Christopher Wakeman

surveillance for Dysplasia in Patients With Inflammatory Bowel Disease: A National Survey of Colonoscopic Practice in New Zealand

BACKGROUNDPatients with chronic ulcerative colitis and Crohn’s colitis have an increased risk of colorectal cancer. Because of this, surveillance colonoscopy is practiced.AIMSWe aimed to describe the practice of surveillance colonoscopy in New Zealand, with comparison among specialties, and with practice internationally.SUBJECTSNew Zealand colonoscopists (both physicians and surgeons) looking after patients with inflammatory bowel disease were surveyed to evaluate attitudes about surveillance colonoscopy and ways in which colonoscopy results are interpreted.METHODSA postal survey assessed the colonoscopist’s understanding of how and why surveillance colonoscopy is undertaken and their interpretation of the results from such evaluations.RESULTSOf the196 physicians and surgeons surveyed, 180 responded (92 percent). Sixty responses were excluded. Only 24 of 120 respondents (20 percent) correctly defined dysplasia. The median number of biopsies taken at colonoscopy was 17. Eighty of 120 (67 percent) and 77 of 120 (64 percent) doctors underestimate the risk of invasive malignancy if low-grade or high-grade dysplasia, respectively, is identified. The colectomy referral rate for dysplasia-associated lesion or mass was 115/120 (96 percent); that for high-grade dysplasia was 110/120 (92 percent); and that for low-grade dysplasia was 26/120 (22 percent). Thirty of 120 (25 percent) doctors offer patients the option of colectomy after 20 years of colitis. Seventy of 120 (58 percent) doctors sought the opinion of a second pathologist if dysplasia was found. There were differences in responses between specialist groups, with colorectal surgeons most likely to correctly define dysplasia and appreciate the significance of low-grade dysplasia.CONCLUSIONSMany New Zealand colonoscopists have a poor understanding of the definition and importance of dysplasia associated with colitis. Although colectomy referral rates are higher in this study than in similar studies, low-grade dysplasia is often not referred for colectomy. Improved education may improve surveillance practice.

The impact of splenectomy on outcome after resection for colorectal cancer: a multicenter, nested, paired cohort study.

PurposeThis study was designed to determine whether incidental splenectomy for iatrogenic injury affects long-term cancer-specific survival in patients having resection of an adenocarcinoma of the sigmoid or rectum.MethodsA retrospective case-matched review of patients undergoing surgery for colorectal cancer with incidental splenectomy between January 1, 1990 and December 31, 1999 was undertaken. Data were analysed for age, American Society of Anesthesiologists physical status, gender, disease stage, operation type, and outcome. These cases were matched with patients from the same center, of the same age and gender, with the same stage of disease and operation, who did not require a splenectomy at the time of their surgery.ResultsFifty-five patients were identified who had an iatrogenic splenectomy. Matched gender, stage, and American Society of Anesthesiologists-matched controls were identified. Follow-up from time of surgery to death or last follow-up ranged from 2 to 205 (median, 43) months. A Kaplan-Meier survival analysis using the Cox proportional hazards model to define the statistical significance found a significant difference between the groups favoring those without splenectomy (hazard ratio, 1.8; 95 percent confidence interval (CI), 1–3.3; P = 0.0399). Cancer-specific survival at five years was 70 vs. 47 percent and at ten years was 55 vs. 38 percent.DiscussionPatients with colorectal cancer who had splenectomy as a result of iatrogenic damage of the spleen while undergoing resection of the sigmoid or rectum for adenocarcinoma had a significantly worse prognosis.

The process and outcomes of a nurse‐led colorectal cancer follow‐up clinic

Aim  Evidence suggests that follow‐up after colorectal cancer improves survival. Colorectal cancer is so common that patient follow‐up can overwhelm a service, affecting the ability to see new referrals and reassess patients seen previously who have new symptoms. In order to cope with this demand a nurse‐led follow‐up service was started in 2004. We aimed to review the results of a nurse‐led colorectal cancer follow‐up clinic.

Pancreatic cancer: management and survival

Aim:  To review the management and survival from all pancreatic cancer over a 5‐year period at a tertiary referral hospital in New Zealand and to examine similar outcome data from the national cancer registry.

Progress in the management of retrorectal tumours

Tumours in the retrorectal space are rare and pathologically heterogeneous. The roles of imaging and preoperative biopsy, nonoperative management and the indications for surgical resection are controversial. This study investigated a series of retrorectal tumours treated in a single institution with the aim of producing a modern improved management algorithm.

Lymph node yield following injection of patent blue V dye into colorectal cancer specimens.

Aim  The study aimed to assess whether the ex vivo injection of patent blue V dye would increase lymph node yield in operative specimens of colorectal cancer.

Population-based study demonstrating an increase in colorectal cancer in young patients

New Zealand has among the highest rates of colorectal cancer in the world and is an unscreened population. The aim of this study was to determine the trends in incidence and tumour location in the New Zealand population before the introduction of national colorectal cancer screening.

Hinchey I and II diverticular abscesses: long-term outcome of conservative treatment.

The management of diverticular disease and its complications are an increasing burden to the health system. The natural history of conservatively managed diverticular abscesses (Hinchey I and II) is poorly described and it remains open to debate whether subsequent sigmoid resection is indicated after conservative management. This observational study compares outcomes of patients treated with conservative management (antibiotics +/− percutaneous drainage) and surgery.

Acute colonic pseudo-obstruction in pregnancy

Acute colonic pseudo‐obstruction is an uncommon but potentially morbid complication of pregnancy. The aim of the study was to review a single institutions experience with acute colonic pseudo‐obstruction in post‐partum patients and develop an algorithm for management based on a literature review.

Cohort study of mesenteric panniculitis and its relationship to malignancy

Mesenteric panniculitis (MP) is a rare condition that historically has been associated with the presence of malignancy. Paraneoplastic phenomena in general regress with cure and in most cases with treatment of the cancer. This study was undertaken to determine whether MP regressed with cancer treatment and cure.