Is there a role for neoadjuvant treatment with Gleevec for large rectal gastrointestinal stromal tumors?
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
Robert W Beart
Publications and source records attributed to Robert W Beart.
Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection.
INTRODUCTION: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction. METHODS: This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years. RESULTS: There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up. CONCLUSIONS: The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted this outcome.
Adolescent↗
Primary solitary extragastrointestinal stromal tumor of the greater omentum coexisting with ulcerative colitis.
Explore the source record for details and available documents.
Colitis, Ulcerative↗
Intraoperative physical diagnosis in the management of anal fistula.
This report reviews a prospective database applying a systematic fistulomy technique in 101 patients requiring surgery for fistula in ano at LAC+USC Medical Center during a 15-month period. Data were collected for the reliability of primary crypt palpation, success of tract injection with peroxide/methylene blue, and the accuracy of Goodsall's rule. Time to healing, recurrence, and incontinence according to type of procedure were also recorded. Palpation of the primary crypt was possible in 93 per cent. Hydrogen peroxide/methylene blue injection successfully delineated the tract in 83 per cent. Goodsall's rule was correct in 81 per cent. Each fistula was categorized as intersphincteric (n = 72), transphincteric (n = 33), extrasphincteric (n = 1), or submucosal (n = 6). At a mean follow-up period of 44 weeks, 89.2 per cent of patients were cured. Reasons for recurrence included wound bridging (n = 6), misdiagnosis of the tract (n = 3), and two blind-ended fistulae (n = 2). Time to healing in weeks was (mean, range): simple fistulotomy (12, 3-21), seton (16, 4-28), Hanley procedure (28, 8-48). Patients with a marsupialized tract healed at an average of 6 weeks (range 4-8). Four (3.9%) patients reported postoperative incontinence (1 gas, 3 liquid, 0 solids).
Diagnosis, Differential↗
Care after colonic operation--is it evidence-based? Results from a multinational survey in Europe and the United States.
BACKGROUND: Despite clinical evidence showing that steps can be taken perioperatively to enhance postoperative recovery and decrease morbidity in colonic operation patients, there is no comprehensive information on how widespread such practices are, or the combination of such steps into effective multimodal rehabilitation (fast-track) colonic surgery programs to decrease hospital stay. This survey investigated clinical practice around colonic operations across Europe and the United States. METHODS: The survey was conducted in 295 hospitals in the United Kingdom, France, Germany, Italy, Spain, and the United States. Details of perioperative care and postoperative recovery were recorded for 1,082 patients who had undergone elective colonic operations and who were discharged (or died) over a 2-week period (United States: up to 4 weeks). RESULTS: Preoperative bowel clearance was used in >85% of patients. A nasogastric tube was left in situ postoperatively in 40% versus 66% of patients in the United States and Europe, respectively, and was removed about 3 days postoperatively. It took 3 to 4 days until 50% of the patients first tolerated liquids and 4 to 5 days until 50% of patients were eating and having a bowel movement. Postoperative ileus was found to persist for over 5 days in approximately 45% of patients. Mean length of postoperative hospital stay was over 10 days in the United Kingdom, France, Germany, Italy, and Spain, and 7 days in the United States, compared with 2 to 5 days reported in trials of fast-track colonic surgery programs. CONCLUSIONS: Strategies that can contribute to improved recovery and reduced complications after colonic operations do not appear to be applied optimally in clinical practice across Europe and the United States. These findings indicate a potential for major improvements in outcomes and reduction of costs if peri- and postoperative care can be adjusted to be in line with published evidence.
Aged↗
Preservation of bowel and urinary continence in the management of locally recurrent rectal cancer.
