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ABSTRACT: : To evaluate surgical outcomes after stent insertion for obstructing colorectal malignancy and to compare between laparoscopic and open approach.
: Surgical resection was performed after stent insertion for malignant colorectal obstruction in 36 patients with a median age of 73 years. Eighteen patients were treated with open resection, whereas 18 underwent a laparoscopic resection. The outcomes were evaluated and comparison was made between patients with laparoscopic and open resection.
: The mean interval between stent insertion and surgery was 11 days. One patient died within 30 days (2.8%). The overall incidence of postoperative morbidity was 22% and reoperation was required in 3 patients (8.8%). The median postoperative hospital stay was 8.5 days for the open surgery group and 5.5 days for the laparoscopic group (P=0.004). The postoperative morbidity rates for the open and laparoscopic groups were 33.3% and 11.1%, respectively (P=0.228). In those patients with nonmetastatic disease, with the median follow-up of 20 months, the 5-year survival rate was 49.5%.
: Our experience showed that after successful endoscopic stent insertion for malignant colorectal obstruction, elective surgical resection could be performed safely. The combined endoscopic and laparoscopic procedure provides a less invasive alternative to the multistage open operations and is feasible for patients with obstructing colon cancer.
Surgical laparoscopy, endoscopy & percutaneous techniques 02/2013; 23(1):29-32. · 1.23 Impact Factor
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ABSTRACT: The aims of the study were to assess the health preference and health-related quality of life (HRQOL) in patients with colorectal neoplasms (CRN), and to determine the clinical correlates that significantly influence the HRQOL of patients.
Five hundred and fifty-four CRN patients, inclusive of colorectal polyp or cancer, who attended the colorectal specialist outpatient clinic at Queen Mary Hospital in Hong Kong between October 2009 and July 2010, were included. Patients were interviewed with questionnaires on socio-demographic characteristics, and generic and health preference measures of HRQOL using the SF-12 and SF-6D Health Surveys, respectively. Clinical information on stage of disease at diagnosis, time since diagnosis, primary tumour site was extracted from electronic case record. Mean HRQOL and health preference scores of CRN patients were compared with age-sex matched controls from the Chinese general population using independent t-test. Multiple linear regression analyses were conducted to explore the associations of clinical characteristics with HRQOL measures with the adjustment of socio-demographic characteristics.
Cross-sectional data of 515 eligible patients responded to the whole questionnaires were included in outcome analysis. In comparison with age-sex matched normative values, CRN patients reported comparable physical-related HRQOL but better mental-related HRQOL. Amongst CRN patients, time since diagnosis was positively associated with health preference score whilst patients with rectal neoplasms had lower health preference and physical-related HRQOL scores than those with sigmoid neoplasms. Health preference and HRQOL scores were significantly lower in patients with stage IV colorectal cancer than those with other less severe stages, indicating that progressive decline from low-risk polyp to stage IV colorectal cancer was observed in HRQOL scores.
In CRN patients, a more advanced stage of disease was associated with worse HRQOL scores. Despite potentially adverse effect of disease on physical-related HRQOL, the mental-related HRQOL of CRN patients were better than that of Chinese general population.
PLoS ONE 01/2013; 8(3):e58341. · 4.09 Impact Factor
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ABSTRACT: OBJECTIVES: To test for the measurement invariance of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) in patients with colorectal neoplasms between two modes of administration (self- and interviewer administrations). It is important to establish the measurement invariance of the FACT-C across different modes of administration to ascertain whether it is valid to pool FACT-C data collected by different modes or to assess each group separately. METHODS: A cross-sectional sample of 391 Chinese patients with colorectal neoplasms was recruited from specialist outpatient clinics between September 2009 and July 2010. Confirmatory factor analysis (CFA) was used to test the original five-factor model of the FACT-C on data collected by self- and interviewer administrations in single-group analysis. Multiple-group CFA was then used to compare the factor structure between the two modes of administration using chi-square tests and other goodness-of-fit statistics. RESULTS: The hypothesized five-factor model of FACT-C demonstrated good fit in each group. Configural invariance and metric invariance were fully supported in multiple-group CFA. Some item intercepts and their corresponding error variances were not identical between administration groups, suggesting evidence of partial strict factorial invariance. CONCLUSIONS: Our results confirmed that the five-factor structure of FACT-C was invariant in Chinese patients using both self- and interviewer administrations. It is appropriate to pool or compare data in the emotional well-being and colorectal cancer subscale scores collected by both administrations. Measurement invariance in three items, one from each of the other subscales, may be contaminated by response bias between modes of administration.
