Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis(ASC) both in children and in adults.Colectomy should be regarded as a life saving pro...Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis(ASC) both in children and in adults.Colectomy should be regarded as a life saving procedure in ASC,and must be seriously considered in any steroid-refractory patient.However,colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems,including fecal incontinence,pouchitis,irritable pouch syndrome,cuffitis,anastomotic ulcer and stenosis,missed or de-novo Crohn's disease and,in young females,reduced fecundity.This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon.Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine,tacrolimus and infliximab,which seem equally effective in the short term.Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%.This accuracy is sufficiently high for initiat-ing medical therapy,but usually not colectomy,early in the admission without delaying colectomy if required.This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays,and the mortality rate from over 70% in the 1930s to about 1%.In general,restorative proctocolectomy(ileoanal pouch or ileal pouch-anal anastomosis),especially the J-pouch,is preferred over straight pullthrough(ileo-anal) or ileo-rectal anastomosis,which may still be considered in young females concerned about infertility.Colectomy in the acute severe colitis setting,is usually performed in three steps due to the severity of the inflammation,concurrent steroid treatment and the generally reduced clinical condition.The first surgical step involves colectomy and constructing an ileal stoma,the second-constructing the pouch and the third-closing the stoma.This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.展开更多
Objective We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation （RFA）. Methods A retrospective analysis of 67 patients who had recurrent liver cancer afte...Objective We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation （RFA）. Methods A retrospective analysis of 67 patients who had recurrent liver cancer after RFA treatment and received salvage hepatectomy in the Department of Hepatobiliary Surgery, Southwest Hospital, Third Mili- tary Medical University （China）, from January 2006 to January 2014, was performed. The analysis included patient gender, age, hepatitis type, alpha-fetoprotein （AFP）, and TNM stage prior to RFA and salvage hepatectomy, overall survival rates, and tumor-free survival rates after salvage hepatectomy. Results Among the 67 patients, there were 57 cases of hepatitis B, two cases of hepatitis C, and eight cases did not have hepatitis. AFP levels in patients ranged from 3 to 4521 ng/mL （median 33 ng/mL）. Before RFA, 54 cases were stage I tumors, and 13 were stage II tumors. Tumor sizes varied from 0.82 to 4.83 cm （median 3.0 cm）. In 20 cases, one RFA was performed, and for 47 cases, RFA was repeated. RFA- ablated region diameters ranged from 3.8 to 5.2 cm （median 4.5 cm）. The interval between the salvage surgical resection and RFA was 3-37 months. Before salvage hepatectomy, 23 stage I tumors, 12 stage II tumors, and 32 stage III tumors were present （size ranged 4.83-11.84 cm; median 6.3 cm）. For salvage hepatectomy, laparotomy was performed for 56 cases, and laparoscopy was performed for 28 cases. Inflow clamping was performed for 39 cases （15-45 rain）. Surgery was 219-370 rain and intraoperative blood loss was 100-2100 mL. For 13 cases, intraoperative blood transfusion was required. Tumor pathological data revealed 31,35, and 1 poorly, moderately, and well differentiated tumors, respectively. No patients died due to operative complications, and hospital stays were 8-10 days. Overall and tumor-free survival rates were 85% and 79% for 1 year, 50% and 20% for 3 years, and 39% and 19% for 5 years, respectively. Kaplan- Meier analysis and Cox regression confirmed that tumor number and size prior to salvage liver cancer were risk factors affecting survival. Conclusion Patients who received RFA to treat early-stage liver cancer with postoperative recurrent stage I tumors have satisfactory outcomes with salvage hepatectomy.展开更多