BACKGROUND: The management of locally recurrent rectal cancer should achieve local tumor control and potentially improving disease-free and overall survival. Radical pelvic resection has traditionally been associated with permanent fecal and urinary diversion. However, as advanced techniques have evolved to allow restoration of intestinal and urinary continence, we reviewed the use of these techniques in patients with recurrent rectal cancer. METHODS: Patients with recurrent rectal cancer who underwent a resection at Norris Comprehensive Cancer Center between 1993 and 1999 were retrospectively reviewed. Data collected included demographic data, surgical and oncological history, patterns of recurrence, treatment modalities, and outcome. Follow-up data was obtained from the last clinic visit and/or tumor registry. RESULTS: Sixty-seven patients with locally recurrent rectal cancer (male/female 45/22, age 32-81 years) were included in the analysis. Continence was re-established in 22 (33%) patients, urinary continence was restored in 12 patients, and intestinal continuity in 14 patients (both in 4 patients). A temporary diverting ostomy was necessary in 5 out of 14 (36%) patients. Mortality was zero and morbidity was low and included two urinary leaks and one fecal leak all of which could be managed non-operatively. At a median follow-up of 16 months (range 5-55), 11 (50%) patients were still alive, 7 (31%) without evidence of disease. Comparison of the groups of patients either with or without continence preservation showed no statistically significant difference in disease-free survival and overall survival rates. High quality of life was achieved with restoration of continuity, no patient with restored continuity expressed a desire for a diversion. CONCLUSION: If an oncologically adequate resection of the recurrent rectal cancer can be performed without impairment of the pelvic floor integrity, continence preservation is feasible and results in good functional and oncological outcome.
Adult↗
Fistula-in-ano: do antibiotics make a difference?
BACKGROUND: The objective of this study was to evaluate the hypothesis that antibiotics in conjunction with drainage of anorectal abscesses will reduce the incidence of fistulae formation. The impact of age and associated comorbidity on the formation of fistulae were also evaluated. METHODS: Patients with a diagnosis of anorectal abscesses were identified from the database of a single colorectal practice. Demographic data, comorbidity, antibiotic usage, and fistulae formation were collected from review of patient's charts and phone contact. Statistical analysis was performed with the two-sided Fisher's exact and Wald's chi-square tests. RESULTS: Fifty-six patients with complete data were analyzed. The overall fistulae formation rate was 32%. Of all patients, 45% received a course of broad-spectrum antibiotics at the time of drainage and 48% of patients had associated comorbidity. Although trends were evident, there were no statistical significant associations between fistulae formation and age, comorbidity, and antibiotics. CONCLUSION: Although not statistically significant, there was a trend that antibiotics and age >45 years may be protective against the formation of fistulae. Similarly, the data suggest that the presence of comorbidity may increase the risk of fistula formation. We are encouraged by this result and propose to conduct a larger randomized prospective study.
Abscess↗
Stability of colon stem cell methylation after neo-adjuvant therapy in a patient with attenuated familial adenomatous polyposis.
BACKGROUND: Methylation at certain human CpG rich sequences increases with age. The mechanisms underlying such age-related changes are unclear, but methylation may accumulate slowly in a clock-like manner from birth and record lifetime numbers of stem cell divisions. Alternatively, methylation may fluctuate in response to environmental stimuli. The relative stability of methylation patterns may be inferred through serial observations of the same colon. CASE PRESENTATION: A 22 year-old male with attenuated familial adenomatous polyposis received neo-adjuvant chemotherapy and radiation prior to surgery for rectal adenocarcinoma. Colon crypt methylation patterns before and after neo-adjuvant therapy (62 days apart) were essentially identical with respect to percent methylation and diversity. Consistent with previous studies, methylation patterns recorded no evidence for enhanced colon crypt stem cell survival with a germline mutation (codon 215) proximal to the mutation cluster region of APC. CONCLUSION: The inability of neo-adjuvant therapy to significantly alter crypt methylation patterns suggests stem cells are relatively protected from transient environmental changes. Age-related methylation appears to primarily reflect epigenetic errors in stem cells that slowly accumulate in a clock-like manner from birth. Therefore, life-long human stem cell histories are potentially written within and may be read from somatic cell epigenomes.
