International Journal of Colorectal Disease (Int J Colorectal Dis Clin Mol Gastroenterol Surg)

Publications in this journal

• Article: Four cases of carcinoid tumour in Crohn's disease: coincidence or correlation?

  Chiara Praticò, Fernando Rizzello, Giulia Spuri Fornarini, Andrea Calafiore, Carlo Calabrese, Massimo Campieri, Paola Tomassetti, Paolo Gionchetti
  International Journal of Colorectal Disease 06/2013;
• Article: The Two-Week Referral System for colorectal cancer-not fit for purpose.

  Robert T Padwick, Adeel A Bajwa, Annabel Shaw, Edmund Leung, James Francombe, Michael L Stellakis
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  ABSTRACT: PURPOSE: The UK government target expects all suspected colorectal cancer (CRC) patients to be seen within the Two-Week Referral (TWR) system made by general practitioners. These guidelines originally derived from only level 5 evidence. However, this has significant impact on the workload for colorectal surgeons. The aim of the study is to investigate the effectiveness of this colorectal service and whether the referral criteria are predictive of CRC. METHODS: A retrospective study of all patients referred under the TWR guidance in 2010 was assessed. The first 573 TWRs were piloted for analysis. Clinical information from each patient was collected regarding TWR criteria and additional colorectal symptoms or risk factors. Multiple regression analysis was performed to determine which symptoms independently correlated with CRC. RESULTS: One hundred twenty-six CRCs were diagnosed via all methods of referral in 2010. There were 940 patients referred under the TWR guidelines in that year, when 50 CRC patients were identified. Amongst the 573 patients, 32 CRCs were diagnosed. Multiple regression analysis revealed tenesmus to be independently associated with CRC (p = 0.003, Pearson's r = 0.09185). None of the individual TWR criteria confidently predicted CRC. CONCLUSION: Our preliminary results suggest that the current TWR guidelines cannot effectively predict CRC. There is an urgent need for an evidence-based approach to referral criteria for suspected CRC.
  International Journal of Colorectal Disease 06/2013;
• Article: Laparoscopic repair of internal hernia following laparoscopic anterior resection.

  Nabila Ansari, Anil Keshava, Matthew J F X Rickard, Gillian L Richardson
  International Journal of Colorectal Disease 06/2013;
• Article: A new colorectal/coloanal anastomotic technique in sphincter-preserving operation for lower rectal carcinoma using transanal pull-through combined with single stapling technique.

  Mengjun Bie, Zheng-Qiang Wei
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  ABSTRACT: PURPOSE: This study aims to introduce a new anastomotic technique-transanal pull-through combined with single stapling technique (PT-SST), and evaluate the value in the sphincter-preserving operation for lower rectal carcinoma. METHODS: Between January 2004 and September 2011, 131 consecutive patients had sphincter-preserving operations using PT-SST and double stapling technique (DST) for low colorectal anastomosis. The data was prospectively collected. RESULTS: There are 45 patients (male 26, median = 55 years) in PT-SST group and 86 (male 46, median = 55 years) in the DST group. Anastomotic leakage took place in three patients in DST group, while no anastomotic leakage happened in PT-SST group. There are recurrences in pelvic cavity for one patient (2.2 %), in anastomotic stoma for no patient, and hepatic metastasis for four patients (8.9 %) in PT-SST group; while there are recurrences in pelvic cavity for three patients (3.5 %), in anastomotic stoma for two patients (2.3 %), and hepatic metastasis for seven patients (8.1 %) in DST group. No significant difference was indicated in the terms of the recurrence and hepatic metastasis between the two groups. Patients were satisfied with functional results. CONCLUSIONS: This new technique can solve some technique problems of DST and has at least comparable outcomes compared with DST. It is a safe and feasible procedure for performing low anastomosis with high rate of sphincter preservation. It can be used especially for patients with small pelvis.
  International Journal of Colorectal Disease 06/2013;
• Article: Anorectal malformation associated with a mutation in the P63 gene in a family with split hand-foot malformation.