Quality of Life Research 09/2012; · 2.30 Impact Factor
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ABSTRACT: To map Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Cancer Therapy-Colorectal (FACT-C) subscale scores onto six-dimensional health state short form (derived from short form 36 health survey) (SF-6D) preference-based values in patients with colorectal neoplasm, with and without adjustment for clinical and demographic characteristics. These results can then be applied to studies that have used FACT-G or FACT-C to predict SF-6D utility values to inform economic evaluation.
Ordinary least square regressions were estimated mapping FACT-G and FACT-C onto SF-6D by using cross-sectional data of 537 Chinese subjects with different stages of colorectal neoplasm. Mapping functions for SF-6D preference-based values were developed separately for FACT-G and FACT-C in four sequential models for addition of variables: 1) main-effect terms, 2) squared terms, 3) interaction terms, and 4) clinical and demographic variables. Predictive performance in each model was assessed by the R(2), adjusted R(2), predicted R(2), information criteria (Akaike information criteria and Bayesian information criteria), the root mean square error, the mean absolute error, and the proportions of absolute error within the threshold of 0.05 and 0.10.
Models including FACT variables and clinical and demographic variables had the best predictive performance measured by using R(2) (FACT-G: 59.98%; FACT-C: 60.43%), root mean square error (FACT-G: 0.086; FACT-C: 0.084), and mean absolute error (FACT-G: 0.065; FACT-C: 0.065). The FACT-C-based mapping function had better predictive ability than did the FACT-G-based mapping function.
Models mapping FACT-G and FACT-C onto SF-6D reached an acceptable degree of precision. Mapping from the condition-specific measure (FACT-C) had better performance than did mapping from the general cancer measure (FACT-G). These mapping functions can be applied to FACT-G or FACT-C data sets to estimate SF-6D utility values for economic evaluation of medical interventions for patients with colorectal neoplasm. Further research assessing model performance in independent data sets and non-Chinese populations are encouraged.
Value in Health 05/2012; 15(3):495-503. · 2.19 Impact Factor
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ABSTRACT: Single-incision laparoscopic colectomy (SILC) is a newly developed procedure with the benefit of better cosmetic outcome and potentially reduced wound pain compared with conventionally laparoscopic colectomy (CLC). However, the application of SILC requires careful evaluation to prove its benefit and safety. This randomized, controlled study compared the operative outcome of patients who underwent SILC and CLC.
Patients who had small cancer (<4 cm) or adenomatous polyp requiring colectomy were randomized to have SILC or CLC. The patients were blinded to the procedures and the postoperative pain was used as the primary outcome measure. All patients had patient-controlled analgesia with intravenous morphine after the operation and the nominal rating score on days 1-3 and day 14 were recorded by research staff, who did not known the types of operations. Other operative outcomes of the two groups of patients also were recorded prospectively and compared.
There were 25 patients in each group. The patients' demographics, tumor characteristics, operating time, blood loss, complication rate, number of lymph nodes harvested, and resection margin have no statistically significant difference between the two groups. There was no operative mortality in both groups. The SILC group had consistently lower median pain score than CLC group in the whole postoperative course and the difference was statistically significant on day 1 (0 (0-5) vs. day 3 (0-6) respectively; p = 0.002) and day 2 (0 (0-3) vs. 2 (0-8) respectively; p = 0.014). The median hospital stay in the SILC group also was shorter the CLC group.
In a selected group of patients with small tumor and good operative risk, SILC is a safe alternative to CLC. Single-port laparoscopic colectomy also is associated with the benefits of less postoperative pain and shorter hospital stay than CLC.
