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Wai Lun Law

Publications and source records attributed to Wai Lun Law.

At least 19 recordsLinked to original sources
PubMed2007

Impact of laparoscopic resection for colorectal cancer on operative outcomes and survival.

OBJECTIVE: This study aimed to compare the outcomes of patients who underwent laparoscopic and open resections for colorectal cancer. Comparison of colectomy in 2 consecutive periods (period 1: January 1996-May 2000; period 2: June 2000-December 2004), with laparoscopic surgery being a surgical option in period 2, was also performed. SUMMARY BACKGROUND DATA: Prospective data of 1134 patients (448 in period 1; 656 in period 2) who underwent elective resection for colon and upper rectal cancer (above 12 cm from anal verge) were analyzed. METHODS: The operative outcome and survival were compared between patients who underwent laparoscopic and open resection in period 2. The outcomes of colorectal resections in the 2 periods were also compared. RESULTS: During period 2, the operative mortality rates of patients with laparoscopic (n = 401) and open resection (n = 255) were 0.8% and 3.7%, respectively (P = 0.022), and the morbidity rates were 21.7% and 15.7%, respectively (P = 0.068). The patients who underwent laparoscopic resection had significantly earlier return of bowel function, earlier resumption of diet, and shorter hospital stay. The 3-year overall survivals in those with nondisseminated disease were 74.4% and 78.8% for open and laparoscopic resection, respectively (P = 0.046). The operative morality rates were 4.4% and 2.6% in period 1 and period 2, respectively (P = 0.132). The 3-year overall survivals for patients with nondisseminated disease were 69.7% and 76.1% for period 1 and period 2, respectively (P = 0.019). The overall survivals in patients who underwent open resection in the 2 periods were similar (P = 0.284). CONCLUSIONS: The short-term favorable outcome of laparoscopic resection for colorectal cancer was confirmed and improvement of survival was observed with the practice of laparoscopic resection.

Adult↗
PubMed2006

Outcomes of resection of stage IV rectal cancer with mesorectal excision.

BACKGROUND: There is no consensus as to the management of the primary rectal cancer in the presence of distant metastasis and data on the outcomes of radical resection in stage IV rectal cancer are limited. This study aims to evaluate the results of resection of rectal cancer in the patients with stage IV disease and to analyze the factors that might affect the survival of these patients. METHODS: Of the 744 patients with radical resection of primary rectal and rectosigmoid cancer during the study period from August 1993 to July 2002, 70 had stage IV disease on the initial presentation. The demographics, the operative details, the tumor characteristics, the postoperative outcomes and survival of the patients were collected prospectively. Factors influencing the survival were analyzed with univariate and multivariate analysis. RESULTS: Fifty-three men and 17 women with a median age of 66 years (range: 31-90 years) were included. The median level of the tumor from the anal verge was 10 cm (range 3-20 cm). The operations included abdominoperineal resection (n = 5), anterior resection (n = 53), and Hartmanns operation (n = 11). The operation mortality was 4.3%. The overall morbidity was 42.7% while the surgical morbidity and the reoperation rates were 15.7% and 5%, respectively. The local recurrence rate was 4.3% and the 2-year actuarial rate was 7.8%. All the patients who had local recurrences also had disseminated peritoneal metastasis. The median cancer-specific survival of the patients who survived the surgery was 15.2 months. Multivariate analysis showed that the presence of gross residual local disease, lymph node metastasis, liver involvement of over 50%, the absence of surgical management of liver metastasis and those without chemotherapy were independent factors associated with poor survival. CONCLUSIONS: Postoperative mortality and morbidity were acceptable in patients with stage IV rectal cancer. The local disease can be controlled effectively with radical resection. However, in patients with extensive liver involvement and advanced local disease, resection is not worthwhile because of the poor survival. Surgical management of the metastasis and the administration of chemotherapy are associated with better survival. However, the optional treatment regimes are yet to be defined.

