Colorectal Disease (Colorectal Dis )

Publisher: Association of Coloproctology of Great Britain and Ireland, Blackwell Publishing

Description

Colorectal Disease is a new journal publishing original research in any discipline relating to colorectal pathology. The journal will further education and inter-professional development by including regular review articles, discussions of current controversies, occasional highly selected case reports, and question and answer features.Colorectal Disease is the official organ of the Association of Coloproctology of Great Britain and Ireland. The journal will report news of the Association and take a major interest in coloproctological matters across Europe as a whole.

  • Impact factor
    2.08
  • 5-year impact
    2.39
  • Cited half-life
    3.90
  • Immediacy index
    0.64
  • Eigenfactor
    0.01
  • Article influence
    0.69
  • Website
    Colorectal Disease website
  • Other titles
    Colorectal disease (Online)
  • ISSN
    1463-1318
  • OCLC
    45907159
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • Some journals impose embargoes typically of 6 or 12 months, occasionally of 24 months
    • no listing of affected journals available as yet
  • Conditions
    • See Wiley-Blackwell entry for articles after February 2007
    • Publisher's version/PDF cannot be used
    • On author's server, institutional server or subject-based server
    • Server must be non-commercial
    • Publisher copyright and source must be acknowledged with set statement ("The definitive version is available at www.blackwell-synergy.com")
    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley'
  • Classification
    ​ yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Jones et al highlighted effectiveness of preoperative lean muscle mass determination, referred as sarcopenia, to identify those at higher risk of major complications after colorectal resection (1). We find current results particularly important beside some limitations of current methodology to test the hypothesis of the article. This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: Obstructed defaecation syndrome (ODS) is a symptom complex consisting of a sense of incomplete evacuation, prolonged straining and a persisting desire to defaecate. In patients with ODS structural abnormalities of the colorectum and the pelvic floor including rectal intussuception, rectocele, enterocele and prolapse of the middle pelvic compartment are nearly always present1. The aetiology and nature of rectal intussusception is debatable.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: Background Single incision laparoscopic surgery (SILS) has been proposed as the next step in minimally invasive surgery for appendicectomy. Previous reviews have summarised the results of low evidence comparative studies suggest that the two approaches are comparable in terms of outcomes, but have proven the need for randomised controlled trials (RCTs). This review meta-analyses RCTs on this topic to evaluate the safety and efficacy of single incision laparoscopic appendectomy (SILA).MethodsA comprehensive research of electronic databases has been performed. Primaryoutcomes (overall and access-specific morbidity) were designed as safety issues. Secondaryoutcomes were pain, cosmesis, operative time, conversion rate and length of hospital stay.ResultsFollowing exclusions, 5 RCTs satisfied the inclusion criteria, including a total of761 patients (379 SILA and 382 conventional three-port laparoscopic appendectomies – CLA). Nosignificant differences in overall morbidity, early wound morbidity or length of stay were found between SILA and conventional three-port laparoscopic appendectomy (CLA). Cosmesis and pain were not comparable due to different scales and time records. Conclusions on incisional hernia rate were not reliable due to short follow-up periods.ConclusionsSILA can be considered an acceptable alternative to CLA in the treatment of acute appendicitis,but an economic evaluation of the various techniques for single access must be performed before its widespread clinical introduction. Better designed RCTs are necessary to define a population in which SILA could have major benefits.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
  • A K Danielsen, B M Christensen, J Mortensen, L L Voergaard, P Herlufsen, L Balleby
