Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: A retrospective study

Objective:

Colon cancer patients presented with obstruction were known to have worse postoperative morbidity and mortality rates, but conflicting data has been reported in recent years. We aimed to investigate postoperative complication rates, and short and long-term oncological outcomes in patients with colon cancer treated with either emergency surgery due to obstruction or elective surgery.

Methods:

Two hundred fifty two patients were analyzed. Patients presented with obstruction and underwent an emergency surgery, and patients operated under elective circumstances were compared according to their demographic variables, tumor characteristics, and short and long term treatment outcomes.

Results:

Distribution of age, gender and comorbidities were similar between both the groups. Need for an end colostomy was significantly higher in obstructed patients (22.7% vs 1.6%, respectively). Obstructed patients were tending to be at an advanced stage. Postoperative morbidity and mortality, and prognosis of colon cancer patients presented with obstruction is worse than patients operated under elective circumstances.

Conclusions:

Colon cancer patients presented with obstruction constitutes more than one quarter of all patients. These patients have significantly higher morbidity and mortality rates. Obstructed colon cancer usually appears at advanced stage. Primary resection and anastomosis is safe in most of the cases.

MicroRNA expression profile in patients with stage II colorectal cancer: a Turkish referral center study

BACKGROUND

There are increasing data about microRNAs (miRNA) in the literature, providing abundant evidence that they play important roles in pathogenesis and development of colorectal cancer. In this study, we aimed to investigate the miRNA expression profiles in surgically resected specimens of patients with recurrent and non-recurrent colorectal cancer.

MATERIALS AND METHODS

The study population included 40 patients with stage II colorectal cancer (20 patients with recurrent tumors, and 20 sex and age matched patients without recurrence), who underwent curative colectomy between 2004 and 2011 without adjuvant therapy. Expression of 16 miRNAs (miRNA-9, 21, 30d, 31, 106a, 127, 133a, 133b, 135b, 143, 145, 155, 182, 200a, 200c, 362) was verified by quantitative real-time polymerase chain reaction (qRT-PCR) in all resected colon cancer tissue samples and in corresponding normal colonic tissues. Data analyses were carried out using SPSS 15 software. Values were statistically significantly changed in 40 cancer tissues when compared to the corresponding 40 normal colonic tissues (p<0.001). MiR-30d, miR-133a, miR-143, miR-145 and miR-362 expression was statistically significantly downregulated in 40 resected colorectal cancer tissue samples (p<0.001). When we compared subgroups, miRNA expression profiles of 20 recurrent cancer tissues were similar to all 40 cancer tissues. However in 20 non-recurrent cancer tissues, miR-133a expression was not significantly downregulated, moreover miR-133b expression was significantly upregulated (p<0.05).

CONCLUSIONS

Our study revealed dysregulation of expression of ten miRNAs in Turkish colon cancer patients. These miRNAs may be used as potential biomarkers for early detection, screening and surveillance of colorectal cancer, with functional effects on tumor cell behavior.

The effect of early warm plastic bag application on postoperative pain after hemorrhoidectomy: a prospective randomized controlled trial

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.

The Effect of Early Warm Plastic Bag Application on Postoperative Pain after Hemorrhoidectomy: A Prospective Randomized Controlled Trial

Hemorrhoidectomy is used for the surgical treatment of high-grade hemorrhoids. The most prominent complaint after hemorrhoidectomy is pain. Postoperative pain management is still a big problem after surgery in patients with hemorrhoidectomy. The aim of the study was to assess the effect of early application of warm bag on postoperative pain after hemorrhoidectomy. All patients were randomly divided into warm plastic bag and control groups by using sealed envelopes, which were prepared preoperatively. After standard spinal anesthesia, all patients underwent standard Milligan-Morgan hemorrhoidectomy using Ligasure™. Although the study group received the warm bag application, the control group did not receive such a treatment. Two separate visual analog scale (VAS) measurements were performed for postoperative pain assessments on postoperative days, one during the resting state and the other one during the straining phase after the onset of peristaltic bowel movement. Postoperative VAS scores were significantly lower among the warm plastic bag group as compared with the control group on Days 1 and 3 for the resting state and on Day 3 for defecation. Additionally, a significant difference existed between the two groups in terms of the need for additional anesthesia. Local thermal application appears to be a safe and effective method for pain relief after hemorrhoidectomy.

