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Medical Archives (Sarajevo, Bosnia and... Oct 2019Colorectal Cancer (CRC) is the third most common malignant disease and the fourth most common cause of death associated with malignancy. Adenocarcinomas account for 95%... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Colorectal Cancer (CRC) is the third most common malignant disease and the fourth most common cause of death associated with malignancy. Adenocarcinomas account for 95% of all cases of colon cancer. Treatment usually includes a surgical resection which is preceded or followed by chemotherapy and radiotherapy depending on the stage. There is constant interest in the microbiological ecosystem of the intestine, which is considered to be crucial for the onset and progression of the disease as well as the development of postoperative complications. Iatrogenic factors associated with the treatment of CRC may result in pronounced expression of virulence of the bacterial intestinal flora and fulminant inflammatory response of the host which ultimately leads to adverse treatment results. The modulation of intestinal microflora by probiotics seems to be an effective method of reducing complications in surgical patients. The question is whether ordering probiotics can lead to more favourable treatment outcomes for our patients who are operated due to colorectal adenocarcinoma, and whether this should become common practice.
AIM
To demonstrate the clinical significance of probiotic administration in patients treated for colorectal adenocarcinoma and the results compared with relevant studies.
PATIENTS AND METHODS
In a randomized controlled prospective study conducted at the Clinic of General and Abdominal Surgery of the UCCS in the period of 01 January 2017 until 31 December 2017, there were a total of 78 patients with colorectal adenocarcinoma. Patients were divided into two groups: a group treated with oral probiotics (n = 39) according to the 2x1 scheme starting from the third postoperative day lasting for the next thirty days, followed by 1x1 lasting for two weeks in each subsequent month to one year, and the control group (n = 39) which was not routinely treated with probiotics.
RESULTS
A statistically significant difference in the benefit of using probiotics was found during postoperative hospitalization and the occurrence of fatal outcome in the first six months. All complications were more present in the group of patients untreated with probiotic, with statistical significance shown only in the case of ileus. Probiotic has a statistically significant reduction in postoperative complications in the localization of tumours on the rectum -33.3% and the ascending colon -16.7%.
CONCLUSION
There is a significant benefit of administering probiotics in surgically treated patients for colorectal adenocarcinoma.
Topics: Abdominal Abscess; Adenocarcinoma; Anastomotic Leak; Bifidobacterium; Colectomy; Colon, Ascending; Colorectal Neoplasms; Humans; Ileus; Lactobacillus; Neoplasm Staging; Postoperative Care; Postoperative Complications; Probiotics; Rectal Neoplasms; Streptococcus thermophilus; Surgical Wound Infection
PubMed: 31819304
DOI: 10.5455/medarh.2019.73.316-320 -
Surgical Endoscopy Dec 2018Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding...
BACKGROUND
Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable.
METHODS
An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus.
RESULTS
In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure.
CONCLUSION
Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.
Topics: Anatomy, Regional; Colectomy; Colon, Ascending; Colonic Neoplasms; Germany; Humans; Laparoscopy; Models, Anatomic; Postoperative Complications; Quality Improvement; Reference Standards
PubMed: 30324463
DOI: 10.1007/s00464-018-6267-0 -
Clinical Anatomy (New York, N.Y.) May 2022The precaecocolic fascia, previously known as Jackson's membrane, is a variable vascular peritoneal fold between the ascending colon and the right posterolateral...