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    ABSTRACT: AimThe aim of the paper was to present the Danish Stoma Database Capital Region including clinical variables related to stoma creation including colostomy, ileostomy and urostomy.Method The stomatherapists in the Capital Region of Denmark developed a database covering patient identifiers, interventions, conditions, short term outcome, long term outcome and known major confounders. The completeness of data was validated against the Danish National Patient Register.ResultsIn 2013, five hospitals included data from 1123 patients who were registered during the year. The types of stomas formed from 2007 to 2013 showed a variation reflecting the subspecialization and surgical techniques in the centres. Between 92% and 94% percent of patients accepted participation in the standard programme aimed at handling of the stoma and more than 88% of patients having planned surgery had the stoma site marked pre-operatively.Conclusion The database is fully operational with high data completeness and with data about patients with a stoma from before surgery up to 12 months after surgery. The database provides a solid basis for professional learning, clinical research, and benchmarking.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
  • Felix Aigner, Romed Hörmann, Helga Fritsch, Johann Pratschke, André D'Hoore, Erich Brenner, Norman Williams, Matthias Biebl, Helmut Weiss, Friedrich Herbst, [......], Salvador Morales‐Conde, Ricardo Zorron, Pierpaolo Sileri, Luigi Boni, Eelco JR Graaf, Roland Scherer, Andreas Shamiyeh, Alexander Klaus, Cyrus Tse, Reinhard Mittermair
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    ABSTRACT: AimNerve sparing surgery during laparoscopic rectal mobilization is still limited by anatomical constraints such as obesity, the narrowness of the male pelvis or an ultra low rectal cancer or all of these. The transanal approach for total mesorectal excision has overcome the shortcomings of limited access to the rectal „no-man's land” close to the pelvic floor. The aim of this anatomical study was to define a roadmap of anatomical landmarks for the caudal to cephalic approach so as to standardize nerve sparing rectal mobilization procedures.Method Macroscopic dissections of the pelvis in a caudal to cephalic direction were performed in eight alcohol-glycerol embalmed cadavers. A roadmap of anatomical landmarks was created at different levels of section to demonstrate the sites of nerve injury.ResultsExtrinsic autonomic nerves to the urogenital organs and the internal sphincter muscle are closely adjacent to the lowest portion of the rectum above the pelvic diaphragm.Conclusion This anatomical guide for the pelvic surgeon should facilitate a safe and nerve-sparing dissection of the mesorectal plane with a meticulous overview of the lowest autonomic nerve fibres. New anatomical insights by a „caudal to cephalic” approach to the „no-man's land” should help overcome anatomical constraints of a narrow, obese and male pelvis during rectal mobilization procedures.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: Dear sir, Laparoscopic mobilisation of the splenic flexure can be challenging, but necessary at times to ensure a tension-free colorectal (or indeed coloanal) anastomosis. We favour the medial to lateral approach, with high tie of the inferior mesenteric vein. Hazards encountered during this approach include potential damage to the pancreas, spleen, and injury to the marginal artery. We present a case of a 75-year old female patient who underwent a laparoscopic high anterior resection for a distal sigmoid colon cancer. Intra-operatively, inspection revealed a segment of significant diverticular disease of the proximal sigmoid colon, unsuitable to be used for the anastomosis and therefore splenic flexure mobilisation was necessary. At the time of splenic flexure mobilisation the marginal artery was damaged. This compromised the length of colon available to perform a tension-free colorectal anastomosis. Possible solutions to overcome this problem include performing a total colectomy and forming an ileo-rectal anastomosis, or performing a Deloyer’s procedure, which requires performing mobilisation of the right colon and swinging it down on its ileocolic pedicle to perform an anastomosis [1]. We solved the problem by creating a retroileal transmesenteric anastomosis [2]. This was done laparoscopically by creating a passage in an avascular plane in the transverse ileal mesentery, and bringing the proximal transverse colon through to anastomose to the rectum (see Video S1). The patient experienced no post-operative complications, and was discharged home on the 7th day post-operatively – the delay was due to the patient’s social circumstances. The retroileal transmesenteric approach for colorectal anastomosis is feasible laparoscopically, and may be a useful tool in managing cases of marginal artery damage during splenic flexure mobilisation. REFERENCES: 1. Deloyers L. Suspension of the right colon permits without exception preservation of the anal sphincter after extensive colectomy of the transverse and left colon (including rectum). Technic-indications-immediate and late results. Lyon Chir. 1964;60:404-413. 2. Rombeau JL, Collins JP, Turnbull RB Jr. Left-sided colectomy with retroileal colorectal anastomosis. Arch Surg. 1978;113:1004-5.
    Colorectal Disease 11/2014;
  • Colorectal Disease 11/2014; 16(11).