Adult↗
PubMed2006

Outcomes of surgery for mid and distal rectal cancer in the elderly.

BACKGROUND: This study aimed to evaluate the surgical strategies, operative results, and oncological outcomes of elderly patients who underwent curative resection for mid and distal rectal cancer. Comparison was made with patients of younger age. STUDY DESIGN: Of the 612 patients who underwent curative resection for rectal cancer, 133 were older than 75 years of age. Comparisons were made between the young and elderly patients in the aspects of operative strategies, operative results, and long-term outcomes. RESULTS: Resection resulting in a permanent end colostomy was performed in 96 patients (15.7%), and there was no difference between young and elderly patients. There was a female predominance in the elderly group. Elderly patients also had a higher incidence of comorbid medical diseases, especially cardiovascular and neurological diseases. The operative time, blood loss, and incidence of intraoperative complications did not differ in the two groups. However, significantly fewer elderly patients underwent adjuvant radiation and/or chemotherapy. The overall 30-day mortality was 1.14%. There was no difference between the elderly patients and younger patients in hospital mortality (P = 0.178). The complication rates of the elderly and young patients were 36.8% and 30.1%, respectively (P = 0.141). Comparison between the individual complications in the elderly and young patients revealed significantly more cardiovascular complications in the elderly patients. With the median follow up of the surviving patients of 45.1 months, the overall 5-year survival of the elderly and younger groups was 47.7% and 70.1%, respectively (P < 0.001). The 5-year cancer-specific survival was 75.4% and 67.5% in the young and elderly patients, respectively (P = 0.061). CONCLUSIONS: Curative resection for mid and distal rectal cancer for the elderly can be performed safely with the same strategies of sphincter preservation used for younger patients. The postoperative complications and the 5-year cancer-specific survival rates were similar to those of younger patients.

Adenocarcinoma↗
PubMed2006

Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes.

PURPOSE: This study was designed to compare the outcomes of laparoscopic anterior resection with open operation for mid and upper rectal cancer. METHODS: A total of 265 patients who underwent elective laparoscopic or open anterior resection for cancer of the mid and upper rectum from June 2000 to December 2004 were included. Data about the patients' demographics, operative details, postoperative outcome, and disease status were collected prospectively. Comparison of the outcome between laparoscopic and open resection was performed. RESULTS: The median age of the 265 patients was 69 (range, 27-91) years, and laparoscopic anterior resection was performed in 98 patients (37 percent). There was no difference in the age, gender, comorbidities, and level of tumor between the two groups. The operating time was longer in the laparoscopic group (200 vs. 127 minutes; P < 0.01), but the blood loss was less (200 vs. 250 ml; P = 0.027). The overall operative mortality was 1.8 percent, and the complication rate was 27.9 percent. Significantly more patients with early diseases (Stage I and Stage II) were operated with laparoscopic approach. There was no difference in the mortality or morbidity between the two groups. Anastomotic leakage occurred in five patients with open resection and one with laparoscopic resection (P = 0.418). Patients with laparoscopic resection had an earlier return of bowel function and earlier resumption of diet as well as a shorter median hospital stay (7 vs. 8 days; P < 0.001). With the median follow-up of the surviving patients for 21.2 months, the three-year local recurrence rates for those with open and laparoscopic resection were 4.9 and 3.3 percent, respectively (P = 0.513). In patients with Stage I and Stage II disease, the three-year cancer-specific survivals for open and laparoscopic resection were 89.8 and 88.6 percent, respectively (P = 0.882), whereas those of patients with Stage III disease were 65.6 and 55.5 percent, respectively (P = 0.911). CONCLUSIONS: Laparoscopic anterior resection for mid and proximal rectal cancer is a safe option with short-term advantages compared with open operation. The oncologic outcomes of patients who underwent laparoscopic anterior resection were not compromised, with similar local recurrence rate and the cancer-specific survival rate as patients who underwent open resection.

Adult↗
PubMed2006

Self-expanding metallic stent as a bridge to surgery versus emergency resection for obstructing left-sided colorectal cancer: a case-matched study.