Adenocarcinoma↗
Molecular predictors of lymph node metastasis in colon cancer: increased risk with decreased thymidylate synthase expression.
TNM staging in colon cancer has several limitations. Prognostic molecular markers are now being developed to address these limitations. The aim of this study was to identify a combination of genes and markers whose expression is predictive of nodal status and outcome in colon cancer. The expression of 12 genetic markers were examined in 66 node-positive and 65 node-negative T3 colon cancers. Gene expression was quantified using real-time polymerase chain reaction. Microsatellite instability status was available through the registry. Association with lymph node status was examined using univariate and multivariate logistic regression. Thymidylate synthase expression was statistically significantly associated with lymph node status (odds ratio 0.36; 95% confidence interval: 0.16-0.81). Microsatellite instability and the other genes were not associated with nodal status. Multiple logistic regression did not identify a significant multivariate predictive model. Decreased expression of thymidylate synthase is associated with a higher risk of lymph node metastasis in patients with T3 colon cancers. Microsatellite instability and the expression of other genes are not predictive of nodal status in this population. Thymidylate synthase gene expression may help identify patients at greater risk for progression of disease.
Colonic Neoplasms↗
Cost-saving effect of treatment algorithm for chronic anal fissure: a prospective analysis.
Evidence-based medicine suggests that in the management of chronic anal fissure (CAF), lateral internal sphincterotomy (LIS) is far more effective than medical treatment in lowering the anal sphincter tone and curing the fissure. In the current study, we developed a treatment algorithm from topical nitroglycerin (NTG) to botulinum toxin type A (Botox [BTX]) to LIS and analyzed its cost benefit by calculating the effective and potential costs based on the treatment success and the rate of avoided surgeries. Patients presenting between November 2003 and December 2004 with CAF and symptoms for greater than 3 months were prospectively treated according to a treatment algorithm which started with (1) topical NTG, in case of failure (2) injection of BTX, thus limiting (3) surgery to those who failed both nonsurgical options or at any point chose the surgical approach. Based on the primary end points of fissure healing or surgery, we calculated the true cost (algorithm) and the potential incremental cost (BTX plus surgery or surgery in all patients, respectively). Sixty-seven patients with CAF (25 men and 42 women; median duration of symptoms, 16 weeks) were treated according to the algorithm. NTG alone was successful in fissure healing in 31 of 67 patients (46.2%). Two developed a recurrent fissure and then received BTX as part of the protocol. Of the 36 patients who failed NTG trial, 3 requested surgery; the others were treated with BTX, which was successful in 84.8%. Five patients (15.2%) failed BTX and subsequently required surgery. The overall surgery rate in the whole study group was 11.9%, whereas CAF healed in 88.1% of our patients with medical treatment alone. Cost for NTG is $10; for 100 units BTX, $528; and for outpatient surgery, $1119. The total cost for these 67 patients therefore was $33,252 ($290 for NTG, $20,580 for NTG plus BTX, $3,357 for NTG plus LIS, and $9,025 for NTG plus BTX plus LIS). If all patients had received BTX with a 15% failure rate, the total cost would have been $56,688 (70.3% cost increase). If all patients had undergone surgery as initial/only treatment, the total cost would have been $74,973 (125% cost increase). Our treatment algorithm for CAF with stepwise escalation can avoid surgery in 88% of the patients. It is highly cost-efficient and resulted in savings of 41% (compared with BTX plus LIS) and up to 70% (compared with surgery in all patients), respectively.
Adult↗
The management of complicated diverticulitis and the role of computed tomography.