  • Siv Fonnes, Anders Meller Donatsky, Ismail Gögenur
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    ABSTRACT: AimExperimental studies have shown that some circadian core clock genes may act as tumour suppressors and have an important role in the response to oncological treatment. The study investigated the evidence regarding modified expression of core clock genes in colorectal cancer and its correlation to clinicopathological features and survival.MethodA systematic review was conducted without meta-analysis according to the PRISMA guidelines on March 24th 2014 using PubMed and EMBASE. Eligibility criteria included study design, original research article, English language, human subjects and gene expression of colorectal cancer cells compared with healthy colocytes from specimens analysed by real-time or quantitative real-time polymer chain reaction. Gene expression of the core clock genes was determined including Period, Cryptochrome, Bmal1 and Clock in colorectal tumours compared to healthy mucosa and correlated with clinicopathological features and survival.Results74 articles were identified and eleven studies were included in the srudy. Overall, gene expression of Period was significantly decreased in colorectal cancer cells compared with healthy colocytes. This tendency was also seen in the gene expression of Clock. Other core clock genes did not appear to be differentially expressed. Decreased Period gene expression was correlated to some clinicopathological features.Conclusion The Period genes seemed to be modified in colorectal tumour cells compared with normal mucosa. Core clock genes might be possible future biomarkers in colorectal cancer.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: AimWe report a meta-analysis and systematic review of randomized trials assessing the impact of non-steroidal anti-inflammatory drugs (NSAIDs) in preventing recurrence of colorectal adenoma.Method Pubmed/Medicine, EMBASE and the Cochrane Central Register of Controlled Trials databases were searched for relevant randomized double-blind placebo-controlled trials published before March 2014. Two authors independently assessed study quality and extracted data. STATA software was used to investigate heterogeneity between studies, and analysis was performed using a fixed-effects model to calculate and merge data.ResultsNine studies, with 8521 subjects, were included. Results were categorized by the duration of follow-up. The relative risks of any recurrence of adenoma in patients receiving NSAIDs compared with the placebo group were 0.68 (95% confidence interval [95% CI] 0.63-0.73, P = 0.001) for patients with a 1-year follow-up, 0.75 (95% CI 0.68-0.83, P = 0.246) with 3 years, and 1.43 (95% CI 1.14-1.79, P = 0.127) with follow-up of over 3 years. Using pooled risk ratios, NSAIDs were associated with a significant decrease in adenoma recurrence at 1 and 3 years, although this association was lost beyond 3 years of follow-up. For secondary prevention of advanced adenomas, the pooled risk ratios (compared with placebo) were 0.51 (95% CI 0.43-0.60, P = 0.026) after 1 year, 0.61 (95% CI 0.50-0.76, P = 0.887) at 3 years, and 1.39 (95% CI 0.89-2.16, P = 0.829) after 3 years.Conclusion The meta-analysis indicated that oral NSAIDs may be effective in the early prevention of secondary occurrence of adenomas.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: AbstarctAcute diverticular disease with abscess formation is the most common form of complicated diverticulitis. While typically manifesting as a localized pericolic abscesses or distant extension into the pelvis, unusual presentations are occasionally seen. Pyogenic liver abscesses have resulted from infectious spread into the portal circulation and retroperitoneal spread allows for extraabdominal spread [1]. Atypical involvement of the brain and nervous system, however, are among the rarest complications observed.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
  • Colorectal Disease 11/2014; 16(11).