Surgical Endoscopy 04/2012; 26(10):2729-34. · 4.01 Impact Factor
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ABSTRACT: Despite increasing evidence on the success of laparoscopic resection in colorectal diseases, clinicians remain skeptical about
the application of laparoscopic resection in rectal cancer, although it may benefit patients by resulting in early return
of bowel function, reduced postoperative pain, and shorter hospital stay. Rectal cancer surgery has been regarded as a technically
demanding procedure. Deviation from the oncologic principle of mesrectal dissection will lead to a higher local recurrence
rate. Therefore, rectal cancer was not included in earlier studies on laparoscopic versus open resection for colorectal cancer.
However, many colorectal surgeons who practice laparoscopic surgery soon appreciated that the improved optics of laparoscopy
can provide a much better view of the pelvis, and the Heald principle of meticulous sharp dissection for total mesorectal
excision could be performed without compromise. In recent years, there has been increasing number of reports on laparoscopic
resection of rectal cancers. Apart from the issues on postoperative outcomes and long-term results, laparoscopic resection
has generated interest in its impact on the preservation of sexual and bladder function. We summarize the current evidence
on laparoscopic resection for rectal cancer.
Annals of Surgical Oncology 04/2012; 16(11):3038-3047. · 4.17 Impact Factor
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ABSTRACT: BackgroundLaparoscopic resection for advanced rectal cancer has not been widely accepted, and there are only few studies with survival
data. This study aimed to compare the survival of patients who underwent laparoscopic and open resection for stage II and
III rectal cancer.
Materials and MethodsConsecutive patients (open resection: n=310; laparoscopic resection: n=111) who underwent curative resection for stage II and III rectal cancer from June 2000 to December 2006 were included.
The operative details, postoperative complications, postoperative outcomes, and survival data were collected prospectively.
Comparison was made between patients who had laparoscopic and open surgery.
ResultsThe age, gender, medical morbidity, types of operation, and American Society of Anesthesiologists (ASA) status were similar
between the two groups. There was also no difference in the mortality, morbidity, and pathological staging. Laparoscopic resection
was associated with significantly less blood loss and shorter hospital stay. With the median follow-up of 34months, there
was no difference in local recurrence rates. The 5-year actuarial survivals were 71.1% and 59.3% in the laparoscopic and open
groups, respectively (P=.029). In the multivariate analysis, laparoscopic resection was one of the independent significant factors associated with
better survival (P=.03, hazards ratio: 0.558, 95% confidence interval: 0.339–0.969). Other independent poor prognostic factors included lymph
node metastasis, poor differentiation, perineural invasion, presence of postoperative complications, and no chemotherapy.
ConclusionsLaparoscopic resection for locally advanced rectal cancer is associated with more favorable overall survival when compared
with open resection.
Annals of Surgical Oncology 04/2012; 16(6):1488-1493. · 4.17 Impact Factor
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ABSTRACT: This study aimed to compare the overall and disease specific survivals of patients who underwent laparoscopic and open resection of colorectal cancer in a high volume tertiary center.
Consecutive patients who underwent elective resection for colorectal cancer (open resection, n = 1,197; laparoscopic resection, n = 814) from January 2000 to December 2009 were included. The operative details, postoperative complications, postoperative outcomes, and survival data were collected prospectively. Comparison was made between patients who had laparoscopic and open surgery.
The age, gender, medical morbidity, and American Society of Anesthesiologists status were similar in the two groups. Laparoscopic resection was associated with significantly less blood loss and a shorter hospital stay. The operating mortality and morbidity were significantly lower in the laparoscopic group. The qualities of the specimens in terms of the distal resection margin and the number of lymph nodes examined were not inferior in the laparoscopic group. With the median follow-up of 40.3 months, the 5-year overall survival (74.1% vs. 65.5%, p < 0.001) and disease specific survival (81.9% vs. 75.2%, p = 0.002) were significantly better in patients with non-disseminated disease in the laparoscopic group. The operative approach was an independent prognostic factor in the overall (risk ratio 1.36, 95% CI 1.093-1.700, p = 0.006) and disease specific (risk ratio 1.32, 95% CI 1.005-1.738, p = 0.048) survivals in multivariate analysis.
Laparoscopic resection for colorectal cancer is associated with more favorable overall and disease specific survivals when compared with open resection in a high volume tertiary center.
