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At least 19 recordsLinked to original sources

PubMed2004

Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM).

BACKGROUND: The aim of the study was to develop a dedicated colorectal Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (CR-POSSUM) equation for predicting operative mortality, and to compare its performance with the Portsmouth (P)-POSSUM model. METHODS: Data were collected prospectively from 6883 patients undergoing colorectal surgery in 15 UK hospitals between 1993 and 2001. After excluding missing data and 93 patients who did not satisfy the inclusion criteria, 4632 patients (68.2 per cent) underwent elective surgery and 2107 had an emergency operation (31.0 per cent); 2437 operations (35.9 per cent) for malignant and 4267 (62.8 per cent) for non-malignant diseases were scored. Stepwise logistic regression analysis was used to develop an age-adjusted POSSUM model and a dedicated CR-POSSUM model. A 60:40 per cent split-sample validation technique was adopted for model development and testing. Observed and expected mortality rates were compared. RESULTS: The operative mortality rate for the series was 5.7 per cent (387 of 6790 patients) (elective operations 2.8 per cent; emergency surgery 12.0 per cent). The CR-POSSUM, age-adjusted POSSUM and P-POSSUM models had similar areas under the receiver-operator characteristic curves. Model calibration was similar for CR-POSSUM and age-adjusted POSSUM models, and superior to that for the P-POSSUM model. The CR-POSSUM model offered the best overall accuracy, with an observed : expected ratio of 1.000, 0.998 and 0.911 respectively (test population). CONCLUSION: The CR-POSSUM model provided an accurate predictor of operative mortality. External validation is required in hospitals different from those in which the model was developed.

Adult↗

PubMed1998

Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery. Laparoscopic Colorectal Surgery Study Group (LCSSG).

BACKGROUND: Prospective randomized multicenter studies comparing laparoscopic with open colorectal surgery are not yet available. Reliable data from prospective multicenter studies involving consecutive patients are also lacking. On the basis of the personal caseloads of specialized surgeons or of retrospective analyses, it is difficult to judge the true effectiveness of this new technique. This study aims to investigate the results of laparoscopic colorectal surgery in consecutive patients operated on by unselected surgeons. METHODS: This observational study was begun August 1, 1995, in the German-speaking part of Europe (Germany and Austria) and 43 centers initially agreed to participate. All consecutive cases were documented. All data were rendered anonymous. Analysis was performed on an intention-to-treat basis. The study committee was blinded to the participating center. RESULTS: By the end of the 1st year, 500 patients (M:F ratio 0.83, mean age 62.9 years) had been treated by 18 centers; 269 operations were performed for benign indications and 231 for cancer (palliative and curative). Most operations were done on the distal colon or rectum. An anastomosis was performed in 84%, with an overall leakage rate of 5.3% (colon 3.6% and rectum 11.8%), which required surgical reintervention in 1.7%. The mean operating time was 176 min and showed a decreasing tendency over the period under study. The conversion rate was 7.0% and the overall complication rate 21.4%. The reoperation rate was 6.6%; the most common cause was bleeding. There was one ureteral lesion (0.2%), but urinary tract infections were fairly common (4.8%). A postoperative pneumonia was diagnosed in 1.6% of the cases. No thromboembolic complications were reported. The 30-day mortality rate was 1.4% and overall hospital mortality 1.8%. CONCLUSIONS: Laparoscopic colorectal operations are still rare (about 1% of all colorectal operations in Germany). Laparoscopic procedures are more common on the left colon and rectum than on the right colon. The surgical complication rate is acceptable, comparable with rates reported by others for open surgery. Cardiopulmonary and thromboembolic complications were rarely seen. Mortality and surgical morbidity rates do not differ significantly among participating centers. A learning curve, reflected by a shortening of the operating time and a somewhat lower conversion rate, was observed over the observation period.

Aged↗

PubMed1985

Chemoprophylaxis of postoperative infections in colorectal surgery.

Colorectal surgery involves a high risk of postoperative infections. The major risk factors can be reduced by appropriate preparation of the patient for the operation. Mechanical removal of gross faecal material from the bowel, possible before most elective operations, does not sufficiently reduce the incidence of postoperative infections. Prophylactic medication has not yet been widely accepted, although its effectiveness has been confirmed by a number of studies. Preoperative management of patients subjected to colorectal surgery at our institution in the last three years, consisted of mechanical cleansing of the intestinal tract for two days, followed by rapid intravenous administration of gentamicin 80 mg and metronidazole 500 mg in a single dose, 30 min to 1 h before the operation. From 1971 to 1973, the postoperative infection rate in 432 patients submitted to elective colorectal surgery was 29%. During the period 1981-1983, operations of the same kind were performed in 572 patients, the infection rate being 15%. Prophylactic single-dose administration of gentamicin in combination with metronidazole has proved to be very effective in reducing postoperative infections.

