R. G. Molloy

C‐reactive protein as a predictor of postoperative infective complications following elective colorectal resection

Aimu2002 C‐reactive protein (CRP) may be useful in predicting postoperative complications [ 1 ]. We investigated the sensitivity and specificity of postoperative CRP for infective complications after elective colorectal surgery.

Prospective study on the management of patients with complicated diverticular disease.

Introductionu2002 Diverticular disease is a common condition with high morbidity and mortality related to its complications. The aim of this study was to assess the predictive role of acute diverticulitis in the development of further complications from diverticular disease.

Deprivation and Colorectal Cancer Surgery: Longer-Term Survival Inequalities are Due to Differential Postoperative Mortality Between Socioeconomic Groups

BackgroundDeprivation is associated with poorer survival after surgery for colorectal cancer, but determinants of this socioeconomic inequality are poorly understood.MethodsA total of 4,296 patients undergoing surgery for colorectal cancer in 16 hospitals in the West of Scotland between 2001 and 2004 were identified from a prospectively maintained regional audit database. Postoperative mortality (<30xa0days) and 5-year relative survival by socioeconomic circumstances, measured by the area-based Scottish Index of Multiple Deprivation 2006, were examined.ResultsThere was no difference in age, gender, or tumor characteristics between socioeconomic groups. Compared with the most affluent group, patients from the most deprived group were more likely to present as an emergency (23.5 vs 19.5xa0%; pxa0=xa0.033), undergo palliative surgery (20.0 vs 14.5xa0%; pxa0<xa0.001), have higher levels of comorbidity (pxa0=xa0.03), havexa0<12 lymph nodes examined (56.7 vs 53.1xa0%; pxa0=xa0.016) but were more likely to receive surgery under the care of a specialist surgeon (76.3 vs 72.0xa0%; pxa0=xa0.001). In multivariate analysis, deprivation was independently associated with increased postoperative mortality [adjusted odds ratio 2.26 (95xa0% CI, 1.45–3.53; pxa0<xa0.001)], and poorer 5-year relative survival [adjusted relative excess risk (RER) 1.25 (95xa0% CI, 1.03–1.51; pxa0=xa0.024)] but not after exclusion of postoperative deaths [adjusted RER 1.08 (95xa0%, CI .87–1.34; pxa0=xa0.472)].ConclusionsThe observed socioeconomic gradient in long-term survival after surgery for colorectal cancer was due to higher early postoperative mortality among more deprived groups.

Anterior anal fissures are associated with occult sphincter injury and abnormal sphincter function

Objectiveu2002 The pathogenesis of chronic anal fissure (CAF) remains incompletely understood but most are associated with a high resting anal pressure and reduced perfusion at the fissure site. To date, no major distinction has been made between anterior and posterior anal fissures and their aetiology and treatment. We compared anterior and posterior fissures in patients who have failed to respond to medical treatment with respect to their underlying aetiology, anal canal pressures and sphincter muscle integrity.

Correlation between anal manometry and endosonography in females with faecal incontinence.

Objectiveu2002 Female faecal incontinence (FI) is largely because of sphincter injury at childbirth. Sphincter assessment aims to identify surgically correctable defects. We aimed to identify endoanal ultrasonography (EAUS) parameters that correlate with sphincter function.

Prospective study of the diagnostic evaluation of faecal incontinence and leakage in male patients

Objectiveu2002 Male faecal incontinence (FI) has received little attention. No consistent pathophysiological abnormality has been identified in those studies that have specifically assessed male patients with FI or faecal leakage (FL). This study was designed to re‐examine the different theories relating to the pathophysiology of male incontinence and to assess if manometric and ultrasound assessment yields clinically relevant information that directs patient care.

Mechanical bowel preparation does not influence outcomes following colonic cancer resection

Meta‐analyses have indicated that preoperative mechanical bowel preparation (MBP) confers no clear benefit and may indeed be harmful for patients with colorectal cancer. The effects of bowel preparation on longer‐term outcomes have not been reported. The aim was to compare long‐term survival and surgical complications in patients who did or did not receive MBP before surgery for colonic cancer.

Is pre-operative radiotherapy necessary in T1-T3 rectal cancer with TME?

Objectiveu2002 The indications for pre‐operative radiotherapy in rectal cancer are still unclear with the exception of T4 tumours. The aim of this study was to assess local and overall recurrence in patients with T1‐T3 rectal cancers undergoing total mesorectal excision (TME).

A technically difficult endorectal ultrasound is more likely to be inaccurate.

Objectiveu2002 Endorectal ultrasound (ERUS) is well established as an accurate modality for local staging of rectal tumours. The aim of this study was to identify reasons for inaccurate staging of tumours, and to assess whether difficulties encountered during scanning are likely to influence accuracy.

The lymph node ratio optimises staging in patients with node positive colon cancer with implications for adjuvant chemotherapy

PurposeThe ratio of positive lymph nodes to total retrieved lymph nodes (lymph node ratio, LNR) has been proposed to be the superior prognostic score in colon cancer. This study aimed to validate LNR in a large, multi-centred population, focusing on patients that have undergone adjuvant chemotherapy.MethodsAnalysis of a prospectively collected database (The West of Scotland Colorectal Cancer Managed Clinical Network) with 1,514 patients with colonic cancer identified that had undergone elective curative surgical resection in the 12 hospitals in the West of Scotland from 2000–2004. Variables recorded were as follows: demographics, adjuvant chemotherapy, number of lymph nodes retrieved, lymph node retrieval ≥12, number of positive lymph nodes and LNR. Follow up continued until June 2009. Univariate and multivariate analyses were performed to determine the influence of LNR on overall survival.ResultsIn 673 patients (44.5xa0%), ≥12 lymph nodes were retrieved. Patients had a poorer long-term prognosis with increasing age, T stage and N stage. Retrieval of <12 lymph nodes and increasing LNR were both found to be significantly associated with poorer long-term survival, but on multivariable analysis, LNR was the only independently significant variable. In patients that had received adjuvant chemotherapy, only patients staged in the second lowest LNR group (0.05–0.19) had a significant improvement in long-term survival.ConclusionLymph node ratio is the optimal method of assessing lymph node status and highlights the heterogeneity of patients with node positive disease, altering patient stratification with implications for adjuvant chemotherapy.