The precaecocolic fascia, previously known as Jackson's membrane, is a variable vascular peritoneal fold between the ascending colon and the right posterolateral abdominal wall. First described in 1913, it was originally thought to be of developmental or inflammatory origin and associated with abdominal pain. This investigation aimed to review its frequency, form and structure and look for evidence of association with malformation of the bowel, or previous inflammation. 26 dissecting room cadavers were studied to identify the precaecocolic fascia, any malrotation of the colon or signs of previous inflammation: adhesions, surgical scars, or absence of the appendix. Its structure was examined histologically and latex injections were used to trace the arteries. Membranes comparable with previous descriptions of the precaecocolic fascia occurred in 12 of 26 abdomens. They varied in form and size from long and translucent to short, thick, and opaque. In structure, the fascia resembled a fold of peritoneum containing a thickened fibrous lamina. Large thin-walled arteries in the fascia crossed the arteries in the wall of the colon at the point of attachment. No significant association with colonic malrotation or markers of previous inflammation were found. Attention should be paid to the definition of the precaecocolic fascia and "membrane" seems a more appropriate term than "fascia". It is one of a recognized group of peritoneal folds/bands, doubtful in origin but unlikely to be post-inflammatory. It may modify colonic mobility or complicate colonic operations.
Topics: Colon; Colon, Ascending; Fascia; Humans; Inflammation; Peritoneum
PubMed: 34535937
DOI: 10.1002/ca.23787 -
Medicine, Science, and the Law Jul 2018A 52-year-old man died soon after admission to hospital with a severe metabolic acidosis and likely sepsis. He had a past history of alcohol abuse with withdrawal...
A 52-year-old man died soon after admission to hospital with a severe metabolic acidosis and likely sepsis. He had a past history of alcohol abuse with withdrawal seizures. An abdominal computed tomography scan showed thickened bowel loops but no obvious ischaemic changes, and a blood culture yielded a pure growth of Escherichia coli. At autopsy, the liver showed well-established micro-nodular cirrhosis with steatosis. The peritoneal cavity contained 200 mL of turbid yellow-brown fluid, and the caecum and ascending colon were unusually thickened. Microscopy of the caecum and ascending colon showed oedema, with a florid submucosal acute inflammatory infiltrate and large numbers of rod-shaped bacilli typical of phlegmonous colitis. This rare acute infectious condition predominately involves the caecum and ascending colon and is associated with liver cirrhosis. It should therefore always be considered at autopsy in individuals with cirrhosis, with careful examination and microscopic sampling of the caecum and proximal ascending colon, including ancillary blood/fluid bacterial cultures if the condition is suspected based on the macroscopic findings and/or history.
Topics: Colitis; Escherichia coli; Escherichia coli Infections; Fatal Outcome; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Sepsis
PubMed: 29783922
DOI: 10.1177/0025802418778165 -
The British Journal of Surgery Apr 2021
Topics: Abscess; Adult; Colon, Ascending; Crohn Disease; Humans; Intestinal Perforation; Laparotomy; Male
PubMed: 33793716
DOI: 10.1093/bjs/znaa094 -
BMJ Case Reports Feb 2015A 76-year-old woman with significant cardiovascular comorbidities was investigated under general surgery for weight loss and change in bowel habit. Endoscopic...
A 76-year-old woman with significant cardiovascular comorbidities was investigated under general surgery for weight loss and change in bowel habit. Endoscopic investigations revealed a large ulcer extending from the ileocaecal valve to the ascending colon. Histology of the biopsies from this site revealed chronic inflammation and reactive changes. However, considering the history and suspicious radiological and endoscopic findings, decision was made at a multidisciplinary meeting to offer laparoscopic right hemicolectomy. Owing to complications, the procedure was converted to an open surgery. Postoperatively, histology of resected bowel revealed chronic inflammation and no evidence of malignancy. In light of an 8-year history of nicorandil therapy, the histological changes were thought to represent nicorandil-induced colonic ulceration.
Topics: Aged; Colitis, Ulcerative; Colon, Ascending; Colonoscopy; Diagnosis, Differential; Female; Humans; Ileocecal Valve; Myocardial Ischemia; Nicorandil; Vasodilator Agents
PubMed: 25701830
DOI: 10.1136/bcr-2014-205310 -
Nigerian Journal of Clinical Practice Oct 2017Multiple primary tumors occur in clinical practice causing diagnostic dilemma. It is not very common, but the incidence has increased gradually since it was first...