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    ABSTRACT: IntroductionPerformance in the operating room may be affected by a combination of individual, patient and environmental factors. Stress may negatively impact on performance with the quality of surgical practice and patient safety being affected as a result. In order to appreciate the level of stress encountered during surgical procedures both objective and subjective methods can be used. This study reports the use of a combined objective (physiological) and subjective (psychological) method for evaluating stress experienced by the operating surgeon.Method Six consultant colorectal surgeons were evaluated performing eighteen anterior resections. Heart rate was recorded using a wireless chest strap at eight pre-determined operative steps. Heart Rate Variability indices were calculated offline using computerized software. Surgeon reported stress was collected using the State Trait Anxiety Inventory, a validated clinical stress scale.ResultsA significant increase in stress was demonstrated in all surgeons whilst operating as indicated by sympathetic tone (control 4.02 ± 2.28 vs operative 11.42 ± 4.63 p<0.0001). Peaks in stress according to operative step were comparable across procedures and surgeons. There was a significant positive correlation with subjective reporting of stress across procedures (r=0.766 p=0.0005).DiscussionThis study demonstrates a significant increase in sympathetic tone in consultant surgeons measured using heart rate variability during elective colorectal resections. A significant correlation can be demonstrated between HRV measurements and perceived stress using the State Trait Anxiety Inventory. A combined approach to assessing operative stress is required to evaluate any effect on performance and outcomes.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: AimStrain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and magnetic resonance imaging (MRI) in the same patients.MethodA prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at the institution, defining T0 as adenomas and T1-4 as adenocarcinomas. Subsequent histopathology was used as reference standard.ResultsHistopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were: For ERUS: 0.96 (0.90, 0.99), 0.62 (0.40, 0.80) and 0.90 (0.83, 0.94). For elastography SR: 0.96 (0.90, 0.99), 0.86 (0.66, 0.96) and 0.94 (0.88, 0.97). For MRI: 0.99 (0.94, 0.100), 0.07 (0.00, 0.31) and 0.87 (0.80, 0.93).Conclusions This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas, and should be interpreted with care when early-stage rectal neoplasia is suspected.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: AimThis study aimed to clarify tumour characteristics and treatment patterns of patients aged 80 years or older and the impact of age on survival using a large-scale cancer registry database.Method40,851 colorectal cancer patients who underwent surgery between 1995 and 2004 were identified through the database. Patients were stratified into four age groups (<50, 50–64, 65–79, ≥80). Demographics, tumour characteristics, treatment pattern, and survival were compared between age groups. Additionally, the impact of lymph node dissection and adjuvant chemotherapy on survival was studied using the propensity score-matching method.ResultsIn the over 80 year age group, patients were more commonly female, and right colon cancer, multiple primary cancers, history of colorectal cancer, high serum carcinoembryonic antigen values, large tumour, undifferentiated histology, and pT3/pT4 tumors were more frequent. In contrast metastatic disease, central lymph node dissection and adjuvant chemotherapy were less frequent. Overall survival and cancer-specific survival decreased with increasing age for any stage. Multivariate analysis showed age to be an independent predictor of overall survival (hazard ratio (HR) 1.45, 95% confidence interval (CI) 1.34–1.58, p<0.001). In the propensity score-matched cohort, overall survival of the patients with central node dissection and having adjuvant chemotherapy was significantly better than for those without. This differences was not statistically significant in patients aged ≥80 years.Conclusion The study showed a significant difference in tumour characteristics and treatment patterns in patients aged ≥80 years. Even after adjustment for clinicopathological factors, the difference in survival persisted and age was considered a robust prognostic factor.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: Cancer was first described four millennia ago and for almost all that time it has been untreatable. Categorised initially by semi-religious concepts such as imbalance of humours, miasmas, neuroses, hysterias, knowledge evolved so that by the 18th century, it was understood that cancer passed through developmental stages and by the 19th century the invention of anaesthesia and anti-sepsis finally allowed a credible surgical approach. The first patient was treated with radiotherapy in 1896 and in the 1950s, systemic chemotherapy started to be used.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: AimExtralevator abdomino-perineal excision (ELAPE) has become increasingly used due to some evidence of improved oncological outcome. It is, however, thought to be associated with a higher incidence of perineal hernia formation, although the exact incidence is not known. The aim of the study was to identify the incidence of perineal hernia after ELAPE.Method The case notes of patients over a 54-month period were reviewed. The perineal closure technique, perineal complications and management plan were recorded.ResultsDuring the period 56 patients underwent ELAPE, of whom 24 (44%) developed a perineal wound complication. Eight patients had undergone primary perineal closure with and 32 without insertion of a biological mesh or myocutaneous flap. Perineal hernia was the commonest complication (26%) and occurred in 9 (45%) of 20) of patients who had a laparoscopic ELAPE.Conclusion Perineal hernia formation was the commonest perineal complication of ELAPE and occurred in nearly half of the patients having a laparoscopic ELAPE.This article is protected by copyright. All rights reserved.