  Pengjun Su, Yuhang Yuan, Ying Huang, Weilin Wang, Zhibo Zhang
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  ABSTRACT: PURPOSE: The aims of this study were to identify the mutation gene of a Chinese family with anorectal malformation (ARM) associated with split hand-foot malformation and to determine the spatiotemporal expression of the mutated gene during hindgut and anorectum development in human embryos. METHOD: A Chinese family with intrafamilial clinically variable manifestation was analyzed and primers were designed for exons 3-14 of P63, DLX5, DLX6, DAC, and HOXD13 as candidate genes and direct sequence analysis of the exons was performed. Immunohistochemical study of mutated gene in the hindgut and anorectum of human embryos of 4th-10th weeks was performed. RESULT: Affected individuals were found to have an Arg227Gln P63 gene mutation. From the 4th-10th weeks of gestation of the human embryo, the P63-positive cells were mainly located on the epithelium of the apical urorectal septum, hindgut, and cloacal membrane. After the anorectum ruptured during the 8th week, the P63 remained strongly immunoreactive on the epithelium of the anal canal and urethra, but the mucous membrane of the rectum exhibited no reaction. CONCLUSIONS: The mutation identified strongly suggests a causal relationship between the ARM phenotype and P63. The expression of P63 was persistently active during the dynamic and incessant septation of the cloaca and hindgut, suggesting that P63 may play a pivotal role in the morphogenesis of the hindgut and anorectum.
  International Journal of Colorectal Disease 06/2013;
• Article: Descriptive profile of PIK3CA-mutated colorectal cancer in postmenopausal women.

  Amanda I Phipps, Karen W Makar, Polly A Newcomb
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  ABSTRACT: PURPOSE: Approximately 10-30 % of colorectal cancers exhibit somatic mutations in the phosphoinositide-3-kinase, catalytic, alpha polypeptide gene (PIK3CA). We evaluated the relationship between PIK3CA mutation status and demographic factors, lifestyle factors, and other tumor characteristics and the relationship between PIK3CA mutation status and colorectal cancer survival. METHODS: The population-based study included postmenopausal women with invasive colorectal cancer diagnosed between 1998 and 2002 in Western Washington State. Participants were interviewed, and tumor specimens were tested for PIK3CA mutations in exons 9 and 20 hotspots, KRAS exon 2 mutations, BRAF p.V600E mutation, and microsatellite instability. We used Cox regression to evaluate the association between PIK3CA mutation status and disease-specific and overall survival. Stratified analyses were conducted by KRAS mutation status. RESULTS: PIK3CA mutations were evident in approximately 13 % of cases (N = 35). Women with PIK3CA-mutated colorectal cancer were significantly more likely than those with PIK3CA wild-type disease to be non-white, to have proximal colon cancer, and to have KRAS-mutated tumors (p < 0.05). In Cox proportional hazards regression analyses, overall survival was poorer, although not statistically significantly so, for women with PIK3CA-mutated versus wild-type colorectal cancer (hazard ratio = 1.74, 95 % confidence interval 0.86-3.50). This association between PIK3CA mutation status and survival was evident only when analyses were restricted to cases without somatic KRAS mutations (hazard ratio = 2.94, 95 % confidence interval 1.12-7.73). CONCLUSIONS: PIK3CA-mutated colorectal cancer appears to have a distinct epidemiologic profile that is of clinical significance. Women with PIK3CA-mutated colorectal cancer experience a poorer prognosis than those with PIK3CA wild-type disease.
  International Journal of Colorectal Disease 06/2013;
• Article: Challenging diagnosis of intra-diverticular colonic adenocarcinoma with submucosal localization.

  Armen Parsyan, Marie-Josee Cardin, Hani Hassoun, Amin Andalib, Donna Tataryn, Sarkis Meterissian, Indrojit Roy
  International Journal of Colorectal Disease 06/2013;
• Article: Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs.

  Jun Gao, Ping Li, Qingguo Li, Dong Tang, Dao-Rong Wang
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  ABSTRACT: PURPOSE: To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA). METHODS: RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95 % confidence intervals (CIs) to evaluate the effect of SILA. RESULT: Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95 % CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95 % CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95 % CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay. CONCLUSION: SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.
  International Journal of Colorectal Disease 06/2013;
• Article: Erratum to: Successful implantation of autologous muscle-derived stem cells in treatment of faecal incontinence due to external sphincter rupture.

  Michal Romaniszyn, Natalia Rozwadowska, Marcin Nowak, Agnieszka Malcher, Tomasz Kolanowski, Piotr Walega, Piotr Richter, Maciej Kurpisz
  International Journal of Colorectal Disease 05/2013;
• Article: An appraisal of lymph node ratio in colon and rectal cancer: not one size fits all.

