AIM:To evaluate clinical validity of the compression anastomosis ring(CARTM27) anastomosis in left-sided colonic resection. METHODS:A non-randomized prospective data collection was performed for patients undergoing an...AIM:To evaluate clinical validity of the compression anastomosis ring(CARTM27) anastomosis in left-sided colonic resection. METHODS:A non-randomized prospective data collection was performed for patients undergoing an elective left-sided colon resection,followed by an anastomosis using the CARTM27 between November 2009 and January 2011.Eligibility criteria of the use of the CARTM27 were anastomoses between the colon and at or above the intraperitoneal rectum.The primary short-term clinical endpoint,rate of anastomotic leakage,and other clinical outcomes,including intraand postoperative complications,length of operation time and hospital stay,and the ring elimination time were evaluated. RESULTS:A total of 79 patients(male,43;median age,64 years) underwent an elective left-sided colon resection,followed by an anastomosis using theCARTM27.Colectomy was performed laparoscopically in 70 patients,in whom two patients converted to open procedure(2.9%) .There was no surgical mortality.As an intraoperative complication,total disruption of the anastomosis occurred by premature enforced tension on the proximal segment of the anastomosis in one patient.The ring was removed and another new CARTM27 anastomosis was constructed.One patient with sigmoid colon cancer showed postoperative anastomotic leakage after 6 d postoperatively and temporary diverting ileostomy was performed.Exact date of expulsion of the ring could not be recorded because most patients were not aware that the ring had been expelled.No patients manifested clinical symptoms of anastomotic stricture. CONCLUSION:Short-term evaluation of the CARTM27 anastomosis in elective left colectomy suggested it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.展开更多
Peritoneal surface malignancies are generally associated with poor prognosis. In daily clinical routine, systemic chemotherapy is still considered the only reasonable therapy despite of encouraging results of cytoredu...Peritoneal surface malignancies are generally associated with poor prognosis. In daily clinical routine, systemic chemotherapy is still considered the only reasonable therapy despite of encouraging results of cytoreductive surgery (CRS) along with intraperitoneal hyperthermic chemotherapy (HIPEC). The Achilles heel of CRS and HIPEC is appropriate patient selection and precise surgical technique preventing patients from excessive morbidity and mortality. Given these findings, new concepts of second look surgery for high risk patients allow detection of peritoneal spread ahead of clinical symptoms or presence of peritoneal masses reducing perioperative morbidity. In addition, personalized intraperitoneal chemotherapy might further improve outcome by appreciating individual tumor biology. These days, every physician should be aware of CRS and HIPEC for treatment of peritoneal surface malignancies. Since there is now sufficient data for the superiority of CRS and HIPEC to systemic chemotherapy in selected patients, our next goal should be providing this strategy with minimal morbidity and mortality even in the presence of higher tumor load.展开更多
文摘AIM:To evaluate clinical validity of the compression anastomosis ring(CARTM27) anastomosis in left-sided colonic resection. METHODS:A non-randomized prospective data collection was performed for patients undergoing an elective left-sided colon resection,followed by an anastomosis using the CARTM27 between November 2009 and January 2011.Eligibility criteria of the use of the CARTM27 were anastomoses between the colon and at or above the intraperitoneal rectum.The primary short-term clinical endpoint,rate of anastomotic leakage,and other clinical outcomes,including intraand postoperative complications,length of operation time and hospital stay,and the ring elimination time were evaluated. RESULTS:A total of 79 patients(male,43;median age,64 years) underwent an elective left-sided colon resection,followed by an anastomosis using theCARTM27.Colectomy was performed laparoscopically in 70 patients,in whom two patients converted to open procedure(2.9%) .There was no surgical mortality.As an intraoperative complication,total disruption of the anastomosis occurred by premature enforced tension on the proximal segment of the anastomosis in one patient.The ring was removed and another new CARTM27 anastomosis was constructed.One patient with sigmoid colon cancer showed postoperative anastomotic leakage after 6 d postoperatively and temporary diverting ileostomy was performed.Exact date of expulsion of the ring could not be recorded because most patients were not aware that the ring had been expelled.No patients manifested clinical symptoms of anastomotic stricture. CONCLUSION:Short-term evaluation of the CARTM27 anastomosis in elective left colectomy suggested it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.
文摘Peritoneal surface malignancies are generally associated with poor prognosis. In daily clinical routine, systemic chemotherapy is still considered the only reasonable therapy despite of encouraging results of cytoreductive surgery (CRS) along with intraperitoneal hyperthermic chemotherapy (HIPEC). The Achilles heel of CRS and HIPEC is appropriate patient selection and precise surgical technique preventing patients from excessive morbidity and mortality. Given these findings, new concepts of second look surgery for high risk patients allow detection of peritoneal spread ahead of clinical symptoms or presence of peritoneal masses reducing perioperative morbidity. In addition, personalized intraperitoneal chemotherapy might further improve outcome by appreciating individual tumor biology. These days, every physician should be aware of CRS and HIPEC for treatment of peritoneal surface malignancies. Since there is now sufficient data for the superiority of CRS and HIPEC to systemic chemotherapy in selected patients, our next goal should be providing this strategy with minimal morbidity and mortality even in the presence of higher tumor load.