Endoanal ultrasonographic evaluation of an unhealed anal fissure after the lateral internal sphincterotomy

OBJECTIVES

The aim of this study was to evaluate the outcomes of the lateral internal sphincterotomy in patients who had unhealed anal fissures using the endoanal ultrasonography.

BACKGROUND

Lateral internal sphincterotomy is an effective method in treatment of chronic anal fissures, but it is associated with 1 to 5 % unhealing and recurrence rates. Endoanal ultrasonography can be used to evaluate the sphincterotomy and the efficiency of the treatment.

METHODS

Totally, 40 patients with unhealed anal fissures after the lateral internal sphincterotomy were enrolled consecutively. The fissures were diagnosed by proctologic examination in every patient. The results of sphincterotomy were evaluated by the endoanal ultrasonography.

RESULTS

There were 23 men and 17 women with the median age 29.7 years (range, 20-44 years). Using the endoanal ultrasonography, an incomplete internal sphincterotomy was detected in 26 of patients. In 12 patients, while the internal sphincter was completely intact, a superficial (subcutaneous) external anal sphincterotomy was found. In two patients, although the internal sphincterotomy was observed to be sufficient, a localized abscess formation of less than 1 cm was detected at the anal crypts level.

CONCLUSION

The use of endoanal ultrasonography in patients with unhealed or recurrent anal fissure is a beneficial diagnostic method in assessing the situations of sphincters after the lateral internal sphincterotomy. Although the lateral internal sphincterotomy is a successful surgical treatment and can be performed easily as an outpatient procedure, it should be performed with the correct and rigorously surgical technique (Tab. 2, Fig. 3, Ref. 31).

Spontaneous cholecystocutaneous fistula as a rare complication of gallstones

Spontaneous perforation of gallbladder as a complication of biliary stones may lead to a cholecystocutaneous abscess or fistula. The pathophysiology of this condition has been associated with increased pressure in the gallbladder, secondary to biliary obstruction. Ultrasonography and Computed Tomography (CT) can be used for diagnosis of cholecystocutaneous abscess or fistula. The treatment of fistula requires adequate drainage, antibiotics, followed by elective cholecystectomy with excision of the fistula. We report a case of spontaneous cholecystocutaneous fistula in an 89-year-old female patient who presented with obstructive jaundice and subcutaneous abscess in the right subcostal area. Abdominal CT scan showed gallstones and communication between the abscess and the gallbladder. First abdominal wall abscess was drained externally then cholecystectomy and exploration of common bile duct was performed (Fig. 3, Ref. 8).

Prognostic value of oncoprotein expressions in thyroid papillary carcinoma

The aim of this study was to evaluate the expressions of oncoproteins and to correlate the results with clinicopathologic parameters in papillary thyroid carcinoma (PTC). Papillary thyroid cancer (PTC) is the most common form and accounts for about 80% of all thyroid cancers. Although PTC generally has a good prognosis, some patients suffer from local recurrence and/or distant metastasis. Oncogenes have reported to be related not only in carcinogenesis but also in tumor prognosis, tumor type, differentiation and site of tumor in epithelial malignant tumors such as thyroid, breast, ovarian, and stomach cancer. This study was planned retrospectively and was performed in 87 patients (47 PTC, 40 benign lesions). The data of clinicopathologic parameters and tissue samples were collected from the archives. Sections stained with H&E were evaluated for each case and after confirming the diagnosis of PTC, oncoprotein expressions were determined by immunohistochemical analysis. The differences of oncoprotein expressions in PTC compared with control group were statistically significant. Cyclin D1 and p53 expressions were significantly increased in PTC. The expressions of bcl-2 and c-erbB-2 in PTC were found as increased, but the correlation between these proteins and poor prognostic parameters were not significant. We suggest that increased expressions of cyclin D1 and p53 could be used as prognostic factors in patients with PTC.

The survival effect of E-cadherin and catenins in colorectal carcinomas

AIM

The E-cadherin/catenin complex plays an important role in epithelial tissue architecture. Decreased expression of cell adhesion molecules (E-cadherin, α-, β- and γ-catenin) have been reported to correlate with invasive behaviour. The aim of this study was to investigate the relation between the expression of adhesion molecules and clinicopathological characteristics and survival in colorectal carcinoma.

METHOD

The expression of adhesion molecules were studied by immunohistochemistry in 138 colorectal carcinomas.

