E. Leslie Bokey

Anastomotic Leakage Is Predictive of Diminished Survival After Potentially Curative Resection for Colorectal Cancer

Objective:The aim of this study was to determine whether anastomotic leakage has an independent association with overall survival and cancer-specific survival. Summary Background Data:There are many known prognostic indicators following surgery for colorectal cancer (CRC). However, the impact of anastomotic leakage has not been adequately assessed. Methods:Consecutive patients undergoing resection between 1971 and 1999 were recorded prospectively in the Concord Hospital CRC database. Total anastomotic leakage was defined as any leak, whether local, general, or radiologically diagnosed. Patients were followed until death or to December 31, 2002. The association between anastomotic leakage and both overall survival and cancer-specific survival was examined by proportional hazards regression with adjustment for other patient and tumor characteristics influencing survival. Confidence intervals (CI) were set at the 95% level. Results:From an initial 2980 patients, 1722 remained after exclusions. The total leak rate was 5.1% (CI 4.1–6.2%). In patients with a leak, the 5-year overall survival rate was 44.3% (CI 33.5–54.6%) compared to 64.0% (CI 61.5–66.3%) in those without leak. In proportional hazards regression–after adjustment for age, gender, urgent resection, site, size, stage, grade, venous invasion, apical node metastasis and serosal surface involvement–anastomotic leakage had an independent negative association with overall survival (hazard ratio [HR] 1.6, CI 1.2–2.0) and cancer-specific survival (HR 1.8, CI 1.2–2.6). Conclusion:Apart from its immediate clinical consequences, anastomotic leakage also has an independent negative association with survival.

Pathologic Determinants of Survival Associated with Colorectal Cancer with Lymph Node Metastases A Multivariate Analysis of 579 Patients

Background. Patients with colorectal carcinoma found to have regional lymph node metastases after curative resection form a large and prognostically diverse group. This study aims to determine which pathology variables have independent prognostic effects.

Low Microsatellite Instability Is Associated With Poor Prognosis in Stage C Colon Cancer

PURPOSE The significance of low microsatellite instability (MSI-L) in colorectal cancer is poorly understood. No clear biologic distinction has been found between MSI-L and microsatellite stable (MSS) colorectal cancer, and these two phenotypes are usually combined when analyzed against the well-defined high MSI (MSI-H) phenotype. Evidence is emerging that an O(6)-methylguanine DNA methyltransferase (MGMT) gene defect is associated with MSI-L. Therefore, to further define this phenotype, we undertook a detailed analysis of the prognostic significance of MSI-L and loss of MGMT expression in colon cancer. PATIENTS AND METHODS The study cohort was 183 patients with clinicopathologic stage C colon cancer who had not received adjuvant therapy. We analyzed MSI status, MGMT, and mismatch repair protein expression, as well as MGMT and p16 promoter hypermethylation. RESULTS We showed that MSI-L defines a group of patients with poorer survival (P = .026) than MSS patients, and that MSI-L was an independent prognostic indicator (P = .005) in stage C colon cancer. Loss of MGMT protein expression was associated with the MSI-L phenotype but was not a prognostic factor for overall survival in colon cancer. p16 methylation was significantly less frequent in MSI-L than in MSI-H and MSS tumors and was not associated with survival. CONCLUSION MSI-L characterizes a distinct subgroup of stage C colon cancer patients, including the MSI-L subset of proximal colon cancer, who have a poorer outcome. Neither the MGMT defect nor p16 methylation are likely to contribute to the worse prognosis of the MSI-L phenotype.

Cost of open versus laparoscopically assisted right hemicolectomy for cancer.

The aim of this study was to estimate and compare the costs of open right hemicolectomy (ORHC) versus laparoscopically assisted right hemicolectomy (LARHC) performed for cancer. A retrospective cost analysis of 61 consecutive patients operated on between January 1992 and August 1994 for right-sided colonic cancer by either LARHC (n = 28) or ORHC (n = 33) was performed. The analysis focused on the cost (in Australian dollars) incurred from the date of operation to the date of discharge. LARHC was significantly more expensive than ORHC (total cost LARHC

Clinicopathologically diagnosed residual tumor after resection for colorectal cancer. A 20-year prospective study

9064, ORHC

Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer.

7881; p < 0.001). LARHC was associated with a significantly longer operating room utilization time (LARHC 261 minutes, ORHC 203 minutes; p < 0.001) and a greater cost of disposables (LARHC

Immobiline‐based two‐dimensional gel electrophoresis: An optimised protocol for resolution of human colonic mucosal proteins

854, ORHC

Adjuvant chemotherapy for stage C colonic cancer in a multidisciplinary setting

189; p < 0.001). This study demonstrates no cost benefit for LARHC compared to ORHC when performed for cancer.RésuméLe but de cette étude a été d’évaluer et de comparer les coûts de la colectomie droite effectuée par laparoscopie de celle réaliséc de façon traditionnelle. On a ainsi étudié une série de 61 patients consécutifs opérés entre Janvier 1992 et Août 1994 pour un cancer du colon droit soit par laparoscopie assistée (LARHC, n = 28) soit de façon traditionnelle (ORHC, n = 33). L’analyse était centrée sur les coûts (en dollars australiens [

Outcomes after admission on the day of elective resection for colorectal cancer

Au]) à partir de la date de l’opération jusqu’à la date de la sortie. Les coûts de la LARHC étaient significativement plus élevés que ceux de l’ORHC (coûts totaux de la LARHC = 9064

Rectal bleeding. Do other symptoms aid in diagnosis

Au vs ORHC = 7881