  M Medani, Niall Kelly, George Samaha, G Duff, Vourneen Healy, Elizabeth Mulcahy, Eoghan Condon, David Waldron, Jean Saunders, J Calvin Coffey
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  ABSTRACT: BACKGROUND: Lymph node ratio (LNR) is increasingly accepted as a useful prognostic indicator in colorectal cancer. However, variations in methodology, statistical stringency and cohort composition has led to inconsistency in respect of the optimally prognostic LNR. OBJECTIVE: The aim was to apply a robust regression-based analysis to generate and appraise LNRs optimally prognostic for colon and rectal cancer, both separately and in combination. METHODS: LNR was established for all patients undergoing either a colonic (n = 379) or rectal (n = 160) cancer resection with curative intent. The optimal LNR associated with disease-free and overall survival were established using a classification and regression tree technique. This process was repeated separately for patients who underwent either colonic or rectal resection and for the combined cohort. Survival associated with differing LNR was estimated using the Kaplan-Meier method and compared using a log-rank test. Relationships between LNR, disease-free survival (DFS) and overall survival (OS) were further characterised using Cox regression analysis. All statistical analyses were conducted in the R programming environment, with statistical significance was taken at a level of p < 0.05. RESULTS: Optimal LNRs differed between each cohort, when either overall or disease-free survival was considered. LNRs generated from combined cohorts also differed from those generated by individual cohorts. In relation to DFS, LNR values were obtained and included 0.18 for the colon cancer cohort and 0.19 for the rectal and combined colorectal cancer cohorts. In relation to OS, multiple LNR values were obtained for colon and combined cohorts; however, an optimal LNR was not evident in the rectal cancer cohort. Survival patterns according to LNR closely resembled those associated with standard nodal staging. CONCLUSION: Application of a data-driven approach based on recursive partitioning generates differing lymph node ratios for colon, rectal and combined colorectal cohorts. In each cohort, LNR was similarly prognostic to standard nodal staging in respect to overall and disease-free survival. Overall survival was associated with a multiplicity of LNR values, whilst disease-free survival was associated with a single LNR only. The paper demonstrates the merits of utilising a data-driven approach to determining lymph node ratios from specific patient cohorts. Utilising such an approach enabled the generation of those LNRs that were most associated with particular survival trends in relation to overall and disease-free survival. These differed markedly for colon cancer, rectal cancer and combined cohorts. In general, the survival patterns associated with LNRs generated were similar to those observed with standard nodal staging.
  International Journal of Colorectal Disease 05/2013;
• Article: Letter: response to article "Is there disadvantage to radical lymph node dissection in colon cancer?"

  Sung Uk Bae, Avanish P Saklani
  International Journal of Colorectal Disease 05/2013;
• Article: In vitro motor patterns and electrophysiological changes in patients with colonic diverticular disease.

  Diana Gallego, Francisco Espín, Jan Mikulka, Ondřej Smirg, Víctor Gil, Marcos Faundez-Zanuy, Marcel Jiménez, Pere Clavé
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  ABSTRACT: PURPOSE: The underlying mechanism responsible for motility changes in colonic diverticular disease (DD) is still unknown. In the present study, our aim was to investigate the structural and in vitro motor changes in the sigmoid colon of patients with DD. METHODS: Muscle bath, microelectrodes and immunohistochemical techniques were performed with samples obtained from the left and sigmoid colon of patients with DD and compared with those of patients without DD. RESULTS: The amplitude and area under the curve of the spontaneous rhythmic phasic contractions were greatly reduced in patients with DD whereas their frequency and tone remained unaltered. Electrical field stimulation induced a neurally mediated, enhanced ON-contraction (amplitude) in patients with DD and increased the duration of latency of OFF-contractions. The resting membrane potential of smooth muscle cells was hyperpolarized and the amplitude of the inhibitory junction potential was increased in patients with DD. In contrast, no significant histological differences were observed in patients with DD as smooth muscle (circular and longitudinal layers), interstitial cells of Cajal, glial cells and myenteric neurons densities remained unaltered. CONCLUSIONS: Sigmoid strips from patients with asymptomatic DD showed an altered motor pattern with reduced spontaneous motility and enhanced neurally mediated colonic responses involving both excitatory and inhibitory motor pathways. No major neural and muscular structural elements were detected at this stage of the disease. These findings could be valuable in understanding the pathophysiology of this prevalent digestive disease.
  International Journal of Colorectal Disease 05/2013;
• Article: The nutritional impact of diverting stoma-related complications in elderly rectal cancer patients.