This study aimed to compare the outcomes of patients who suffered from obstructing left-sided colorectal cancer, treated with self-expanding metallic stent (SEMS) as a bridge to surgery, with those who underwent emergency operation. Twenty patients who had acute obstruction due to left-sided colorectal cancer underwent surgical resection after insertion of SEMS (group I) were matched to 40 patients with emergency colonic resection (group II). The two groups were compared for the incidence of primary anastomosis, stoma rate, hospital stay, duration of intensive care, postoperative morbidity, and mortality. Both groups had similar preoperative comorbidity and stage of disease, but the tumors in group I were more distally located (P < 0.001). In group I, one patient developed colon perforation and required Hartmann's operation. All the other patients underwent elective operation with primary anastomosis. In group II, primary anastomosis was performed in 29 patients (72.5%; P = 0.047). The operative mortality of group I and group II was 5% and 12.5%, respectively (P = 0.653). Significantly shorter median postoperative hospital stay and median stay in the intensive care unit (ICU) were observed in group I (9 days [range, 5-39 days] vs. 12 days [range, 8-49 days], P = 0.015 and 0 day [range, 0-17 days] vs. 0.5 day [range, 0-18 days], P = 0.022, respectively). There were no differences in hospital mortality (P = 0.653) or 30-day mortality (P = 0.653). Both groups had similar reoperation rates, surgical complications, and medical complications. When compared with emergency resection, insertion of SEMS as a bridge to surgery for obstructing left-sided colorectal cancer is associated with a higher rate of primary anastomosis as well as a better outcome in terms of hospital stay and stay in the ICU. The wider application of this treatment option for obstructing colorectal cancer warranted further studies.

Aged↗
PubMed2006

Urinary retention after haemorrhoidectomy: Impact of stapled haemorrhoidectomy.

OBJECTIVE: Urinary retention is a common complication following haemorrhoidectomy. Stapled haemorrhoidectomy (SH) is associated with less postoperative pain, but whether or not this can reduce the incidence of urinary retention has not been evaluated. This study aimed to compare the incidence of urinary retention in patients treated with SH with those treated with conventional haemorrhoidectomy (CH). METHODS: Charts of patients who underwent haemorrhoidectomy between May 2000 and March 2003 were reviewed. Data on demographics of patients, operative procedures, modes of anaesthesia, postoperative hospital stay and morbidities including urinary retention were collected. Factors that might affect the incidence of urinary retention were analysed by univariate and multivariate analyses. RESULTS: During the study period, 204 patients (100 men and 104 women; mean age, 49 years; age range, 20-82 years) underwent haemorrhoidectomy. SH was performed in 90 (44.1%) patients while the other 114 (55.9%) had CH. Seventy patients (34.3%) were operated on as day cases. One hundred and seventeen (57.4%) patients underwent surgery under general anaesthesia and 87 (42.6%) were operated on under spinal anaesthesia. Urinary retention occurred in 31 patients (seven with SH and 24 with CH, p = 0.009). Logistic regression showed that general anaesthesia (p = 0.044; odds ratio [OR], 2.43; 95% confidence interval [CI], 1.02-5.97) and SH (p = 0.046; OR, 2.66; 95% CI, 1.02-7.00) were independent factors associated with a lower incidence of urinary retention. CONCLUSION: The incidence of urinary retention following haemorrhoidectomy was 15.2%. General anaesthesia and SH were independent significant factors associated with a lower incidence of urinary retention.

Adult↗
PubMed2005

Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options.