RESULTS

The mean age of the patients was 65 years (range: 21-89 years). In primary carcinomas, a reduction in membranous expression of E-cadherin, α-catenin, β-catenin, γ-catenin was demonstrated (70%, 68%, 73%, 77%, respectively). Nuclear expression of β-catenin was found in eight (5%) patients. Decreased membranous β- and γ-catenin expression significantly correlated with tumour differentiation (P = 0.013, P = 0.03, respectively). There was a significant association between advanced stage of the tumour and decreased membranous α-catenin expression (P = 0.012). Decreased E-cadherin and β-catenin membranous expression correlated with short survival following curative resection of the primary tumour (P = 0.04, P = 0.03, respectively).

CONCLUSION

The decreased membranous expression of E-cadherin and β-catenin and increased cytoplasmic expression of β-catenin might be used as a prognostic marker to monitor patients with colorectal cancer.

Persistent high postoperative carcinoembryonic antigen in colorectal cancer patients--is it important?

INTRODUCTION

Evaluation of pre- and postoperative serum CEA levels together has seldom been assessed for the prognosis of colorectal cancer (CRC).

OBJECTIVE

To concurrently evaluate pre- and postoperative CEA as factors of relapse and survival.

METHODS

The study consisted of 114 patients who had undergone surgery from February 2002 to June 2006 for CRC. All patients were classified into four groups according to their pre- and postoperative CEA levels. Data obtained for clinicopathologic parameters, lymph node metastasis, stage, recurrence, and CEA levels were analyzed to determine their association with survival. Multivariate analysis by the Cox proportional hazard regression model was performed to identify the independent prognostic factors associated with survival.

RESULTS

Postoperative serum CEA levels remained high in Group 3 (n = 32). Nineteen patients (59.3%) demonstrated a detectable cause for persistent high CEA levels, while the reasons for those in the other thirteen patients (40.6%) remained obscure. Abnormal preoperative CEA levels significantly correlated with the depth of tumor invasion, lymph node metastasis, TNM stage, and recurrence (p < 0.05). Abnormal postoperative CEA levels were significantly related to the depth of tumor invasion, TNM stage, and postoperative relapse (p<0.05). Patients in Group 3 demonstrated the worst survival rate. Abnormal postoperative CEA levels, lymph node metastasis, and location of the tumor were independent prognostic factors for survival.

CONCLUSION

The survival of patients with high postoperative CEA levels due to unknown reasons may be extended if they are exhaustively tested with sensitive diagnostic methods and treated at an early stage.

The effects of hyperbaric oxygen therapy on colonic anastomosis in rats with peritonitis

The aim of this study is to investigate the healing effect of hyperbaric oxygen (HBO) on colonic anastomoses in the presence of experimentally induced peritonitis. Thirty-two rats were allocated randomly into short-term anastomosis (STA), short-term anastomosis + HBO treatment (STA+HBO), long-term anastomosis (LTA), and long-term anastomosis + HBO (LTA+HBO) treatment groups. The STA and LTA groups were administered fluid resuscitation and antibiotics for 3 and 7 days, respectively, whereas the HBO treatment groups received additional HBO therapy for 3 and 7 days, respectively. The rats were reoperated on the third and the seventh days of anostomoses for evaluation. The bursting pressures in STA+HBO and LTA+HBO therapy groups were significantly higher than those in groups with anastomoses alone (p < .001 and p < .01). HBO therapy did not affect the fibrotic index neither in STA nor in LTA groups (p > .05 for both); however, it was significantly higher in LTA+HBO group than that in STA+HBO group (p < .05). The hydroxyproline level was significantly higher in LTA group than in STA group (p < .05), yet HBO therapy did not affect the hydroxyproline levels in STA or LTA groups (p > .05 for both). It is concluded that hyperbaric oxygen treatment has positive effects on colonic anastomotic healing in case of peritonitis.

