BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical per...BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.展开更多
BACKGROUND Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic.Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human ...BACKGROUND Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic.Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body’s immune response.Though life threatening infection after hemorrhoidectomy rarely occurs,all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.CASE SUMMARY Here,we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management.There was no history of systemic diseases or recent disease infection.Hemorrhoidectomy was suggested and performed.After surgery,the patient developed hypotension,tachycardia,fever with chills and renal function impairment on day 2 post-operation.The clinical condition progressed to severe septic shock and metabolic acidosis.The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation.The results of the blood and wound cultures showed group A streptococcus pyogenes.CONCLUSION Although extremely uncommon,all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.展开更多
基金Supported by the Taipei Medical University,No. TMU104-AE1-B35。
文摘BACKGROUND Approximately 20 percent of patients with a tumour localized in the low rectum still encounter the possibility of requiring permanent stoma(PS), which can cause drastic changes in lifestyle and physical perceptions.AIM To determine the risk factors for PS and to develop a prediction model to predict the probability of PS in rectal cancer patients after sphincter-saving surgery.METHODS A retrospective cohort of 421 rectal cancer patients who underwent radical surgery at Taipei Medical University Hospital between January 2012 and December 2020 was included in this study. Univariate and multivariate analyses were performed to identify the independent risk factors for PS. A nomogram was developed according to the independent risk factors obtained in the multivariate analysis. The performance of the nomogram was assessed using a receiver operating characteristic curve and a calibration curve.RESULTS The PS rate after sphincter-saving surgery was 15.1%(59/391) in our study after a median follow-up of 47.3 mo(range 7–114 mo). Multivariate logistic regression analysis demonstrated that local recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, tumor size and operative time were independent risk factors for PS. These identified risk factors were incorporated into the nomogram, and the concordance index of this model was 0.903(95%CI: 0.851-0.955). According to the calibration curves, the nomogram represents a perfect prediction model.CONCLUSION Several risk factors for PS after sphincter-saving surgery were identified. Our nomogram exhibited perfect predictive ability and will improve a physician’s ability to communicate the benefits and risks of various treatment options in shared decision making.
文摘BACKGROUND Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic.Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body’s immune response.Though life threatening infection after hemorrhoidectomy rarely occurs,all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.CASE SUMMARY Here,we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management.There was no history of systemic diseases or recent disease infection.Hemorrhoidectomy was suggested and performed.After surgery,the patient developed hypotension,tachycardia,fever with chills and renal function impairment on day 2 post-operation.The clinical condition progressed to severe septic shock and metabolic acidosis.The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation.The results of the blood and wound cultures showed group A streptococcus pyogenes.CONCLUSION Although extremely uncommon,all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.