International Journal of Colorectal Disease 02/2012; 27(8):1077-85. · 2.38 Impact Factor
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ABSTRACT: Objectives To estimate the direct medical cost of colorectal neoplasia (CRN) from newly diagnosed to the completion of the tumour-specific treatment in the initial year of disease across stages and tumour primary sites. Methods Only direct medical costs from the perspective of the health care service provider were incorporated in the cost analysis (in 2009 USD) using a bottom-up approach. Tumour-specific treatments of surgery, chemotherapy and radiotherapy data in the initial year of disease were identified from the 401 CRN adult patients by a review of their medical records. Service utilization for diagnosis, staging, pre-operative assessment and post-operative follow-up consultations was estimated from the recommendations of established surveillance and clinical practice guidelines. Results Direct medical cost for the care of a newly diagnosed CRN was ranging from $1941 for low-risk polyp to $45 115 for stage IV colorectal cancer in the initial year of care. Costs of care showed a gradient increase from $1748 for low-risk colonic polyps to $42 899 for stage IV colon cancer, and from $2232 for low-risk rectal polyps to $48 453 for stage IV rectal cancers. Diagnostic/pre-operative assessment and treatment accounted for most of total costs of colorectal polyp (58.9-76.7%) and cancer (60.8-85.2%) care. Conclusion The results provided stage and site-specific estimations of the direct medical costs of CRN in a Chinese population that can assist policy decision making and facilitate health care service planning and cost-effectiveness evaluations.
Journal of Evaluation in Clinical Practice 11/2011; 18(6):1203-1210. · 1.23 Impact Factor
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ABSTRACT: There is increasing concern about the surgeon maintaining a static posture during laparoscopic surgery, which can contribute to musculoskeletal disorders. A series of studies are being conducted in Hong Kong examining the surgeons' real-time movements and electromyography in the operating theater during different operations. The present paper examines the postures and movements of surgeons during real-time open and laparoscopic procedures.
Fourteen surgeons participated in the study (12 men, 2 women). Cervical spine movements were measured using a biaxial inclinometer attached to the surgeon's head via a headband. Biaxial electrogoniometers were attached to the surgeon's bilateral shoulder joints. Real-time joint movements in sagittal and coronal planes were recorded during open and laparoscopic surgeries for periods ranging from 30 to 80 min.
Surgeons generally maintained a flexed neck posture during open surgery and a more extended neck posture during laparoscopic procedures. There were statistically significant differences in mean neck posture and mean left shoulder abduction posture between the two types of surgery. Laparoscopic procedures showed a trend for longer duration in static posture in the neck, while open procedures showed trends for higher frequencies of movements.
This study presented a novel approach to quantify the physical workload of surgeons using biomechanical parameters to describe duration of static posture and repetitiveness of movements. Results showed that long durations of static postures in laparoscopic surgery were closely associated with low-level muscle tension, which may contribute to an increased risk of surgeons developing musculoskeletal disorders.
Journal of Surgical Research 08/2011; 172(1):e19-31. · 2.25 Impact Factor
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ABSTRACT: Objective To establish the validity and reliability of traditional Chinese version of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C). Methods A total of 536 subjects self-administered (n = 331) or interviewer-administered (n = 205) FACT-C (version 4), EORTC QLQ-C30/CR38 and SF-12v2 instruments for health-related quality of life assessment. Construct validity was examined by item-scale correlation, scaling success and concurrent validity. Reliability was evaluated by test-retest reliability and internal consistency. Sensitivity was assessed by known-groups comparisons. Results The completion rates for FACT-C were almost perfect (>98%). The FACT-C demonstrated item-internal consistency and item discriminant validity through item-scale correlation. Scaling success and concurrent validity were satisfactory to support the construct validity. The five subscales of the FACT-C showed good internal consistency with Cronbach alpha coefficient and substantial reproducibility, demonstrating good reliability. Sensitivity was supported when there were significant differences in scores related to physical condition between patients who were receiving treatment and those who were not. Conclusion Traditional Chinese version of the FACT-C was demonstrated to have satisfactory psychometric properties in terms of applicability, reliability, validity and sensitivity in Chinese patients with colorectal neoplasm. The FACT-C was valid colorectal-specific health-related quality of life tool for the Chinese population.