Aged↗

PubMed1983

Thrombosis of peripheral aneurysms. A complication of colorectal surgery.

Colorectal surgery performed with patients in the lithotomy position resulted in acute limb ischemia due to thrombosis of unrecognized peripheral aneurysms. A search of the literature failed to find this complication reported. It is postulated that the mechanism of injury is due to calf compression in the lithotomy position and/or external iliac artery compression by a retractor. Awareness of the peripheral aneurysm prior to colorectal surgery and appropriate modification of the operative approach should prevent this complication.

Aged↗

PubMed2003

Robot-assisted laparoscopic colorectal surgery.

Colorectal surgery can be difficult at open and laparoscopic surgery. This is particularly the case for rectal surgery deep in the pelvis. In obese males distal rectal dissection can be challenging because of instrument and visual limitations. Robot-assisted laparoscopic colorectal operations do not differ significantly from the standard laparoscopic approach but it has certainly been shown that it is feasible to perform the same operation using robotic assistance for the dissection. This allows the surgeon to benefit from vastly enhanced vision and dexterity, which may ultimately translate into benefit for the patient in terms of reduced operating time, and better preservation of pelvic nerves and other structures.

Colonic Diseases↗

PubMed1990

[Preoperative oral antimicrobial bowel preparations in elective colorectal surgery].

Colorectal surgery is associated with high incidence of postoperative wound infection due to contamination of the field of operation by organisms from the intestine. A consecutive series of 300 patients undergoing elective operations on the colon and rectum, was studied to determine the efficacy of oral antibacterial preparations on the influence of intestinal organisms at operation and the incidence of postoperative wound infection. The patients were divided into four groups as their preoperative bowel preparations as follows; 1st group: mechanical preparation alone, 2nd group: mechanical preparation and oral kanamycin, 3rd group: mechanical preparation and oral kanamycin and metronidazole, and 4th group: mechanical preparation and oral polymyxin B and metronidazole. The results of bacteriological studies on specimens taken by swab from colonic lumen and wound at operation showed effectiveness of kanamycin and polymyxin B against aerobic gram-negative rods and metronidazole against anaerobes. The rates of postoperative wound infection were 47.5% in 1st group, 27% in 2nd group, 12% 3rd group, and 2.7% in 4th group, respectively.

Administration, Oral↗

PubMed2001

The prevention of wound infection in patients undergoing colorectal surgery.

Colorectal operations are, at best, clean-contaminated procedures, and at times there is gross contamination of both the peritoneal cavity and the surfaces of the surgical wound. In addition, the diseases of the large bowel that require surgery tend to afflict elderly patients. Collectively, the combination of an unclean environment, major surgery and debilitated patients creates a situation that is associated with a very high incidence of wound infection. This review documents the considerable support from clinical trials and meta-analyses that exists for the prophylactic use of a single dose of a suitable parenteral antimicrobial agent. In addition, although the evidence is less clear cut, it does not appear that the use of mechanical bowel preparations reduces the incidence of wound infections after colorectal surgery.

Age Factors↗

PubMed1998

The current status of intraoperative radiotherapy in colorectal surgery.

Colorectal cancer is the second most common malignancy in Singapore and its incidence is increasing. Results of surgery have been augmented in selected cases by the addition of radiotherapy and chemotherapy. This standard approach only offers palliation in locally advanced and locally recurrent cancers. Newer modalities and combinations are currently being investigated to improve the results in this particular group of patients. One such modality is the use of intraoperative radiotherapy (IORT). This paper discusses the rationale for using IORT, the patient selection, method of delivery and treatment, tolerance and results in centers which have been using IORT as part of a multi-modality therapy for colorectal cancer.

Colorectal Neoplasms↗

PubMed2001

Heparins and mechanical methods for thromboprophylaxis in colorectal surgery.

