Resected specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up after STARR procedures

AIM:To investigate stapled transanal rectal resection (STARR) procedures as surgical techniques for obstructed defecation syndrome (ODS) by analyzing specimen evaluation,anorectal manometry,endoanal ultrasonography and clinical follow-up.METHODS:From January to December 2007,we have treated 30 patients.Fifteen treated with double PPH-01 staplers and 15 treated using new CCS 30 contour.Resected specimen were measured with respect to average surface and volume.All patients have been evaluated at 24 mo with clinical examination,anorectal manometry and endoanal ultrasonography.RESULTS:Average surface in the CCS 30 group was 54.5 cm2 statistically different when compared to the STARR group (36.92 cm2).The average volume in the CCS 30 group was 29.8 cc,while in the PPH-01 it was23.8 cc and difference was statistically significant.The mean hospital stay in the CCS 30 group was 3.1 d,while in the PPH-01 group the median hospital stay was 3.4 d.As regards the long-term follow-up,an overall satisfactory rate of 83.3% (25/30) was achieved.Endoanal ultrasonography performed 1 year following surgery was considered normal in both of the studied groups.Mean resting pressure was higher than the preoperative value (67.2 mmHg in the STARR group and 65.7 mmHg in the CCS30 group vs 54.7 mmHg and 55.3 mmHg,respectively).Resting and squeezing pressures were lower in those patients not satisfied,but data are not statistically significant.CONCLUSION:The STARR procedure with two PPH-01 is a safe surgical procedure to correct ODS.The new Contour CCS 30 could help to increase the amount of the resected tissue without differences in early complications,post-operative pain and in hospital stay compared to the STARR with two PPH-01 technique.

Impact of age-related comorbidity on results of colorectal cancer surgery

AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.

Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors

AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors.METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors' institution. They were divided into three groups with regard to age. Patients <70 and >60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old)and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type Ⅰ tumors, and extended gastrectomy and distal esophagectomy for type Ⅱ and Ⅲ lesions.RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P＜0.05). Primary resection was performed in 811 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P＜0.05), while morbidity was similar in both groups. A curative resection (R0) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P＞0.05). The overall 3- and 5-year survival rates were 26.7% and 117.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P = 0.1544). Survival rates were significantly associated with R0 resection,pathological node-positive category and tumor differentiation in both groups.CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.

Presacral ganglioneuroma: A case report and review of literature

骶骨前 ganglioneuromas 是仅仅 17 个案例在文学被报导了的那么稀罕的良性瘤。他们是慢慢地成长的腹的群众并且微分诊断不得不被考虑。因为它代表唯一的治疗学的选择，外科的切除术为权威的诊断是重要的。因为神经节瘤的良性的性质，辅助化学或放射疗法没被显示，但是常规后续为潜在的本地复发的早诊断是必要的。我们与一个骶骨前神经节瘤报导一个 64 岁的人的一个案例。