Resterilized mesh in repair of abdominal wall defects in rats

A variety of negative opinions about repeated usage of relatively expensive resterilized synthetic meshes have been considered. It had been stated that resterilized polypropylene meshes inhibits fibroblastic activity, decreases proliferative activity, and increases apoptosis in human fibroblast culture, in vitro. The purpose of this study is the in vivo evaluation of the resterilized mesh repairs of abdominal hernia defects in rat models of incisional hernia by comparing primer repair and original mesh repairs. The rats (n = 22) were separated into three groups. While the abdominal defect was repaired by primary suture in the control group (CG), the defects were repaired by original mesh (OG) or resterilized mesh (RG) in mesh-repaired groups. After 21 days, the rats were evaluated for tissue tensile strengths, tissue hydroxyproline levels, tissue inflammation, fibrosis, and apoptosis. Although the tensile strengths in OG and RG were significantly higher than those of CG (p < .05 and p < .05), there was no significant difference between two groups. The tissue hydroxyproline levels in OG and RG were also higher than those of CG. The difference was not significant between the two groups. The inflammation and fibrosis indexes in OG and RG were significantly higher than those of CG (p < .0001 for both), but there was no difference between groups. While the apoptosis index in OG and RG was also higher than that of CG (p < .0001 for both), there was no significant difference between OG and RG. The usage of resterilized mesh in abdominal wall repair did not reduce the tissue tensile strength, did not affect the tissue hydroxyproline levels, did not decrease the fibrosis, and did not increase the tissue inflammation and apoptosis. In conclusion, usage of resterilized meshes in abdominal wall defects was as safe as sterilized meshes.

Overlapping repair in patients with anal sphincter injury

OBJECTIVE

The aim of this study was to demonstrate the improvement of anal canal function after overlap sphincter repair and confirm that this treatment option is superior in patients with nonobstetric sphincter damage.

SUBJECTS AND METHODS

From 1998 to 2003, 44 women who underwent overlapping sphincter repair were enrolled in this study. The women were allocated to one of two groups, obstetric trauma (n = 31) and nonobstetric (perineal) trauma (n = 13). Both groups were compared in terms of age, operation time, number of deliveries, hospital stay, need for analgesics, complication rate, pre- and postoperative outcomes of anal manometry and quality of life, using the fecal incontinence severity index and a questionnaire for fecal disorders.

RESULTS

Anal canal length was significantly extended postoperatively in both groups compared to preoperative length. Eight-week postoperative resting and squeeze pressures were significantly higher than preoperative pressures in both patients with nonobstetric and obstetric sphincter injury. Although significant increase was seen in both groups, the mean postoperative resting and squeeze pressures at 1 year were rather high in patients with nonobstetric sphincter injury. At the end of a year of follow-up, overall satisfaction of the repair was about 82%.

CONCLUSION

Overlap sphincter repair was feasible, although patient satisfaction was slightly less in the obstetric than in the nonobstetric trauma group. The improvement of anal function at 20- to 24-month follow-up is attributed to both high squeeze pressure and broad anal canal.

The effect of octreotide on healing of injured colonic anastomosis with immediate postoperative intraperitoneal administration of 5-Fluorouracil

PURPOSE

This study was designed to investigate the effect of octreotide on side effects of immediate usage of 5-fluorouracil after colonic anastomosis.

METHODS

Forty male Wistar rats were randomly assigned into four groups and underwent standardized left colonic anastomosis. The rats served as control or received intraperitoneal 5-fluorouracil (20 mg/kg daily), subcutaneous octreotide (20 mug/kg daily), or both. Diarrhea and wound complications were noted during the experiment. The colonic anastomoses were assessed for healing on postoperative Day 7 by determining the anastomotic bursting pressure, performing histologic examination, and measuring the tissue hydroxyproline content, serum malondialdehyde, and nitric oxide levels. Intraperitoneal adhesions and anastomotic leakage were also noted.

RESULTS

No statistical significant difference was found between the control and octreotide groups for each of the parameters measured. Immediate 5-fluorouracil use resulted with higher adhesion score (P = 0.002), significant depression in anastomotic bursting pressure (P = 0.0001), histopathologic score (P = 0.0001), hydroxyproline content (P = 0.0001), and increasing nitric oxide (P = 0.0001) and malondialdehyde levels (P = 0.0001) compared with the control group. Diarrhea was seen in 80 percent of the 5-fluorouracil group but in neither the control nor octreotide groups (P = 0.0001 for each comparison). However, all these parameters were ameliorated by use of concomitant octreotide and 5-fluorouracil (P = 0.019, P = 0.023, P = 0.0001, P = 0.006, P = 0.0001, and P = 0.013, respectively). In addition, diarrhea was found to be prevented (P = 0.0001).

CONCLUSIONS

The results of this study showed that concomitant octreotide use might prevent the side effects of 5-fluorouracil, such as diarrhea, postoperative adhesion, and delaying the anastomotic healing parameters. In addition, it might reduce tissue damage and inflammation.