Multiple primary tumors occur in clinical practice causing diagnostic dilemma. It is not very common, but the incidence has increased gradually since it was first described very many years ago. However, in spite of its increasing incidence, the presence of such primary malignancies in the breast and colon has been rare and far between, as against its presence in breast and lungs, both breasts, colon and stomach, two colonic sites, and endometrium and ovaries. It could be due to genetic disorders such as Li-Fraumeni syndrome in which case the affected individuals develop multiple cancers in childhood or early adulthood. This is, however, very rare. It could be due to metastasis of one cancer to another site. The challenge is making a correct diagnosis and giving the appropriate management. Erroneously handling one as a metastasis of the other and instituting management as such would be inappropriate. It is necessary to make proper clinical and histopathological diagnosis and to institute proper management. We report the case of a woman who had primary cancers involving rare organ combinations of the breast and ascending colon.
Topics: Biopsy, Fine-Needle; Breast Neoplasms; Colectomy; Colon, Ascending; Colonic Neoplasms; Female; Humans; Laparotomy; Li-Fraumeni Syndrome; Mastectomy; Middle Aged; Neoplasms, Multiple Primary; Treatment Outcome
PubMed: 29192643
DOI: 10.4103/njcp.njcp_432_16 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2019
Topics: Abdomen, Acute; Adult; Colon, Ascending; Diagnosis, Differential; Female; Humans; Image Interpretation, Computer-Assisted; Jejunum; Laparoscopy; Mesenteric Cyst; Peritonitis; Rupture, Spontaneous; Tomography, X-Ray Computed
PubMed: 30703828
DOI: 10.1055/a-0832-2468 -
International Medical Case Reports... 2023Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous...
INTRODUCTION
Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous colonic volvulus is extremely rare; even if there are some case reports on synchronous colonic volvulus, there are no reported cases of synchronous ascending and transverse colon volvulus in the medical literature to our knowledge.
CASE PRESENTATION
A 25-year-old girl with a previous history of epilepsy presented with a one-day duration of abdominal cramps with associated symptoms of vomiting of bilious matter, failure to pass faeces, and flatus of the same duration. The patient underwent surgical intervention, and ascending and transverse volvulus were discovered.
CONCLUSION
In spite of ascending and transverse colon volvulus rarity, we advised including these in the differential diagnosis of patients associated with large bowel obstruction.
PubMed: 37408755
DOI: 10.2147/IMCRJ.S413600 -
European Journal of Surgical Oncology :... Apr 2022The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated... (Review)
Review
INTRODUCTION
The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated the oncological relevance of metastatic infrapyloric and gastroepiploic lymph nodes (IGLN) from hepatic flexure and transverse colon tumors. This study aimed to evaluate the incidence and risk factors for IGLN metastases, and the indications, surgical morbidities, and oncological outcome following extended lymphadenectomy.
MATERIALS AND METHODS
According to the PRISMA statement, a systematic review on IGLN lymphadenectomy for colon cancer was conducted into PubMed, Embase, and Cochrane databases. A critical appraisal of study was performed according to the Joanna Briggs Institute Tools.
RESULTS
Nine studies were included. IGLN metastases incidence ranged 0.7-22%. IGLN positivity for patients with metastatic mesocolic lymph nodes ranged 1.7-33.3%. Postoperative complication rate ranged 8.5-36.9%, mostly low grade according to Clavien-Dindo's classification. Postoperative mortality rate ranged 0-5.4% at 30-days. IGLN metastases were associated with advanced disease with a 5-year progression-free survival rate up to 33.9%. Two authors reported perineural invasion and N stage as risk factors, while another reported endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage to be risk factors for IGLN involvement. Apart from one study, all other studies were of moderate/high quality.
CONCLUSIONS
Metastatic IGLNs are not uncommon and should be highly considered. IGLN metastases could be potentially associated with an aggressive disease. IGLN dissection is not associated with higher morbidity and mortality than standard CME. Preoperative risk factors of IGLN involvement could guide surgical indication for extended lymphadenectomy.
Topics: Colectomy; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Mesocolon
PubMed: 34893366
DOI: 10.1016/j.ejso.2021.12.005