BACKGROUND: Colorectal surgery implies higher risk of postoperative thromboembolic complications as deep venous thrombosis (DVT) and pulmonary embolism (PE) than general surgery. The best prophylaxis in general surgery is heparin and graded compression stockings. No systematic review on combination prophylaxis or on thrombosis prophylaxis in colorectal surgery has been published. OBJECTIVES: To compare the incidence of postoperative thromboembolism after colorectal surgery using prophylactic methods focussing on heparins and mechanical methods alone and in combinations. SEARCH STRATEGY: Electronic searches was performed in MEDLINE, EMBASE back to 1970. Abstract books from major congresses were handsearched as were reference lists from previously performed reviews. SELECTION CRITERIA: RCT or CCT comparing prophylactic interventions and/or placebo. Outcomes were ascending venography, 125 I-fibrinogen uptake test, ultrasound methods, pulmonary scintigraphy. Studies, using thermographic methods, other isotopic methods, plethysmographic methods, and purely clinical methods as the only diagnostic measure were excluded. 558 studies were identified - 477 were excluded. Only 3 of the identified studies focused exclusively on colorectal surgery. Studies of general surgery contain considerable numbers of colorectal patients. The authors of 66 studies in general and/or abdominal surgery were contacted for retrieving the results from the colorectal patients. Answers were received from very few. 19 studies entered this review. DATA COLLECTION AND ANALYSIS: All studies and all data extraction were performed independently by at least two of the authors. Outcome was deep venous thrombosis and/or pulmonary embolism. Analysis of bleeding complications were unfeasible. 12 meaningful outcomes were analysed by means of the fixed effects model with Peto Odds Ratios. MAIN RESULTS: Heparins versus no treatment: Any kind of heparincompared to no treatment or placebo (comparison 07.03, 11 studies). Heparin is better in preventing DVT and/or PE with a Peto Odds ratio at 0.32 (95% Confidence Interval 0.20-0.53) Unfractionated heparin versus low molecular weight heparin (comparison 08.03, 4 studies). The two treatments were found equally effective in preventing DVT and/or PE with a Peto Odds ratio 1.01 (95% Confidence Interval 0.67-1.52). Mechanical methods (comparison 10.3, 2 studies). The combination of graded compression stockings and LDH is better than LDH alone in preventing DVT and/or PE with a Peto Odds ratio at 4.17 (95% Confidence Interval 1.37-12.70). REVIEWER'S CONCLUSIONS: The optimal prophylaxis in colorectal surgery is the combination of graduated compression stockings and low-dose unfractionated heparin. The unfractionated heparin can be replaced with low molecular weight heparin.

Anticoagulants↗

PubMed1998

Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. The Laparoscopic Colorectal Surgery Study Group.

PURPOSE: Laparoscopic colorectal surgery for cancer is currently under discussion. Results of large, randomized studies will not be available for a number of years yet. This study analyses the results of such resections in consecutive patients operated on by unselected surgeons. METHODS: A prospective, observational, multicenter study was initiated on August 1, 1995, in the German-speaking countries of Europe. One year after initiation of the study, findings are presented with respect to the quality of oncologic resections. RESULTS: Of 500 operations, 231 (46 percent) were performed for cancer, 167 (33 percent) with a curative intent. The most common curative resections were as follows: 63 anterior rectum resections (38 percent), 51 sigmoid resections (30 percent), and 27 abdominoperineal resections (16 percent). Segmental resections were performed in 20 patients (12 percent). Intraoperative tumor spillage was reported in 2 percent. Mean number of lymph nodes harvested was 13 (confidence interval, 5-95 percent; range, 11.5-14.6) and positive lymph nodes harvested was 2.2 (confidence interval, 5-95 percent; range, 0.9-3.4). Significant differences were noted between participating centers in terms of number of lymph nodes resected (P < 0.0001). Distal and proximal resection margins were tumor-free in every case. Lateral margins were tumor free when examined. In the case of 63 curative anterior resections, the mean distal resection margin was 39 (confidence interval, 5-95 percent; range, 33-45) mm, and in 8 of these resections, it was less than 20 min. Mean blood loss was 344 (confidence interval, 5-95 percent; 292-396) ml, and 21 percent of patients received blood transfusion. CONCLUSIONS: These data document that the average quality of laparoscopic colorectal procedures for cancer is satisfactory but differs among surgeons.

Aged↗

PubMed1999

Usefulness of a state-legislated, comparative database to evaluate quality in colorectal surgery.