PURPOSE: This study examined the accuracy of Portsmouth Physiologic and Operative Severity Score for enUmeration of Mortality and Morbidity system (P-POSSUM) in predicting the mortality of patients who underwent operations for obstructing colorectal cancer. It also is attempted to analyze the actual mortality and the predicted P-POSSUM mortality of different surgical options for obstructing left-sided cancer. METHODS: Data on patients who underwent surgery for obstructing colorectal cancer during 1998 to 2002 were collected. Mortality predicted by P-POSSUM was compared to the actual mortality with the method of linear analysis. The accuracy of using P-POSSUM to predict mortality in this group of patients was assessed by Hosmer and Lemeshow goodness of fit test and Receiver Operator Characteristic curve analysis. The predicted and actual mortality of patients who underwent different surgical options also were analyzed. RESULTS: A total of 160 patients were included in the study and 18 patients died postoperatively. The operative mortality was 11.3 percent. P-POSSUM predicted overall mortality of 15 percent. The observed and predicted mortality was found to have no significant lack of fit (chi-squared = 5.98; degree of freedom = 3; P = 0.11). The area under Receiver Operator Characteristic curve analysis was 0.75. For patients with left-sided tumors, P-POSSUM predicted mortality and actual mortality of patients who had resection without anastomosis were both significantly higher than patients with single-stage resection and primary anastomosis (P = 0.044 and 0.011, respectively). CONCLUSIONS: P-POSSUM system is valid for prediction of overall mortality in patients with operations for obstructing colorectal cancer. Estimation of P-POSSUM predicted mortality during operation and its ability to correlate with choice of procedure is an area that is worth further study in emergency colorectal surgery.

Adult↗
PubMed2005

Outcome of anterior resection for stage II rectal cancer without radiation: the role of adjuvant chemotherapy.

BACKGROUND: This study aimed to evaluate the oncological outcome of patients who had Stage II rectal cancer and underwent curative nonsphincter-ablation surgery without adjuvant radiation. PATIENTS AND METHODS: During the study period from August 1993 to December 2002, 224 patients (141 men) with Stage II cancer underwent curative anterior resection or Hartmann's procedure without adjuvant radiation. Data were collected prospectively. The oncologic outcomes of these patients were studied and the risk factors for recurrence and survival were analyzed. RESULTS: The median age of the patients was 69 (range, 27-89) years and the median level of the tumor from the anal verge was 8 (range, 3-20) cm. Four patients (1.8 percent) died in the postoperative period and postoperative complications occurred in 74 patients (33 percent). The median follow-up time of the surviving patients was 43.6 months. The actuarial five-year recurrence rate was 25.4 percent, whereas the five-year actuarial local and systemic recurrence rates were 6.1 percent and 20 percent, respectively. On multivariate analysis, independent factors associated with a higher recurrence rate included lymphovascular invasion, perineural invasion, and absence of chemotherapy. The overall and cancer-specific survival rates of the patients were 71.1 percent and 81.1 percent, respectively. On multivariate analysis, only adjuvant chemotherapy (P = 0.024; hazard ratio = 6.04; 95 percent confidence interval, 1.27-28.74) and the absence of lymphovascular invasion (P = 0.002; hazard ratio = 3.77; 95 percent confidence interval, 1.63-8.77) were independent factors associated with significantly better cancer-specific survival. CONCLUSION: A low local recurrence rate can be achieved in patients with Stage II rectal cancer treated with nonsphincter-ablation surgery without adjuvant radiation. Postoperative chemotherapy is associated with a lower recurrence rate and higher survival rates. Further study is warranted to define the role of adjuvant chemotherapy in patients with rectal cancer.

Adult↗
PubMed2004

Palliation for advanced malignant colorectal obstruction by self-expanding metallic stents: prospective evaluation of outcomes.

