AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnos...AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs.Investigation of an iron deficiency anemia(147 patients),per rectum blood loss(84 patients),bowel obstruction and/or perforation(81 patients),bowel habits alterations(32 patients),nonspecific symptoms,such as weight loss,intermittent abdominal pain and fatigue,(22 patients) or population screening(21 patients) were the indications for the endoscopic investigation in both groups.Bleeding,either chronic presenting as anemia or acute was significantly higher(P = 0.002) for the antiplatelet arm of the study(71 patients-72.4% of the antiplatelet group vs 160 patients-55.3% of the control group).The mean tumor,node and metastasis stage was 2.57 ± 0.96 for the control group,2.27 ± 0.93 for the antiplatelet group(P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin(P = 0.003).The incidence of advanced disease(stage Ⅳ) was lower for the antiplatelet group of the study(P = 0.033).CONCLUSION:The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.展开更多
BACKGROUND The introduction of minimal invasive principles in colorectal surgery was a major breakthrough,resulting in multiple clinical benefits,at the cost,though,of a notably steep learning process.The development ...BACKGROUND The introduction of minimal invasive principles in colorectal surgery was a major breakthrough,resulting in multiple clinical benefits,at the cost,though,of a notably steep learning process.The development of structured nation-wide training programs led to the easier completion of the learning curve;however,these programs are not yet universally available,thus prohibiting the wider adoption of laparoscopic colorectal surgery.AIM To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.METHODS We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting.Cumulative sum analysis and change-point analysis(CPA)were introduced.RESULTS Overall,214 patients were included.In terms of operative time,CPA identified the 110^(th) case as the first turning point.A plateau was reached after the 145^(th) case.Subgroup analysis estimated the 58^(th) for colon and 52^(nd) case for rectum operations as the respective turning points.A learning curve pattern was confirmed for pathology outcomes,but not in the conversion to open surgery and morbidity endpoints.CONCLUSION The learning curves in our setting validate the comparability of the results,despite the absence of National or Surgical Society driven training programs.展开更多
文摘AIM:To evaluate whether antiplatelet medication leads to an earlier stage colorectal cancer(CRC) diagnosis.METHODS:From January 2002 until March 2010,patients that presented to our institution with the initial diagnosis of CRC and were submitted to an open curative CRC resection or a palliative procedure were retrospectively reviewed.Exclusion criteria were the use of antithrombotic medication,i.e.,coumarins,and appendiceal malignancies.Data acquired from medical files included age,gender,past medical history,antithrombotic treatment received prior to endoscopic diagnosis,preoperative imaging staging,location of the tumor,surgical and final histopathological report.Patients that did not receive any antithrombotic medication prior to the endoscopic diagnosis comprised the control group of the study,while patients that were on antiplatelet medication comprised the antiplatelet group.Primary end point was a comparison of CRC stage in the two groups of the study.CRC presenting symptoms and the incidence of each cancer stage in the two groups were also evaluated.RESULTS:A total of 387 patients with the diagnosis of CRC were submitted to our department for further surgical treatment.Ninety-eight patients(25.32%),with a median age of 71 years(range 52-91 years),were included in the antiplatelet group,while 289(74.67%) patients,with a median age of 67 years(range 4190 years),were not in any thrombosis prophylaxis medication(control group).Thirty-one patients were treated with some kind of palliative procedure,either endoscopic,such as endoscopic stent placement,or surgical,such as de-compressive colostomy or deviation.Coronary disease(77.55%-76 patients),stroke recurrence prevention(14.28%-14 patients) and peripheral arterial disease(8.16%-8 patients) were the indications for the administration of antiplatelet treatment(aspirin,clopidogrel,ticlopidine or dipyridamole) in the antiplatelet group.All patients on aspirin treatment received a dosage of 100 mg/d,while the minimum prophylactic dosages were also used for the rest of the antiplatelet drugs.Investigation of an iron deficiency anemia(147 patients),per rectum blood loss(84 patients),bowel obstruction and/or perforation(81 patients),bowel habits alterations(32 patients),nonspecific symptoms,such as weight loss,intermittent abdominal pain and fatigue,(22 patients) or population screening(21 patients) were the indications for the endoscopic investigation in both groups.Bleeding,either chronic presenting as anemia or acute was significantly higher(P = 0.002) for the antiplatelet arm of the study(71 patients-72.4% of the antiplatelet group vs 160 patients-55.3% of the control group).The mean tumor,node and metastasis stage was 2.57 ± 0.96 for the control group,2.27 ± 0.93 for the antiplatelet group(P = 0.007) and 2.19 ± 0.92 for the subgroup of patients taking aspirin(P = 0.003).The incidence of advanced disease(stage Ⅳ) was lower for the antiplatelet group of the study(P = 0.033).CONCLUSION:The adverse effect of bleeding that is justifiably attached to this drug category seems to have a favorable impact on the staging characteristics of CRC.
文摘BACKGROUND The introduction of minimal invasive principles in colorectal surgery was a major breakthrough,resulting in multiple clinical benefits,at the cost,though,of a notably steep learning process.The development of structured nation-wide training programs led to the easier completion of the learning curve;however,these programs are not yet universally available,thus prohibiting the wider adoption of laparoscopic colorectal surgery.AIM To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.METHODS We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting.Cumulative sum analysis and change-point analysis(CPA)were introduced.RESULTS Overall,214 patients were included.In terms of operative time,CPA identified the 110^(th) case as the first turning point.A plateau was reached after the 145^(th) case.Subgroup analysis estimated the 58^(th) for colon and 52^(nd) case for rectum operations as the respective turning points.A learning curve pattern was confirmed for pathology outcomes,but not in the conversion to open surgery and morbidity endpoints.CONCLUSION The learning curves in our setting validate the comparability of the results,despite the absence of National or Surgical Society driven training programs.
