G. Sinclair

Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence

The aim of this study was to determine whether leakage from a colorectal anastomosis following potentially curative anterior resection for rectal cancer is an independent risk factor for local recurrence.

Mobilization of the Rectum Anatomic Concepts and the Bookshelf Revisited

INTRODUCTION: Sound surgical technique is based on accurate anatomic knowledge. In surgery for cancer, the anatomy of the perirectal fascia and the retrorectal plane is the basis for correct mobilization of the rectum to ensure clear surgical margins and to minimize the risk of local recurrence. METHODS: This review of the literature on the perirectal fascia is based on a translation of the original description by Thoma Jonnesco and a later account by Wilhelm Waldeyer. The Jonnesco description, first published in 1896 in French, is compared with the German account of 1899. These were critically analyzed in the context of our own and other techniques of mobilizing the rectum. CONCLUSIONS: Mobilization of the rectum for cancer can be performed along anatomic planes with minimal blood loss, preservation of the pelvic autonomic nerves and a low prevalence of local recurrence. Different techniques including total mesorectal excision are based on the same anatomic principles, however, popular words have been used to replace accepted, established terminology. In particular, the description of total mesorectal excision has been confusing because of its emphasis on the words “total” and “mesorectum.” The use of the word “mesorectum” anatomically is inaccurate and the implication that total excision of all the perirectal fat contained within the perirectal fascia “en bloc” in all patients with rectal cancer will minimize local recurrence remains contentious.

Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources.

Objective  The aim of this study was to determine the demand for hospital resources generated by anastomotic leakage, including surgical, medical, imaging, pathology, and other allied health consultations or services and length of postoperative hospital stay.

Adverse histopathological findings as a guide to patient management after curative resection of node-positive colonic cancer.

The aim of this study was to identify patient and tumour characteristics that might assist in developing an improved approach to patient selection for chemotherapy after resection of clinicopathological stage C colonic cancer.

KARYDAKIS FLAP REPAIR FOR SACROCOCCYGEAL PILONIDAL SINUS DISEASE: HOW IMPORTANT IS TECHNIQUE?

Numerous operative and conservative treatments have been described in the published work for the management of sacrococcygeal pilonidal sinus; yet there remains considerable debate over its ideal treatment. This report is an audit of our results using the Karydakis flap repair in the management of this condition. We analysed prospective data on 70 patients who had had a Karydakis procedure. The length of follow up ranged from 1 to 79 months (median 36 months). Seventy‐one operations were carried out in 70 patients. This included 12 patients (17%) who had previously undergone between one and four procedures (median 2) for recurrent disease. Superficial wound breakdown occurred in 27 patients (38%) and complete wound breakdown occurred in six patients (8.4%). These wounds were allowed to heal by secondary intent. The median time to complete healing for superficial and complete wound breakdown was 80 and 84 days, respectively. Disease recurrence occurred in three patients (4.2%) – two of whom had recurrent disease at the time of this presentation. Of the three patients who had a recurrence after our surgery, two had a superficial breakdown and one had a complete wound breakdown. Sacrococcygeal pilonidal disease has a low recurrence rate when treated by the Karydakis operation involving flattening of the midline cleft. This procedure avoids the need for more complicated flap repairs.

What factors influence survival in patients with unresected synchronous liver metastases after resection of colorectal cancer

Objective  The aim of this study was to determine whether the survival of patients with untreated synchronous liver metastases after resection of a colorectal cancer was associated with any features of the primary tumour.

Endoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures

Background: A fibrous stricture may develop at the site of a colorectal anastomosis or as a complication following abdominal aortic surgery. A major resection may be necessary if the stricture cannot be released. The authors’ experience with endoscopic stricturotomy using neodymium:yttrium–aluminium–garnet laser, together with balloon dilatation, as a conservative method of treating such strictures, is reported here.

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

Background:  The aim of this study was to identify independent background and perioperative risk factors for prolonged postoperative hospital stay among patients having a resection for colorectal cancer.

Understanding the anatomy of lymphatic drainage and the use of blue-dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues.

Objective  This paper reviews the literature on the pathways of lymphatic drainage of the rectum and their significance in radical cancer surgery.