Giulio P. Angelucci

Small-Bowel Obstruction Secondary to Adhesions After Open or Laparoscopic Colorectal Surgery

Background and Objectives: Small-bowel obstruction (SBO) is a common surgical emergency that occurs in 9% of patients after abdominal surgery. Up to 73% are caused by peritoneal adhesions. The primary purpose of this study was to compare the rate of SBOs between patients who underwent laparoscopic (LPS) and those who had open (OPS) colorectal surgery. The secondary reasons were to evaluate the rate of adhesive SBO in a cohort of patients who underwent a range of colorectal resections and to assess risk factors for the development of SBO. Method: This was a retrospective observational cohort study. Data were analyzed from a prospectively collected database and cross checked with operating theater records and hospital patient management systems. Results: During the study period, 707 patients underwent colorectal resection, 350 of whom (49.5%) were male. Median follow-up was 48.3 months. Of the patients included, 178 (25.2%) underwent LPS, whereas 529 (74.8%) had OPS. SBO occurred in 72 patients (10.2%): 20 (11.2%) in the LPS group and 52 (9.8%) in the OPS group [P = .16; hazards ratio (HR) 1.4 95% CI 0.82–2.48] within the study period. Conversion to an open procedure was associated with increased risk of SBO (P = .039; HR 2.82; 95% CI 0.78–8.51). Stoma formation was an independent risk factor for development of SBO (P = .049; HR, 0.63; 95% CI 0.39–1.03). The presence of an incisional hernia in the OPS group was associated with SBO (P = .0003; HR, 2.85; 95% CI 1.44–5.283). There was no difference in SBO between different types of procedures: right colon, left colon, and rectal surgery. Patients who developed early small-bowel obstruction (ESBO) were more often treated surgically compared to late SBO (P = .0001). Conclusion: The use of laparoscopy does not influence the rate of SBO, but conversion from laparoscopic to open surgery is associated with an increased risk of SBO. Stoma formation is associated with a 2-fold increase in SBO. Development of ESBO is highly associated with a need for further surgical intervention.

Outcome of Colorectal Surgery in Elderly Populations

Purpose The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. Methods The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. Results A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. Conclusion Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.

Corrigendum: Correction of the First Author's Affiliation. Outcome of Colorectal Surgery in Elderly Populations

[This corrects the article on p. 139 in vol. 32, PMID: 27626024.].

Short Term Outcomes After Colorectal Surgery in Octogenarians

PURPOSE: Sphincter-sparing chemoradiotherapy (CRT) is the standard of care for patients with anal canal cancer. Despite good response rates, some patients require radical surgery (abdominoperineal resection or exenteration)for persistent or recurrent disease. The purpose of this study was to evaluate the outcomes of patients following radical resection for persistent or recurrent disease. METHODS: All patients treated with CRT or RT for anal cancer between 1990 and 2008 were identified using the regional cancer registry. Inclusion criteria: pathologically confirmed squamous cell carcinoma of the anal canal, localized disease, receiving ≥ 45Gy of RT. Statistical analysis was conducted to calculate survival rates and identify risk factors for poor outcomes. RESULTS: 105 patients (25 male) were identified. Median age was 57 years (range 33-87 yr). Median follow up was 40 months (range 3185). Median T stage and size at presentation were 2 and 35 mm (range 6-260mm) respectively. Median dose to the primary tumor was 54 Gy (45-76 Gy) at a median 28 fractions (range 20-37). 92 patients(88.5%) received concurrent chemotherapy. At 3 month followup 85 (83.3%) patients had complete clinical response, one patient had insufficient followup. 19 (18.1%) patients had persistent disease, of whom 12 underwent radical resection for cure; 5 (41.7%) are alive at a median of 106 months from diagnosis, while the remaining 7 died at a median 15 months from diagnosis. Recurrence occurred in 17 (20.0 %) patients at a median time of 9 months (4-53m). 8 patients underwent radical resection for recurrence; 2 (25.0%) patients are alive at 127 and 21 months, the remaining 6 died at a median time from recurrence of 24.5 months. Overall, disease specific and disease free survival, were 66%, 71% and 67% respectively for all anal canal carcinoma patients at 5 years. Multivariate analysis showed tumor size to be a significant risk factor for disease free (aOR 1.02, 95% CI: 1.01-1.04) and overall survival (aOR 1.03, 95% CI: 1.01-1.04) for all patients. CONCLUSION: Despite good response rates to sphincter-sparing therapy, 20% still required radical resection for persistent or recurrent disease. Survival rates following radical resection are poor.