Journal of Evaluation in Clinical Practice 08/2011; 18(6):1186-1195. · 1.23 Impact Factor
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ABSTRACT: There is general concern that high-risk patients are more susceptible to the adverse effect of pneumoperitoneum and they are often denied laparoscopic surgery. This study investigated the impact of laparoscopic colorectal cancer resection for patients with high operative risk, which was defined as American Society of Anesthesiologist classes 3 and 4.
Three hundred thirty-five consecutive high-risk patients who had colorectal cancer resection by open or laparoscopic surgery were included. The patient and tumor characteristics and operative outcomes were recorded prospectively, and comparison was made between the two groups.
Compared to open surgery, patients with laparoscopic resection had a shorter hospital stay (8 [6-12] vs. 6 [4-9] days; P < 0.001), less blood loss (200 [100-400] vs. 140 [80-250] mL; P = 0.006), reduced cardiac complication rate (13.2% vs. 3.7%; P = 0.006), overall operative complication rate (36.6% vs. 21.3%; P = 0.006), and a trend toward a lower mortality rate (4.4% vs. 0.9%; P = 0.083). There was no difference in 3-year overall and disease-free survival between two groups. Operative blood loss (P = 0.035; odds ratio = 2.69; 95% confidence interval, 1.00-6.78) and open surgery (P = 0.007; odds ratio = 2.31; 95% confidence interval, 1.26-4.23) were independent factors for occurrence of complication.
Laparoscopic colorectal cancer resection is associated with more favorable short-term results and should be recommended as the preferred treatment option for high-risk patients.
Annals of Surgical Oncology 01/2011; 18(7):1884-90. · 4.17 Impact Factor
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ABSTRACT: Both laparoscopic colectomy and application of enhanced recovery program (ERP) in open colectomy have been demonstrated to enable early recovery and to shorten hospital stay. This study evaluated the impact of ERP on results of laparoscopic colectomy and comparison was made with the outcomes of patients prior to the application of ERP.
An ERP was implemented in the authors' center in December 2006. Short-term outcomes of consecutive 84 patients who underwent laparoscopic colonic cancer resection 23 months before (control group) and 96 patients who were operated within 13 months; after application of ERP (ERP group) were compared.
Between the ERP and control groups, there was no statistical difference in patient characteristics, pathology, operating time, blood loss, conversion rate or complications. Compared to the control group, patients in the ERP group had earlier passage of flatus [2 (range: 1-5) versus 2 (range: 1-4) days after operation respectively; p = 0.03)] and a lower incidence of prolonged post-operative ileus (6% versus 0 respectively; p = 0.02). There was no difference in the hospital stay between the two groups [4 (range: 2-34) days in control group and 4 (range: 2-23) days in ERP group; p = 0.4)]. The re-admission rate was also similar (7% in control group and 5% in ERP group; p = 0.59).
In laparoscopic colectomy for cancer, application of ERP was associated with no increase in complication rate but significant improvement of gastrointestinal function. ERP further hastened patient recovery but resulted in no difference in hospital stay.
International Journal of Colorectal Disease 10/2010; 26(1):71-7. · 2.38 Impact Factor
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ABSTRACT: The Asian population is believed to have lower incidence of abdominal aortic aneurysm (AAA), and hence, the benefit of screening is uncertain. The size of native aorta in Asians, which shall affect the definition of AAA, has also never been reported. Our study investigated the prevalence of AAA and the infra-renal aortic diameter (AD) in Chinese patients with severe coronary artery disease.
This is a prospective observational study of infra-renal aortic size for patients who had coronary artery bypass surgery by ultrasound. The patients' demographics, important co-morbidities and maximum AD were recorded.
The study included 624 consecutive Chinese patients (mean age = 63.2 years). The mean maximum infra-renal AD was 17.5 mm for men and 14.8 mm for women. The presence of AAA was defined as maximum AD greater than 30 mm. The result was also compared with an alternate definition that defines AAA as maximum AD of greater than 1.5 times of the group's mean. Eleven patients had an AD greater than 30 mm, and the prevalence of AAA was only 1.8%. With AAA defined as maximum AD of 1.5 times greater than the group's mean, 19 patients had AAA. The prevalence of AAA in this high-risk group would become 3% overall.
