The contribution of follow-up programs in the reduction of mortality of rectal cancer recurrences.

AIM: The aim of this study is to investigate whether patients, who have undergone curative surgery for rectal cancer and present with recurrence of the disease, could have a better chance of radical reoperation and increased survival if they were diagnosed earlier due to a screening program, when they were still asymptomatic, than those who were not followed up and their recurrence is discovered by its symptoms. METHODS: 113 patients, 52 men and 61 women (mean age 64.19 years, SD 10.76), who presented recurrence of the disease after radical resection for rectal carcinoma were evaluated in a follow-up period of 5 years. 53 of them (46.9%, group I) were asymptomatic and their recurrence was detected in a routine follow-up examination. The remaining 60 patients (53.1%, group II) were not followed up regularly and the recurrence was diagnosed by the development of symptoms. RESULTS: The two groups were comparable with regard to patients' sex, type of operation, postoperative morbidity, tumor stage, histologic differentiation, size of primary tumors, the distance from the anal ring and distal margin. There was no difference in the disease-free period between the two groups (17.3 +/- (SD) 9.9 months in group I versus 20.3 +/- (SD) 14.4 months in group II, p = 0.1). 24 out of 53 patients in group I (45.2%) and 24 out of 60 patients in group II (40%) underwent surgery for their recurrence, but only in 8 and 9 cases, respectively, could the operation be considered as curative. The mean postrecurrence survival was 13.14 +/- (SD) 23.8 months for group I and 10.97 +/- (SD) 18.03 months for group II (p = 0.113). There was no difference in survival between the two groups after surgical treatment of the recurrence (p = 0.14). CONCLUSIONS: Our data show that if we exclude the palliative treatment of symptoms such as hemorrhage or obstruction, only a small percentage of patients with recurrent colorectal cancer will benefit from the treatment and achieve an increased survival, which is independent of the postoperative follow-up program.

Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases.

BACKGROUND/AIM: In this prospective study the results of rubber band ligation (RBL) of symptomatic hemorrhoids in 500 consecutive patients with 2nd (255 cases), 3rd (218 cases) and 4th degree (27 cases) hemorrhoids are presented. METHODS: The patients' symptoms were hemorrhage in 142 cases (28.4%), prolapse in 33 cases (6.6%) and both hemorrhage and prolapse in 325 cases (65%). Sixteen patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using the St Marks' applicator (Seward) on an outpatient basis. Multiple ligations in two (259 cases) or three (190 cases) sessions were undertaken in 449 patients (89.8%), while a single ligation was done in 51 cases (10.2%). RESULTS: Successful results were achieved in 440 cases (88%) in a 24-month follow-up. A total of 94 patients (18.8%) had complications which required no hospitalization. Pain and hemorrhage were the most frequent complications. RBL proved to be safe in 16 patients with coagulation disorders due to liver cirrhosis. Two years after RBL, symptomatic recurrence was 11.9% (53/445) with repeat RBL or surgery in 9.2% (41/445). CONCLUSIONS: RBL is a useful, safe and successful method for treating symptomatic 2nd and 3rd degree hemorrhoids, which can be applied successfully in selected cases with 4th degree hemorrhoids, but with an increased rate of recurrence and additional treatment requirements. Also, RBL seems to be safe in patients with liver cirrhosis and portal hypertension.