  Bong-Hyeon Kye, Hyung-Jin Kim, Jun-Gi Kim, Hyeon-Min Cho
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  ABSTRACT: PURPOSE: Diverting stomas following rectal cancer surgery can affect patients' quality of life, and their complications may negatively affect patients' long-term outcomes and quality of life. The purpose of this study is to investigate the relationship between diverting stoma-related complications and nutritional status. METHODS: In a retrospective study of 114 patients aged 65 years and older who underwent diverting loop ileostomy following rectal cancer surgery between June 2004 and March 2011, we analyzed retrospectively diverting stoma-related complications and nutrition status for the following time periods: before stoma construction, before stoma closure, and after stoma closure. RESULTS: Complications related to the diverting stoma developed in 24 (21.1 %) patients and complications related to stoma closure in 11 (9.6 %) patients. Nutritional screening performed prior to stoma closure showed that patients who experienced stoma formation-related complications had lower albumin levels (P = 0.016) and lower total lymphocytes (P = <0.0001). Body weight loss was more severe in patients with stoma-related complication (P = 0.036). CONCLUSIONS: Diverting stoma-related complications may affect patient's nutritional status. Stoma closure operation and proper nutritional support may be important for avoiding complications and improving patients' long-term outcomes and quality of life.
  International Journal of Colorectal Disease 05/2013;
• Article: Expression and localization of axin 2 in colorectal carcinoma and its clinical implication.

  Ute Schaal, Sandra Grenz, Susanne Merkel, Tilman T Rau, Michel V Hadjihannas, Elisabeth Kremmer, Priya Chudasama, Roland S Croner, Jürgen Behrens, Michael Stürzl, Elisabeth Naschberger
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  ABSTRACT: PURPOSE: Aberrant activation of the Wnt/β-catenin pathway plays a major role in the development of colorectal carcinoma (CRC). Axin 2 is a key protein of this pathway and is upregulated in CRC. Here, we investigated RNA- and protein expression of axin 2 in CRC tissues at the single cell level. Moreover, the association of axin 2 with prognosis and survival was investigated in a large cohort of CRC patients (n = 280). METHODS: Localization and expression of axin 2 and β-catenin was investigated using in situ hybridization and immunohistochemical staining. The quantitative expression levels of axin 2 were determined using RT-qPCR. The association of axin 2 expression with prognosis and survival of the patients was determined by statistical analysis (logrank test, Kaplan-Meier). RESULTS: Our results confirmed the upregulation of axin 2 in CRC and showed that it is broadly expressed in the cytoplasm of the tumor epithelial cells both, in the tumor center and at the invasion front. Axin 2 was rarely expressed by tumor stromal cells and only weakly by normal colonic epithelial cells. Staining of β-catenin and axin 2 in consecutive CRC tissue sections revealed that nuclear translocation of β-catenin in the tumor front was not associated with changes in the cytoplasmic localization of axin 2. Axin 2 did not show any association with proven prognostic factors or survival of the CRC patients. CONCLUSION: The generally increased expression of axin 2 in all tumor stages as compared to normal tissue suggests an initiating pathogenic function in the development of CRC.
  International Journal of Colorectal Disease 05/2013;
• Article: The incidence of mucinous appendiceal malignancies: a population-based study.

  M G W van den Heuvel, V E P P Lemmens, R H A Verhoeven, I H J T de Hingh
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  ABSTRACT: PURPOSE: Mucinous appendiceal tumours were described already 180 years ago, but reliable data on the incidence of these tumours are sparse. The clinical importance of these tumours is increasing since they are now identified as the most common site of origin for pseudomyxoma peritonei (PMP), which is currently recognised as a treatable condition. METHODS: Data on the incidence of mucinous appendiceal tumours were retrieved from the Eindhoven Cancer Registry, which collects data on all patients with newly diagnosed cancer in a large part of the southern Netherlands that comprises about 2.3 million inhabitants. From 1980 to 2010, all cases of primary adenocarcinomas of the appendix were included. RESULTS: From 1980 to 2010, a mucinous adenocarcinoma was diagnosed in 78 patients being 48 % of all cases of appendiceal adenocarcinoma diagnosed during this period (n = 164). The incidence increased during the study period from 0.6 to 1.9 per 1,000,000 person-years for women and from 0.4 to 1.0 per 1,000,000 person-years for men. CONCLUSION: The reported incidence of mucinous adenocarcinomas of the appendix shows an increasing trend. This is probably mainly explained by the increased awareness of this tumour and its relation with PMP, and better registration of this specific diagnosis.
  International Journal of Colorectal Disease 05/2013;
• Article: Neoadjuvant chemotherapy can improve outcome of colorectal cancer patients with unresectable metastasis.

