance can be helpful in right colectomies.

Robot-assisted right colectomy: surgical technique and review of the literature.

Following the successful introduction of robotic surgery to the field of urology and gynecology, its use gained even more interest among those in the field of colorectal surgery. Rectal resection is believed to be among the best suited for robotic assistance. In particular, the right hemicolectomy procedure has been proposed as a training tool in order to gain clinical experience with the robot. This article and attached video demonstrates, in detail, the robot-assisted right hemicolectomy, including key landmarks of the procedure. The case presented involved a 58-year-old man with an advanced cecal adenocarcinoma. In our opinionrobot-assisted right colon resection is a procedure that offers particular value for the novice robotic team who is in the beginning stages of their colorectal surgery experience. Although no concrete advantages for use of the robot in this particular procedure have been demonstrated in the literature, because it is a relatively straightforward and simple procedure, it can serve as a valuable training tool for the novice robotic surgeon.