PURPOSE: This study was designed to evaluate the outcomes of self-expanding metallic stents as a palliative treatment for malignant obstruction of the colon and rectum. METHODS: The insertion of self-expanding metallic stents was attempted for palliation in 52 patients (33 males; mean age, 66.5 +/- 16.4 years) with colorectal obstruction caused by advanced malignancies. The stents were inserted under endoscopic and fluoroscopic guidance. The data on the success of the procedure, the complications, and the outcomes of the patients were collected prospectively. RESULTS: Thirty patients had locally advanced or disseminated primary colorectal cancers, and 22 had recurrent cancer of colorectal or other primaries. Successful insertion of the stent was achieved in 50 patients. The median survival of the patients was 88 (range, 3-450) days. Complications occurred in 13 patients (25 percent). These included perforation of the colon (n=1), migration or dislodgement of the stents (n=8), severe tenesmus (n=1), colovesical fistula (n=1), and tumor ingrowth (n=2). Insertion of a second stent was required in eight patients. Subsequent operations were performed in nine patients, and stoma creation was required in seven patients. CONCLUSIONS: Self-expanding metallic stents are highly effective in relieving malignant colorectal obstruction. The complication rate is acceptable and palliation can be achieved in the majority of the patients without a stoma.

Adult↗
PubMed2004

Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients.

OBJECTIVE: This study aims to review the operative results and oncological outcomes of anterior resection for rectal and rectosigmoid cancer. Comparison was made between patients with total mesorectal excision (TME) for mid and distal cancer and partial mesorectal excision (PME) for proximal cancer, when a 4- to 5-cm mesorectal margin could be achieved. Risk factors for local recurrence and survival were also analyzed. SUMMARY BACKGROUND DATA: Anterior resection has become the preferred treatment option rectal cancer. TME with sharp dissection has been shown to be associated with a low local recurrence rate. Controversies still exist as to the need for TME in more proximal tumor. METHODS: Resection of primary rectal and rectosigmoid cancer was performed in 786 patients from August 1993 to July 2002. Of these, 622 patients (395 men and 227 women; median age, 67 years) underwent anterior resection. The technique of perimesorectal dissection was used. Patients with mid and distal rectal cancer were treated with TME while PME was performed for those with more proximal tumors. Prospective data on the postoperative results and oncological outcomes were reviewed. Risk factors for anastomotic leakage, local recurrence, and survival of the patients were analyzed with univariate and multivariate analysis. RESULTS: The median level of the tumor was 8 cm from the anal verge (range, 2.5-20 cm) and curative resection was performed in 563 patients (90.5%). TME was performed in 396 patients (63.7%). Significantly longer median operating time, more blood loss, and a longer hospital stay were found in patients with TME. The overall operative mortality and morbidity rates were 1.8% and 32.6%, respectively, and there were no significant differences between those of TME and PME. Anastomotic leak occurred in 8.1% and 1.3% of patients with TME and PME, respectively (P < 0.001). Independent factors for a higher anastomotic leakage rate were TME, the male gender, the absence of stoma, and the increased blood loss. The 5-year actuarial local recurrence rate was 9.7%. The advanced stage of the disease and the performance of coloanal anastomosis were independent factors for increased local recurrence. The 5-year cancer-specific survival was 74.5%. The independent factors for poor survival were the advanced stage of the disease and the presence of lymphovascular and perineural invasion. CONCLUSIONS: Anterior resection with mesorectal excision is a safe option and can be performed in the majority of patients with rectal cancer. The local recurrence rate was 9.7% and the cancer-specific survival was 74.5%. When the tumor requires a TME, this procedure is more complex and has a higher leakage rate than in those higher tumors where PME provides adequate mesorectal clearance. By performing TME in patients with mid and distal rectal cancer, the local control and survival of these patients are similar to those of patients with proximal cancers where adequate clearance can be achieved by PME.

Adult↗
PubMed2003

Non-curative surgery for colorectal cancer: critical appraisal of outcomes.

BACKGROUND AND AIMS: The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery. PATIENTS AND METHODS: Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis. RESULTS: Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy. CONCLUSION: Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment.

Adult↗
PubMed2003

Evaluation of an automated immunochemical fecal occult blood test for colorectal neoplasia detection in a Chinese population.