PURPOSE: Colorectal surgery, a high-volume procedure, has been targeted for performance improvement to reduce length of stay. Specific postoperative quality indicators and readmission rates should be analyzed concomitantly to assure that adverse events are not associated with earlier discharge. METHODS: From July 1, 1990, to June 30, 1997, 1,218 consecutive patients who underwent transabdominal colorectal surgery were analyzed for length of stay, mortality, morbidity, and discharge disposition. Each patient was assigned an Admission Severity Group rating 0 to 4 using a hospital-based state-legislated software system (Atlas) to validate comparative performance internally and externally. Readmission data within 120 days of discharge were available for the last 678 consecutive patients from July 1, 1993, to June 30, 1997, using Lastword (computerized medical records). RESULTS: The annual frequencies of the 1,218 procedures were 173, 183, 175, 146, 167, 189, and 185, respectively, from July 1990 through June 1997. Severity distribution was 32 for Admission Severity Group 0, 517 for Admission Severity Group 1, 540 for Admission Severity Group 2, 128 for Admission Severity Group 3, and 1 for Admission Severity Group 4, with no annual difference (P = 0.012). There was a significant reduction in total length of stay of 3.1 (12.9-9.8) days during the seven years (P = 0.001). The overall operative mortality rate was 1.4 percent, and the morbidity was 2.6 percent, with no annual differences (P = 0.655 and P = 0.033, respectively). The disposition to home did not change (P = 0.21). Of the 678 patients followed up for readmission, 100 (14.7 percent) were readmitted within 120 days, with no annual difference (P = ().302). CONCLUSION: Mortality, morbidity, disposition, and readmission rates were not affected by a decreased length of stay after colorectal surgery.

Colonic Diseases↗

PubMed1994

A look through the "retrospectoscope": reflections and realities on a decade of evolution of colorectal surgery in Canada. Colorectal guest lecture.

Although the origin of colorectal surgery dates back to 1835, it has only been in the past decade that major strides in this specialty have been made in Canada. The Canadian Society of Colon and Rectal Surgeons was incorporated in 1983. Many other countries have also established national societies of colon and rectal surgery. In Canada, acknowledgement of the importance of the specialty has been slow for a number of reasons, not least of which have been concerns over turf. Nevertheless, it is unrealistic to expect a surgeon whose operative experience is spread thinly over numerous segments of surgery to equal the current achievement of various experts in only one of these fields. Despite their small numbers, members of the Canadian Society of Colon and Rectal Surgeons have made disproportionately large contributions to clinical care, teaching and research. A vibrant image and vital subjects of study will positively sustain the future direction of the specialty.

Canada↗

PubMed2006

Differential production of cytokines following colorectal surgery.

BACKGROUND: Colorectal surgery is associated with a number of postoperative complications, including anastomotic leak and local recurrence. These complications are more common after rectal surgery than after colon surgery. Cytokines are secreted into the peritoneal cavity after colorectal surgery and have a number of metabolic and immunological effects. Hence we suggested that differential secretion of these may contribute to the differences in complications between colon and rectal surgeries. METHODS: Patients undergoing either elective rectal excision or colectomy for benign or malignant disease were recruited into the study. The region in relation to the anastomosis was drained with a silastic drain for 12-18 h. Drain fluid was collected on the morning following surgery. The drain fluid was assayed for interleukin (IL)-1beta, tumour necrosis factor-alpha, IL-6, IL-8, IL-10 and IL-13 using multiplexed biomarker immunoassays. RESULTS: Interleukin-8 concentrations were significantly higher in the region of the anastomosis after rectal excision compared with colectomy. Also, IL-6 levels were very high in both groups, but there was no significant difference between the groups. Although the concentrations of IL-10 were higher in the rectal group relative to the colectomy group, only low levels of this cytokine were present in the drain fluids. No other cytokines were consistently detected in significant concentrations. CONCLUSION: This study has shown that the concentration of IL-8 in the region of the anastomosis of patients who have undergone rectal surgery is much higher than those who have undergone colonic surgery. The increased level of IL-8 may provide a milieu conducive to local recurrence and anastomotic leak.

Adult↗

PubMedDate not supplied

Problems and complications associated with colorectal surgery.

Successful colorectal surgery requires a combination of thorough patient evaluation and surgical judgment to determine the correct surgical approach and to properly apply the general principles of colorectal surgery. These principles include gentle tissue handling, preservation of blood and nerve supply, proper suture selection and suture techniques, postoperative monitoring, and early recognition and treatment of complications.

Animals↗

PubMed1987

Systemic Timentin is superior to oral tinidazole for antibiotic prophylaxis in elective colorectal surgery. University of Melbourne Colorectal Group.