PURPOSE: Acute diverticulitis is a disease with a wide clinical spectrum, ranging from a phlegmon (stage Ia), to localized abscesses (stages Ib and II), to free perforation with purulent (stage III) or feculent peritonitis (stage IV). While there is little debate about the best treatment for mild episodes and/or very severe episodes, uncertainty persists about the optimal management for intermediate stages (Ib and II). The aim of our study was therefore to define the role of computed tomography (CT) and to analyze its impact on the management of acute diverticulitis. METHODS: We retrospectively analyzed 511 patients (296 males, 215 females) admitted for acute diverticulitis between January 1994 and December 2003. Excluded were patients with stoma reversal only, "diverticulitis" mimicked by cancer, or significantly deficient patient records. Patients were analyzed either as a whole or subgrouped according to age (<40 yr, >40 yr). A modified Hinchey classification was used to stage the severity of acute diverticulitis. RESULTS: In 99 patients (19.4%), an abscess was found (74 pericolic, 25 pelvic, median diameter: 4.0 cm). CT-guided drainage was performed in 16 patients, one failure requiring a two-stage operation. Whereas conservative treatment failed in 6.8% in patients without abscess or perforation, 22.2% of patients with an abscess required an urgent resection (68.2%, one-stage, 31.8%, two-stage). Recurrence rates were 13% for mild cases, as compared to 41.2% in patients with a pelvic abscess (stage II) treated conservatively with/without CT-guided drainage. Of all surgical cases, resection/primary anastomosis was achieved in 73.6% with perioperative mortality of 1.1% and leak rate was 2.1%. CONCLUSIONS: CT evidence of a diverticular abscess has a prognostic impact as it correlates with a high risk of failure from nonoperative management regardless of the patient's age. After treatment of diverticulitis with CT evidence of an abscess, physicians should strongly consider elective surgery in order to prevent recurrent diverticulitis.
Abdominal Abscess↗
Anorectal pathology in HIV/AIDS-infected patients has not been impacted by highly active antiretroviral therapy.
PURPOSE: The aim of this study was to determine if the prevalence and distribution of anorectal pathology in HIV-infected patients treated by colorectal surgeons have changed after the introduction of highly active antiretroviral therapy. METHODS: The Los Angeles County-University of Southern California HIV Clinic is solely dedicated to the care of HIV patients. A colorectal clinic was established within this environment in 1991 and has served as the exclusive provider for the care of anorectal pathology in these patients. A prospective database of patients treated at this clinic was reviewed for two 18-month periods. The first group (early period) was composed of patients treated between January 1994 through June 1995, before the institution of more effective antiretroviral therapy. The second group (later period) consisted of patients treated between January 2001 through June 2002, after the introduction of highly active antiretroviral therapy. Data were tabulated for HIV-related anorectal pathologies, such as anal ulcer and anogenital condyloma, and non-HIV-related pathologies, including fissure, fistula in ano, hemorrhoids, perianal abscess, and other pathologies, for each of the two time periods. RESULTS: A total of 117 individual patients with anorectal pathology were treated in the early period and 109 received care in the later period, of which 107 were able to be evaluated. The pathology was distributed as follows for the early vs. late periods: 33 vs. 33 percent for ulcer, 30 vs. 34 percent for condyloma, 9 vs. 4 percent for fissure, 6 vs. 6 percent for fistula, 4 vs. 5 percent for hemorrhoids, 3 vs. 3 percent for abscess, and 15 vs. 16 percent for all other anorectal pathology. There was no statistically significant difference in any of these groups. CONCLUSION: The prevalence and distribution of both HIV-related and non-HIV-related anorectal pathology seen in our HIV patients have not been altered by the introduction of highly active antiretroviral therapy.
Acquired Immunodeficiency Syndrome↗
A comparison of laparoscopically assisted and open colectomy for colon cancer.