文摘Despite the growing use of medical salvage therapy,colectomy has remained a cornerstone in managing acute severe ulcerative colitis(ASC) both in children and in adults.Colectomy should be regarded as a life saving procedure in ASC,and must be seriously considered in any steroid-refractory patient.However,colectomy is not a cure for the disease but rather the substitution of a large problem with smaller problems,including fecal incontinence,pouchitis,irritable pouch syndrome,cuffitis,anastomotic ulcer and stenosis,missed or de-novo Crohn's disease and,in young females,reduced fecundity.This notion has led to the widespread practice of offering medical salvage therapy before colectomy in most patients without surgical abdomen or toxic megacolon.Medical salvage therapies which have proved effective in the clinical trial setting include cyclosporine,tacrolimus and infliximab,which seem equally effective in the short term.Validated predictive rules can identify a subset of patients who will eventually fail corticosteroid therapy after only 3-5 d of steroid therapy with an accuracy of 85%-95%.This accuracy is sufficiently high for initiat-ing medical therapy,but usually not colectomy,early in the admission without delaying colectomy if required.This approach has reduced the colectomy rate in ASC from 30%-70% in the past to 10%-20% nowadays,and the mortality rate from over 70% in the 1930s to about 1%.In general,restorative proctocolectomy(ileoanal pouch or ileal pouch-anal anastomosis),especially the J-pouch,is preferred over straight pullthrough(ileo-anal) or ileo-rectal anastomosis,which may still be considered in young females concerned about infertility.Colectomy in the acute severe colitis setting,is usually performed in three steps due to the severity of the inflammation,concurrent steroid treatment and the generally reduced clinical condition.The first surgical step involves colectomy and constructing an ileal stoma,the second-constructing the pouch and the third-closing the stoma.This review focuses on the role of surgical treatment in ulcerative colitis in the era of medical rescue therapy.
文摘Objective We studied the efficacy of salvage hepatectomy for treating recurrent hepatic cancer after radiofrequency ablation （RFA）. Methods A retrospective analysis of 67 patients who had recurrent liver cancer after RFA treatment and received salvage hepatectomy in the Department of Hepatobiliary Surgery, Southwest Hospital, Third Mili- tary Medical University （China）, from January 2006 to January 2014, was performed. The analysis included patient gender, age, hepatitis type, alpha-fetoprotein （AFP）, and TNM stage prior to RFA and salvage hepatectomy, overall survival rates, and tumor-free survival rates after salvage hepatectomy. Results Among the 67 patients, there were 57 cases of hepatitis B, two cases of hepatitis C, and eight cases did not have hepatitis. AFP levels in patients ranged from 3 to 4521 ng/mL （median 33 ng/mL）. Before RFA, 54 cases were stage I tumors, and 13 were stage II tumors. Tumor sizes varied from 0.82 to 4.83 cm （median 3.0 cm）. In 20 cases, one RFA was performed, and for 47 cases, RFA was repeated. RFA- ablated region diameters ranged from 3.8 to 5.2 cm （median 4.5 cm）. The interval between the salvage surgical resection and RFA was 3-37 months. Before salvage hepatectomy, 23 stage I tumors, 12 stage II tumors, and 32 stage III tumors were present （size ranged 4.83-11.84 cm; median 6.3 cm）. For salvage hepatectomy, laparotomy was performed for 56 cases, and laparoscopy was performed for 28 cases. Inflow clamping was performed for 39 cases （15-45 rain）. Surgery was 219-370 rain and intraoperative blood loss was 100-2100 mL. For 13 cases, intraoperative blood transfusion was required. Tumor pathological data revealed 31,35, and 1 poorly, moderately, and well differentiated tumors, respectively. No patients died due to operative complications, and hospital stays were 8-10 days. Overall and tumor-free survival rates were 85% and 79% for 1 year, 50% and 20% for 3 years, and 39% and 19% for 5 years, respectively. Kaplan- Meier analysis and Cox regression confirmed that tumor number and size prior to salvage liver cancer were risk factors affecting survival. Conclusion Patients who received RFA to treat early-stage liver cancer with postoperative recurrent stage I tumors have satisfactory outcomes with salvage hepatectomy.