A prospective, randomized, single-blind, controlled clinical trial was undertaken to compare two different prophylactic antibiotic regimens in patients undergoing elective colorectal surgery. Systemic Timentin, a combination of ticarcillin and the beta-lactamase inhibitor clavulanic acid, was assigned to 101 patients. Oral tinidazole, an agent active only against anaerobic bacteria, was assigned to 102 patients. The wound infection rate was 2.4 percent in the patients receiving Timentin and 14 percent in those receiving tinidazole (P = 0.01). Multivariate analysis of factors affecting the wound infection rate showed that the only factor that independently reached statistical significance was the prophylactic antibiotic used. The mortality of patients receiving Timentin prophylaxis was 3.4 percent compared with 8.9 percent of those receiving tinidazole (P = 0.15). The clinical anastomotic leakage rate was 1.3 percent in patients receiving Timentin and 13 percent in those receiving tinidazole (P = 0.01). These results, together with those of two previously published clinical trials by this group, indicate that antibiotic prophylaxis in elective colorectal surgery should consist of a short course of an agent effective against both aerobic and anaerobic bowel flora.

Administration, Oral↗

PubMedDate not supplied

Virtual CT colectomy by three-dimensional imaging using multidetector-row CT for laparoscopic colorectal surgery.

Laparoscopic colorectal surgery has been attracting attention for its capacity to improve the quality of life (QOL) of patients. However, there are disadvantages to this approach, namely, it is difficult to obtain an image of the entire view of the operative field, and organs and lesions cannot be manipulated directly by the surgeon during surgery. For this reason, it takes a relatively large amount of time to ligate vessel, which can vary between patients. Furthermore, vessels and organs can be damaged during lymph nodes dissection under laparoscopic guidance, leading to heavy bleeding that prevents the surgeon from having access to a good view of the operative field. Then, to assess preoperatively the vascular anatomy, we carried out multiphase, contrast-enhanced examinations using multidetector-row CT (MDCT) on patients with colorectal cancer, and prepared the fused image of 3D images of arteries, veins, the colorectum, organs, and tumor. We called the utilization of 3D imaging virtual CT colectomy, which contributed to rapid and safe manipulation of the origins of the arteries and the veins, as well as lymph nodes dissection, without incurring injury to the involved arteries and veins.

Colectomy↗

PubMed1985

Should antimicrobial prophylaxis in colorectal surgery include agents effective against both anaerobic and aerobic microorganisms? A double-blind, multicenter study. The Norwegian Study Group for Colorectal Surgery.

It is now well demonstrated that a mixed flora of aerobic and anaerobic microorganisms will be found in wound abscesses and peritonitis after bowel surgery. An impressive reduction in infectious complications caused by anaerobic microorganisms can be achieved with nitroimidazole prophylaxis, but considerable uncertainty about the role of agents active against aerobic microorganisms in such prophylaxis still exists. We have earlier reported that a single dose of tinidazole and doxycycline significantly reduces postoperative infections and is superior to doxycycline alone. The effect of an agent active only against anaerobic microorganisms was tested in a double-blind study of 267 patients who underwent elective colorectal surgery. The patients received either tinidazole (1600 mg) and placebo or tinidazole (1600 mg) and doxycycline (400 mg) as a single preoperative infusion. Patients who received tinidazole and doxycycline had significantly fewer infectious complications, reoperations, additional use of antibiotics, and a shorter hospital stay. Microbiologic studies demonstrated that tinidazole alone gave effective protection against anaerobic organisms but did not protect the patients from aerobic gram-negative infectious complications. A single preoperative dose of antimicrobial agents effective against both anaerobic and aerobic bowel organisms seems to be the preferred prophylaxis for patients undergoing colorectal surgery.

Adolescent↗

PubMed1998

[Colorectal surgery--an integral part of general surgery!].

The controversy, whether colorectal surgery should be performed by the general surgeon or the specialist colorectal surgeon, is gaining increasing importance in Europe. The short and long term results in colorectal surgery as well as in other subspecialties are largely determined by the annual case load and the surgical training in colorectal surgery. If both conditions are met, colorectal surgery can be just as safely and successfully performed in a district hospital by a general surgeon. The following advantages support the treatment of colorectal lesions by a general surgeon: the capacity to cope with unforeseen intraoperative problems thanks to the broad surgical experience of the general surgeon, the ability and authorisation to perform multivisceral resections and the ability through the daily training in abdominal surgery to perform emergency interventions since about 30% of all colorectal operations are performed in an emergency setting. Against colorectal specialisation can be argued: increased costs through the need of specialised colorectal surgeons, the establishment of independent units for colorectal surgery, impairment of surgical training and sometimes loss of enthusiasm through the daily routine of the highly specialised surgeon. The common colorectal surgery should remain an integral part of general surgery, given the conditions of an sufficient annual case load of at least 30 colorectal resections and of an adequate surgical training in colorectal surgery.

Clinical Competence↗