  Yen-Chen Shao, Yu-Yao Chang, Jen-Kou Lin, Chun-Chi Lin, Huann-Sheng Wang, Shung-Haur Yang, Jeng-Kai Jiang, Yuan-Tzu Lan, Tzu-Chen Lin, Anna Fen-Yau Li, Wei-Shone Chen, Shih-Ching Chang
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  ABSTRACT: BACKGROUND: The prognosis for colorectal cancer (CRC) patients with unresectable metastases is dismal. This study compared outcomes of different metastatic treatments. PATIENTS AND METHODS: We collected 653 CRC cases with unresectable metastases including 490 cases receiving primary tumor resection then chemotherapy (surgery group) and 163 patients receiving neoadjuvant chemotherapy then did or did not receive operations (chemotherapy (C/T) group) from 2004 to 2010. The statistical endpoint was overall survival from the date of diagnosis. RESULTS: In the C/T group, 124 (76 %) patients received an operation after 9.0 ± 6.2 months of chemotherapy, including 57 (34.9 %) patients with curative surgery. The C/T group had a higher proportion of T4 lesions (37.4 %) than the surgery group (26.9 %). Survival of the C/T group was longer than that of the surgery group (28.8 ± 8.8 vs. 24.3 ± 7.5 months; p = 0.043). Survival of 57 patients receiving curative surgery was 36.0 ± 6.3 months, which was significantly better than that of the 67 patients receiving palliative resection (25.2 ± 5.6, p < 0.001). In the surgery group, 42 (8.6 %) patients received curative metastasectomy after 8.5 ± 7.1 months of postoperative chemotherapy; survival was 30.8 ± 7.8 months, which was significantly better than that of patients who did not receive metastasectomy (22.4 ± 6.3 months). In multivariate analysis, poor differentiation, lymphovascular invasion, isolated cancer nodules, clinical risk score, and curative surgery were independent prognostic factors of overall patient survival. CONCLUSIONS: Neoadjuvant chemotherapy can improve outcome of CRC patients with unresectable metastases.
  International Journal of Colorectal Disease 05/2013;
• Article: Risk factors for the development of prolonged post-operative ileus following elective colorectal surgery.

  Ryash Vather, Ian P Bissett
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  ABSTRACT: PURPOSE: Prolonged post-operative ileus (PPOI) increases post-operative morbidity and prolongs hospital stay. An improved understanding of the elements which contribute to the genesis of PPOI is needed in the first instance to facilitate accurate risk stratification and institute effective preventive measures. The aim of this retrospective cohort study was to therefore determine the perioperative risk factors associated with development of PPOI. METHODS: All elective intra-abdominal operations undertaken by the Colorectal Unit at Auckland District Health Board from 1 January to 31 December 2011 were accessed. Data were extracted for an assortment of patient characteristics and perioperative variables. Cases were stratified by the occurrence of clinician-diagnosed PPOI. Univariate and regression analyses were performed to identify correlates and independent risk factors, respectively. RESULTS: Two hundred and fifty-five patients were identified of whom 50 (19.6 %) developed PPOI. The median duration for PPOI was 4 days with 98 % resolving spontaneously with conservative measures. Univariate analysis identified increasing age; procedure type; increasing opiate consumption; elevated preoperative creatinine; post-operative haemoglobin drop, highest white cell count and lowest sodium; and increasing complication grade as significant correlates. Logistic regression found increasing age (OR 1.032, 95 % CI 1.004-1.061; p = 0.026) and increasing drop in pre- to post-operative haemoglobin (OR 1.043, 95 % CI 1.002-1.085; p = 0.037) as the only independent predictors for developing PPOI. An important limitation of this study was its retrospective nature. CONCLUSIONS: Increasing age and increasing drop in haemoglobin are independent predictors for developing PPOI. Prospective assessment is required to facilitate more accurate risk factor analysis.
  International Journal of Colorectal Disease 05/2013;
• Article: Treating symptomatic adhesions to the sigmoid colon: colectomy improves quality of life.