BACKGROUND: Most commercial fecal occult blood tests (FOBT) used for colorectal carcinoma screening of Western populations are guaiac-based, manually developed, subjective, and sensitive to dietary components. Preliminary studies demonstrated the unsuitability of these tests for screening a Chinese population. The goal of the current study was to evaluate the performance characteristics of a human hemoglobin-specific automated immunochemical FOBT, the Magstream 1000/Hem SP (Fujirebio, Inc., Tokyo, Japan), in a Chinese population referred for colonoscopy. METHODS: Two hundred fifty consecutive patients who were referred for colonoscopy and met the study inclusion criteria provided samples for the immunochemical FOBT (without dietary restrictions) from two successive stool specimens. Tests were developed with an automated instrument that had an adjustable sensitivity threshold. The sensitivity, specificity, and positive predictive value for detecting colorectal adenomas and carcinomas were calculated according to the manufacturer's instructions over a range of sensitivity levels. RESULTS: At the optimal threshold level, the sensitivity, specificity, and positive predictive value for detection of significant colorectal neoplasia (adenomas >or= 1.0 cm and carcinomas) were 62%, 93%, and 44%, respectively. The test was easy to use, and results did not depend on operator experience. CONCLUSIONS: The automated immunochemical FOBT used in the current study was a robust, convenient, and useful tool for colorectal carcinoma screening in the study population.

Adenoma↗
PubMed2003

Scirrhous colonic metastasis from ductal carcinoma of the breast: report of a case.

Metastasis of breast cancer to the colon is rare. We report a case of a 49-year-old female who presented with a stenotic tumor of the descending colon five years after treatment of breast cancer with mastectomy and pedicled transverse rectus abdominis musculocutaneous flap. Laparotomy showed a diffusely infiltrated tumor over the descending colon. Anterior resection with loop ileostomy was performed, and the pathology showed that the colonic wall and the mesentery were diffusely infiltrated with poorly differentiated adenocarcinoma, which stained strongly for cytokeratin 7. The histologic diagnosis is consistent with colonic metastasis from ductal carcinoma of breast origin. In a patient with a history of breast cancer, colonic metastasis from the breast primary cancer should be considered, especially if the colonic lesion is scirrhous in nature. The incision for laparotomy and the probable stoma site should be planned carefully in females after breast reconstructive surgery.

Adenocarcinoma, Scirrhous↗
PubMed2003

Granulomatous appendicitis progressing to Crohn's disease with bleeding complication.

Granulomatous appendicitis can be idiopathic or due to a number of specific causes. Idiopathic granulomatous appendicitis is regarded as a separate disease entity and usually has a benign course. We report on a case of granulomatous appendicitis, which progressed to fulminant Crohn's colitis shortly after appendicectomy. During the treatment with intravenous steroid, torrential gastro-intestinal bleeding developed and emergency subtotal colectomy had to be performed. The clinical and histological features of the case are presented and the literature on granulomatous appendicitis reviewed.

Adult↗
PubMed2002

Functional outcome following low anterior resection with total mesorectal excision in the elderly.

BACKGROUND AND AIMS: Disturbance of bowel function is not uncommon following low anterior resection, but the effect of low anterior resection on the elderly has seldom been documented. This study investigated the functional outcome in elderly patients following low anterior resection for carcinoma of the rectum. PATIENTS AND METHODS: The study included 87 patients with carcinoma of middle and lower rectum who underwent curative low anterior resection with total mesorectal excision and remained alive without recurrence for at least 6 months following the resection or closure of stoma. Anorectal manometry and questionnaire survey of the patients' bowel function were performed during follow-up (median 24.1 months) to investigate the functional outcome after surgery. RESULTS: The median number of bowel motions was 2.5 per day in both elderly and young patients. Complete continence was achieved in 71.3% of patients, with both elderly and young patients performing similarly. The most common symptoms were clustering of bowel motions and urgency, which occurred in 30.3% and 34.9% of patients respectively, regardless of age. Manometric findings were also similar between the elderly and their younger counterparts. CONCLUSION: Bowel function and manometric findings following low anterior resection with total mesorectal excision in the elderly are not worse than in younger patients.

Aged↗