    Colorectal Disease 11/2014;
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    ABSTRACT: We thank Drs Bugiantella et al for their interest in our article recently published in Colorectal Disease [1]. Concerning the first point about preoperative bowel preparation, it remains controversial. Elective colonic resection without mechanical bowel preparation (MBP) has been demonstrated [2, 3].This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimSeveral studies have suggested an increased lymph node yield, reduced loco-regional recurrence and increased disease-free survival (DFS) after complete mesocolic excision (CME) for colorectal cancer. This review was undertaken to assess the use of CME for colon cancer by evaluating the technique and its clinical outcome.MethodA literature search of publications was performed using Pubmed and Medline. Only studies published in English were included. Studies assessed for quality and data were extracted by two independent reviewers. Endpoints included numbers of lymph nodes per patient, quality of the plane of mesocolic excision, postoperative mortality and morbidity, 5 year locoregional recurrence and 5-year cancer-specific survival.ResultsThere were 34 articles comprising 12 retrospective studies, nine prospective studies, 13 original articles including case series, observational studies and editorials. Of the prospective studies, four reported an increased lymph node harvest and a survival benefit. The others reported an improvement in the quality of the specimen as assessed by histopathological examination. Laparoscopic CME has the same oncological outcome when compared with open surgery but completeness of excision during laparoscopy may be compromised for tumours in the transverse colon.Conclusion Studies demonstrate that CME removes significantly more tissue around the tumour including maximal lymph node clearance. There is little information on serious adverse events after CME and a long-term survival benefit has not been proven.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimThe aetiology of Crohn's disease-related anal fistula remains obscure. Microbiological, genetic and immunological factors are thought to play a role but are not well understood. The microbiota within anal fistula tracts has never been examined using molecular techniques. The present study aimed to characterise the microbiota in the tracts of patients with Crohn's and idiopathic anal fistula. .Method Samples from the fistula tract and rectum of patients with Crohn's and idiopathic anal fistula were analysed using fluorescent in situ hybridisation, Gram staining and scanning electron microscopy were performed to identify and quantify the bacteria present.ResultsFifty-one patients including 20 with Crohn's anal fistula, 18 with idiopathic anal fistula and 13 with luminal Crohn's disease and no anal fistula were recruited. Bacteria were not found in close association with the luminal surface of any of the anal fistula tracts.Conclusion Anal fistula tracts generally do not harbour high levels of mucosa-associated microbiota. Crohn's anal fistulas do not seem to harbour specific bacteria. Alternative explanations for the persistence of anal fistula are needed.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;
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    ABSTRACT: AimMost colorectal cancer patients are elderly, but there are few data on the optimal surgical treatment for this age group and most studies are observational. We have reviewed the characteristics of randomised trials reporting laparoscopic surgery for colorectal cancer to determine the degree to which the elderly are represented.MethodA search was conducted of the NIH clinical trial registry and the ISRCTN register for randomized trials on laparoscopic surgery for colorectal cancer. Trial characteristics and end points were extracted from the registry website and supplemented by published results where available.ResultsOf 52 trial protocols the majority did not state any restrictions regarding cardiac (40 [77%]) or pulmonary function (41 [79%]). More than half (30 [58%]) had no restrictions regarding ASA-score. Twenty three (44%) trials excluded the elderly either simply on age or by comorbidity or organ function. When an upper age limit was set, half of the studies had no restriction regarding organ function, indicating that chronologic age rather than physical condition was taken as the reason for exclusion. In 45 (86%) of the trials the average age of participants was less than 70years, and no details of concurrent disease were given.Conclusion Participation of the elderly in trials of laparoscopic surgery for colorectal cancer is very limited. This should be remedied in future trials if adequate information on the majority of patients with colorectal cancer is to be obtained.This article is protected by copyright. All rights reserved.
    Colorectal Disease 10/2014;