The prevalence of AAA in Chinese patients was low, and the result did not support routine screening. The smaller mean infra-renal AD in Chinese merits validation by large-scale study and consideration when deciding threshold for small AAA repair in our locality.
ANZ Journal of Surgery 09/2010; 80(9):630-3. · 1.25 Impact Factor
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ABSTRACT: Single-incision laparoscopic surgery was developed recently and has the benefit of reducing the number of incisions. Its application in colectomy has been published only in case reports. The present study evaluated our early results of single-incision laproscopic surgery in a series of 8 patients who underwent colectomy for various colorectal pathologies.
Eight patients underwent single-incision laparoscopic colectomy for cancer (n = 5), polyps (n = 2), and diverticulitis (n = 1) during the study period. The data on the operations and outcomes were collected prospectively and analyzed.
The median age of the patients was 78 years (range, 49-88). The operations were right colectomy (n = 6), left colectomy (n = 1), and anterior resection (n = 1). The median operating time was 175 minutes (range, 103-260) and the median blood loss was 55 mL (range, 20-200). The average length of the incision was 3.4 cm (range, 3.0-5.0). One patient required conversion to hand-assisted laparoscopy with a 5-cm incision. The median hospital stay was 3.5 days (range, 3-6) and 1 patient had ileus after the operation. There was no mortality and no reintervention within 30 days. In patients with cancer, all of the resection margins were clear. The median number of lymph nodes examined was 13.5 (range, 9-36).
Single-incision laparoscopic surgery can be applied to colectomy safely. Oncologic resection similar to conventional laparoscopy can be performed with this technique. Further studies are needed to evaluate the outcomes against those of conventional laparoscopic resection.
Diseases of the Colon & Rectum 03/2010; 53(3):284-8. · 3.13 Impact Factor
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ABSTRACT: Autopsy examination has been the bedrock of western medicine. With the decline in the autopsy rate secondary to the negative psychological impact to the deceased's relatives, the benefits of autopsy have been undermined. Minimally invasive autopsy has been introduced but has not been widely adopted as an alternative to the 'traditional' open approach. This technique not only provides information on the cause of death abut also minimizes the disfigurement induced to the deceased. Our study aims to explore the feasibility and evaluate the accuracy of this technique.
A series of coroner cases ordered for autopsy were examined by a group including an experienced forensic pathologist and two experienced laparoscopic surgeons using thoracoscopic, laparoscopic, endoluminal or endovascular approaches. The procedure was video-recorded and the provisional diagnoses and causes of death were made based on the findings. These findings were subsequently correlated with the full autopsy examination. A few limited clinical post-mortem examinations were also performed with consent from relatives.
A total of 22 cases of minimally invasive autopsies were performed from November 2007 to March 2008. The median duration of the procedures was 78.3+/-20.7 min. Thoracoscopies and laparoscopies were performed in 18 patients while additional arterioscopic examination with endoscope was performed in two patients with suspected aortic diseases. Four consented limited clinical autopsies were also performed: two of them involved thoracoscopic biopsies of lung tissues, one was a para-mortem upper endoscopy for the investigation of pathology of the stomach and the other one was laparoscopy for a patient, who died of unexplained acidosis. Comparison with full autopsies showed that the accuracy of the diagnosis was 94.4%, the sensitivity was 90%, the specificity was 100%, the positive predictive value was 100% and the negative predictive value was 88.9%.
Minimally invasive autopsy is a feasible approach, yielding accurate findings when compared with conventional autopsies. The former can be a valuable tool for obtaining more valuable information in situations when the next-of-kin of the deceased does not consent to a conventional autopsy.
Forensic science international 02/2010; 195(1-3):93-8. · 2.10 Impact Factor
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World Journal of Surgery 02/2010; · 2.36 Impact Factor
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ABSTRACT: Lymph node status is the most important prognostic factor for colorectal cancer. The number of lymph nodes that should be histologically examined has been controversial. The aims of this study were to assess the impact of the number of lymph nodes examined on survival of patients with stage II colorectal cancer and to determine the optimal number of lymph nodes that should be examined.