BACKGROUND: Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence (based on frequent reports of tumor recurrences within surgical wounds) prompted a controlled trial evaluation. METHODS: We conducted a noninferiority trial at 48 institutions and randomly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons. The median follow-up was 4.4 years. The primary end point was the time to tumor recurrence. RESULTS: At three years, the rates of recurrence were similar in the two groups--16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group (two-sided P=0.32; hazard ratio for recurrence, 0.86; 95 percent confidence interval, 0.63 to 1.17). Recurrence rates in surgical wounds were less than 1 percent in both groups (P=0.50). The overall survival rate at three years was also very similar in the two groups (86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group; P=0.51; hazard ratio for death in the laparoscopic-surgery group, 0.91; 95 percent confidence interval, 0.68 to 1.21), with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer. Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group, as reflected by a shorter median hospital stay (five days vs. six days, P<0.001) and briefer use of parenteral narcotics (three days vs. four days, P<0.001) and oral analgesics (one day vs. two days, P=0.02). The rates of intraoperative complications, 30-day postoperative mortality, complications at discharge and 60 days, hospital readmission, and reoperation were very similar between groups. CONCLUSIONS: In this multi-institutional study, the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.
Adenocarcinoma↗
Is pouchitis a clinical, endoscopic, or histologic problem?
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
Management of retained colorectal foreign bodies: predictors of operative intervention.
PURPOSE: This study was designed to review experience at our hospital with retained colorectal foreign bodies. METHODS: We reviewed the consultation records at Los Angeles County + University of Southern California General Hospital from October 1993 through October 2002. Ninety-three cases of transanally introduced, retained foreign bodies were identified in 87 patients. Data collected included patient demographics, extraction method, location, size and type of foreign body, and postextraction course. RESULTS: Of 93 cases reviewed, there were 87 individuals who presented with first-time episodes of having a retained colorectal foreign body. For these patients, bedside extraction was successful in 74 percent. Ultimately, 23 patients were taken to the operating room for removal of their foreign body. In total, 17 examinations under anesthesia and 8 laparotomies were performed (2 patients initially underwent an anesthetized examination before laparotomy). In the eight patients who underwent exploratory laparotomy, only one had successful delivery of the foreign object into the rectum for transanal extraction. The remainder required repair of perforated bowel or retrieval of the foreign body via a colotomy. In our review, a majority of cases had objects retained within the rectum; the rest were located in the sigmoid colon. Fifty-five percent of patients (6/11) presenting with a foreign body in the sigmoid colon required operative intervention vs. 24 percent of patients (17/70) with objects in their rectum (P = 0.04). CONCLUSIONS: This is the largest single institution series of retained colorectal foreign bodies. Although foreign objects located in the sigmoid colon can be retrieved at the bedside, these cases are more likely to require operative intervention.
Adolescent↗
Molecular biology of squamous cell carcinoma of the anus: a comparison of HIV-positive and HIV-negative patients.
The molecular mechanisms involved in progression of squamous cell carcinoma of the anus (SCCA) are poorly elucidated, as well as the potential role of HIV infection. Loss of heterozygosity (LOH) is one of the mechanisms responsible for inactivation of tumor suppressor genes. We hypothesized that HIV-induced immunosuppression may contribute to an alternate molecular pathway in SCCA progression, through persistence of human papillomavirus infection within the anal canal. This study was undertaken to compare the molecular biology of SCCA in HIV-positive (HIV+) and HIV-negative (HIV-) patients. We retrieved tumor specimens from 18 HIV- and 10 HIV+ patients diagnosed with SCCA in two institutions. DNA from tumor and normal tissues was extracted and then amplified by polymerase chain reaction. LOH was investigated at 14 loci: three at 18q (DCC), two at 13q (Rb), three at 17p (p53), three at 11q, one at 2p, and two at 5q (APC). LOH was defined by a tumor DNA-to-normal tissue DNA ratio of >2. HIV+ patients were younger (36 +/- 7 years versus 53 +/- 13 years, P=0.001) and showed a trend toward tumors of larger size (3.7 +/- 1.6 cm versus 2.6 +/- 1.5 cm, P=0.09). The median CD4+ count in HIV+ patients at the time of diagnosis was 74 x 10(6)/L (range, 5-900). The overall frequency of LOH was 17.3% (41 LOH of 236 informative loci). Tumors in HIV- patients were more likely to present LOH than were tumors in HIV+ patients (24.1% versus 6.6%, P=0.0004). Differences between the two groups with regard to allelic losses were also observed at specific loci, such as 18q (41% [HIV-] versus 0% [HIV+], P=0.05), 17p (43% versus 10%, P=0.09), and 5q (33% versus 0%, P=0.12). Consistent LOH on chromosomes 17p, 18q, 5q, and 11q were observed in HIV- patients with SCCA. By contrast, allelic losses at 17p, 5q, and 18q seem to be rare in tumors of HIV+ individuals. These data suggest that immunosuppression may promote SCCA progression through an alternate pathway and that persistence of HPV infection within the anal canal may play a central role in this process.