  Awad Jarrar, James Church
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  ABSTRACT: INTRODUCTION: When severe chronic pelvic pain, constipation, and bloating are due to dense pelvic adhesions fixing the sigmoid loops, patients may be offered the option of sigmoid colectomy. This study examines the effectiveness of colectomy in the treatment of such patients. METHODS: Patients were identified from a surgical database, demographic data were abstracted, and charts were reviewed. Patients were interviewed postoperatively. Primary end points were morbidity, length of stay, change in bowel habit, and patient satisfaction. RESULTS: There were 46 patients (44 women) with a mean age of 54.7 years (±14.3). Forty-three had a history of prior pelvic surgery (93 %), including 30 (65 %) with hysterectomy. One quarter had been diagnosed with irritable bowel syndrome. Surgery revealed adhesive tethering of the sigmoid colon in 43 patients (94 %). Mean length of stay was 6.5 days (±2.5), and complications occurred in eight (17.3 %) patients. There were no deaths, and no patients required a stoma. Follow-up in 37 patients after mean of 7.2(±5.0) years showed significant reductions in abdominal pain and bloating postoperatively, with normalization of bowel function and increase in quality of life. CONCLUSION: When severe lower abdominal pain and bloating in women who have had pelvic surgery are reproduced by colonoscopy, and there is an obvious kink in the bowel, sigmoid colectomy is worth considering.
  International Journal of Colorectal Disease 05/2013;
• Article: Barriers to screening colonoscopy in an urban population: a study to help focus further efforts to attain full compliance.

  Vishal Ghevariya, Sushil Duddempudi, Nehal Ghevariya, Madhavi Reddy, Sury Anand
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  ABSTRACT: BACKGROUND: Awareness of colorectal cancer and decision for colorectal cancer screening is influenced by multiple factors including ethnicity, level of education, and adherence to regular medical follow up. OBJECTIVE: Our survey aimed at assessing barriers to colorectal cancer screening among urban population. DESIGN: This study is a survey of the general population. SETTING: This study was made at a local community in the downtown area of a metropolitan city. PATIENTS/SUBJECTS: The study population for this survey included 2000 non-institutionalized residents from local community of Brooklyn downtown area of City of Brooklyn, NY, USA. All participants were 50 years or older. INTERVENTION: No intervention was done. MAIN OUTCOME MEASUREMENT: The survey questionnaire collected information about demographic, socioeconomic level, awareness of various cancers and their screening methods, and awareness of screening colonoscopy. RESULTS: Colonoscopy was identified as the best screening test by 31 % of the subjects. Pain and discomfort was the major reason for not having a colonoscopy. The fear of a complication declined significantly after the first colonoscopy but fear of pain and discomfort increased. Difficulty with bowel preparation before a colonoscopy was a significant problem; it discouraged significant number of participants from having another colonoscopy. LIMITATION: This study is limited by its small sample size. CONCLUSION: Physician/family and peer influence seems important but influencing only a minority of subjects. Fear of complications should be allayed using accurate statistical information. Pain should be significantly diminished and/or eliminated during colonoscopy. Future research should focus to minimize complexity and discomfort associated with bowel preparation.
  International Journal of Colorectal Disease 05/2013;
• Article: Nerve-oriented mesorectal excision (NOME): autonomic nerves as landmarks for laparoscopic rectal resection.

  Norbert Runkel, Harald Reiser
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  ABSTRACT: PURPOSE: We have developed nerve-oriented mesorectal excision (NOME) as a novel concept in rectal cancer surgery by which autonomic pelvic nerves serve as landmarks for a standardized navigation along fascial planes. This article describes the technique step by step and presents our results from 2008 to 2012. MATERIAL AND METHODS: The key steps are: preparation of the splanchnic nerves at the mid-posterior sidewall, the hypogastric nerves at the upper sidewall, and the urogenital nerve branches (Walsh) at the caudal-anterior sidewall. The dissection of the lateral ligament is strictly performed as the last step. NOME was applied in 274 consecutive mesorectal excisions (partial 20.4 %, total 79.6 %); a subgroup of 42 male patients underwent a questionnaire-based interview on sexual activity. RESULTS: The conversion rate was 0.7 %. High (complete) specimen quality and circumferential margin negativity were achieved in 90.1 % and 95.3 %, respectively. Anastomotic leaks occurred in 13 (4.7 %) patients. Mortality was 1.8 %. The frequency of prolonged urinary catheter was 1.8 %. Of 22 sexually active males interviewed, 18 (81.8 %) maintained activity postoperatively. CONCLUSIONS: NOME achieves high-quality mesorectal specimens and a high rate of preservation of autonomic nerve function. The concept of using nerves as laparoscopic landmarks may help to standardize and master laparoscopic rectal cancer surgery.
  International Journal of Colorectal Disease 05/2013;