The study included 664 patients who underwent resection for stage II colorectal cancer. The clinical and histopathologic data of the patients were prospectively collected and analyzed.
The median number of lymph nodes examined was 12 (range: 1 to 58). The 5-year disease free survival rate was significantly higher for patients with 12 or more lymph nodes examined compared to those with less than 12 lymph nodes examined. The significant difference in 5-year disease free survival persisted if the dividing number increased progressively from 12 to 23. However, the difference in survival was most significant (lowest p value and highest hazard ratio) for the number 21. The 5-year disease free survival of patients with 21 or more lymph nodes examined was 80% whereas that of patients with less than 21 lymph nodes examined was 60% (p = 0.001, hazard ratio 2.08). Multivariate analysis showed that 21 or more lymph nodes examined was a factor that independently influenced survival. The 5-year disease free survival also increased progressively with the number of lymph node examined up to the number 21. After the number 21, the survival rate did not increase further. It was likely that 21 was the optimal number, at and above which the chance of lymph node metastasis was minimal.
The number of lymph nodes examined in colorectal cancer specimen significantly influences survival. It is recommended that at least 21 lymph nodes should be examined for accurate diagnosis of stage II colorectal cancer.
BMC Cancer 01/2010; 10:267. · 3.01 Impact Factor
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ABSTRACT: To assess the early and midterm results of endovascular stent graft repair in patients with thoracic aortic pathologies.
Between March 2000 and December 2005, 44 consecutive patients undergoing endovascular repair for 45 thoracic aortic lesions were studied. Follow-up protocol includes regular clinical examination and computed tomographies.
There were 37 men and 7 women with a median age of 59 years at operation (range, 26-90). The pathologies consisted of 15 thoracic aortic aneurysms, nine pseudoaneurysms, 16 thoracic aortic dissections, and five thoracic aortic injuries. Successful deployment of the endovascular stent grafts with complete sealing of the pathology were achieved in all but one patient who had the procedure abandoned as a result of access difficulty, giving a technical success of 98%. The median hospital stay was 7 days (range, 3-196), with no hospital death nor paraplegia. The median follow-up was 25 months (range, 0-86). There were eight follow-up deaths, two of which were thoracic aortic pathology related (both patients had aortoesophageal fistulae). There were three other clinical failures: distal attachment endoleak in a patient with thoracic aortic aneurysm, one enlarging and one newly developed dissecting thoracic aortic aneurysm despite endografting. The cumulative freedom from clinical failure and failure free survival were 90% and 75% at 18 months respectively.
Endovascular stent graft repair is a feasible option in thoracic aortic pathologies with promising early and midterm results.
Asian Journal of Surgery 02/2009; 32(1):39-46. · 0.57 Impact Factor
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ABSTRACT: This study aimed to review the outcomes of laparoscopic colorectal resection for patients with stage IV colorectal cancer.
From the prospectively collected database for patients who underwent surgery for colorectal cancer in our institution, those with stage IV colorectal cancer who underwent elective resection of tumor during the period from January 2000 to June 2006 were included. The outcomes of those with laparoscopic resection were reviewed and comparison was made between patients with laparoscopic and open resection.
A total of 200 patients (127 men) with median age of 69 years (range: 25-91 years) were included, and 77 underwent laparoscopic resection. Conversion was required in ten patients (13.0%) and all except one conversion were due to fixed or bulky tumors. There was no operative mortality in the laparoscopic group. The complication rate was 14% and the median postoperative hospital stay was 7 days. When patients with laparoscopic resection were compared with those with open operations, there was no difference in age, gender, comorbidity, or tumor size between the two groups. However, the complication rate was significantly lower in those with laparoscopic resection (14% versus 32%, P = 0.007) and the median hospital stay was significantly shorter (7 days versus 8 days, P = 0.005). The operative mortalities and the survivals were similar in the two groups.
Colorectal resection can be performed safely in patients with stage IV colorectal cancer. The operative outcomes in terms of complication rate and hospital stay compare favorably with patients with open resection.
Annals of Surgical Oncology 06/2008; 15(5):1424-8. · 4.17 Impact Factor