Adult↗
Patterns of Internet use: bariatric versus colorectal patients in a private institution.
BACKGROUND: The frequency of Internet use for self-directed medical care in different patient populations is increasing. We evaluated Internet use by patients presenting for bariatric surgery. STUDY DESIGN: Surveys were completed by 136 patients (109 women, 22 men) presenting to a private academic clinic for bariatric surgery. Data collected included age, gender, education level, household income, and pattern of Internet use. Comparisons were made with a group of 135 patients who visited a colorectal surgery clinic in the same institution. RESULTS: Bariatric patients who used the Internet were more likely than colorectal patients to inform themselves about their medical problem (76% versus 49%, p < 0.001) and tended to use the Internet more overall (85% versus 78%, p = ns). Use of the Internet to research bariatric surgery was associated with education level (p = 0.002) and household income (p = 0.01), but not with age or gender. Bariatric patients were more likely than colorectal patients to search our institution's Web site (40% versus 17%, p < 0.001) and to use the Internet to find out about their surgeon (47% versus 31%, p = 0.01). Only 9% of bariatric patients used a chat room. Ninety-six percent of bariatric patients found the information on the Internet easy to understand and 58% described it as very helpful. CONCLUSIONS: Bariatric patients are especially likely to use the Internet to gain information about their medical condition, possibly reflecting their limited mobility. This represents an educational opportunity for the surgical community.
Adult↗
Laparoscopic-assisted vs. open colectomy for colon cancer: a prospective randomized trial.
PURPOSE: Although laparoscopic-assisted colectomy (LAC) has evolved as a technical option in the treatment of benign colonic diseases, its role in the treatment of malignancies remains controversial. The purpose of this prospective randomized trial was to compare perioperative parameters and outcomes between LAC vs. open colectomy (OC) in patients with stage I-III colon cancer. PATIENTS AND METHODS: Eligible patients with colon cancer who were scheduled for an elective colon resection from January 1995 to February 2001 were randomized to either the LAC or the OC treatment group. The two groups were compared with regard to operative time, blood loss, complications, pathologic findings and lymph node yield, length of postoperative hospital stay, gastrointestinal function, use of analgesic drugs, recurrence, and survival rates. The median follow-up was 35 months (range, 3-69 months). RESULTS: A total of 49 patients were enrolled in the study: 20 were randomized to OC and 29 to LAC, one of whom was lost to follow-up. Thirteen patients in the LAC group had to be converted to OC (COC), and were analyzed in a separate group. The three patient groups were comparable with regard to age, gender distribution, tumor site, lymph node harvest, operative procedure, anastomotic type, perioperative complication, recurrence, and survival rates. Tumor margins were clear in all patients. No incidence of port-site recurrence in the LAC group, or wound recurrence in the OC and COC groups, was found. Three patients died of cancer-related causes, one in each patient group. The LAC patients had significantly shorter hospital stay, faster recovery of gastrointestinal function, and less use of intravenous analgesia. CONCLUSION: Short-term outcomes revealed that LAC could be performed safely and has therapeutic results similar to OC for colon cancer. Conversion of LAC to an open procedure was frequent but was not associated with a negative outcome.
Adult↗