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Emergency vs bridge surgery for obstructive right sided colon cancer: multicenter retrospective study
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Scientific Poster Presentations: 2015 Clinical Congress
Emergency vs bridge surgery for obstructive right sided colon cancer: multicenter retrospective study Hyun Jong Kang, MD, Bonghyeon Kye, Hyung Jin Kim, Yoon Suk Lee, Jun-Gi Kim, Seong-Taek Oh, MD, Won Kyung Kang, In Kyu Lee, Chang-Hyuck Ahn, Jong Kyung Park College of Medicine, The Catholic University of Korea, Seoul, Korea INTRODUCTION: Recently, bridge surgery (BS) after decompression with self-expandable stent has been accounted as a possible surgical option for malignant obstruction in right sided colon (MORC). METHODS: A total of 1,785 patients who underwent curative surgery for stage II or III colon cancer in 7 Hospitals in Korea were reviewed retrospectively. Seventy-four (4.1% of all patients, 24.9% in malignant obstruction) had MORC. We compared postoperative outcome and mid-term oncologic outcome between emergency surgery (EMS) group (49 patients) and bridge surgery (BS) group (25 patients). RESULTS: There was no mortality within 30 days after surgery. Operation time was 241.66 and 254.84 minutes in EMS group and BS group (p¼0.534). In EMS group, open surgery was more frequently performed (67.3% vs 40.0%, p¼0.028). There were no differences in length of distal and proximal resection margin (p¼0.820 and p¼0.620), number of metastatic lymph nodes (p¼0.221), flatus passage (p¼0.242), diet start (p¼0.336), and hospital stay (p¼0.444) between the two groups. There was no difference in postoperative morbidity (19.1% vs 24.0%, p¼0.762) between the two groups. Mean overall survival (OS) was 86.49 (EMS group) and 115.73 months (BS group), 3-year OS rate was 76.3% (EMS group) and 90.7% (BS group) (p¼0.172). Mean disease-free survival (DFS) was 75.87 (EMS group) and 97.82 (BS group), 3-year DFS rate was 77.1% (EMS group) and 76.2% (BS group) (p¼0.929). CONCLUSIONS: Based on above result, postoperative course and oncologic outcomes of EMS group were similar to that of BS group. We think that BS after colonic stent may be a good surgical option for malignant obstruction in right sided colon. Hemorrhoids treatment with transanal hemorrhoidal dearterialization method Afshin Heydari, MD, Enrico Merolla, MD, Reza Fazl Alizadeh, MD, Simona Giuratrabocchetta, MD, Micaela Piccoli, MD, Gianluigi Melotti, MD, FACS Nuovo Ospedale Civile S. Agostino-Estense (NOCSAE), Modena, Italy INTRODUCTION: The transanal hemorrhoidal dearterialization (THD) device is a specifically designed proctoscope for Dopplerguided transanal ligation of hemorrhoidal arteries. It can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. The objective of this study was to evaluate outcomes and possible complications of THD.
J Am Coll Surg
METHODS: Between January 2011 and June 2014, 146 patients with grade II in 31 (21.2%), grade III in 102 (69.8%), and grade IV in 13 (8.9%) were submitted to THD operation. The operation was performed under spinal anesthesia in an ambulatory setting. Following THD surgery, patients were regularly evaluated at 1 week, 1 month, and 1 year after operation. RESULTS: The mean age of the 146 patients was 60 (range, 28-90) years. 84 (57.5%) were men, and 62 were women (42.4%). There were two cases of postoperative bleeding; only one required local hemostasis using local sclerosal injection (0.6%). At twelve-month follow up, prolapse was noticed in 7 patients who underwent operation for grade III and IV. The clinical follow-up range for all the patients was 12.8 months (range 1-24 months). Hemorrhoidal thrombosis, chronic pain, and fecal incontinence were not observed, however some patients reported rectal tenesmus in immediate postoperative time. CONCLUSIONS: Our study indicates that THD is a minimally invasive procedure, which is safe and effective in treating hemorrhoids, and can be performed in ambulatory settings. In the future we plan to increase the number of the patients and compare THD with other procedures to show the significant potentials of this procedure and define adequate indications for this approach. IgG4+ plasma cells in inflammatory bowel disease (IBD): true biomarker or nonspecific marker of inflammation? Elizabeth He, MD, Timothy Witalka, Matthew Hoscheit, N Valluru, MD, Xianzhong Ding, MD, Dana M Hayden, MD Loyola University Medical Center, Maywood, IL INTRODUCTION: IgG4+plasma cells (PC) have been identified in several sclerosing diseases of the gastrointestinal tract, however their role in inflammatory bowel disease has yet to be elucidated. METHODS: Immunohistochemical staining for IgG4+PC was performed on 80 bowel resection samples from patients with Crohn’s disease (CD) and ulcerative colitis (UC), 2009-2013 and retrospective chart review was performed. RESULTS: Only one specimen had >50 IgG4+ PC/HPF diagnostic of IgG4-sclerosing disease, however, mean IgG4+PC level was increased in both CD and UC when compared to controls (10.7 vs 2.33, p¼0.000 and 15.8 vs 2.33, p¼0.000). No significant difference in level was found in CD vs UC even though levels tended to be higher in UC samples (15.8 vs 10.7, p¼0.282). Infiltration depth was also not different. However, when evaluating IBD patients alone, females had deeper infiltration than males (p¼0.033) and obese patients (BMI>30) had higher levels of IgG4+PC compared to normal weight (p¼0.001). Age and race did not correlate with level or infiltration. IgG4+PC levels were not associated with steroids, anti-TNF agents, TPN, weight loss, previous bowel resection, age <20 years at diagnosis or surgery, or smoking. CONCLUSIONS: IgG4+ PC are associated with actively inflamed IBD tissue when compared to controls. Depth of infiltration and level did not differ between CD and UC. Although some patient characteristics, like female gender and higher BMI, were associated
Scientific Poster Presentations: 2015 Clinical Congress
Emergency vs bridge surgery for obstructive right sided colon cancer: multicenter retrospective study Hyun Jong Kang, MD, Bonghyeon Kye, Hyung Jin Kim, Yoon Suk Lee, Jun-Gi Kim, Seong-Taek Oh, MD, Won Kyung Kang, In Kyu Lee, Chang-Hyuck Ahn, Jong Kyung Park College of Medicine, The Catholic University of Korea, Seoul, Korea INTRODUCTION: Recently, bridge surgery (BS) after decompression with self-expandable stent has been accounted as a possible surgical option for malignant obstruction in right sided colon (MORC). METHODS: A total of 1,785 patients who underwent curative surgery for stage II or III colon cancer in 7 Hospitals in Korea were reviewed retrospectively. Seventy-four (4.1% of all patients, 24.9% in malignant obstruction) had MORC. We compared postoperative outcome and mid-term oncologic outcome between emergency surgery (EMS) group (49 patients) and bridge surgery (BS) group (25 patients). RESULTS: There was no mortality within 30 days after surgery. Operation time was 241.66 and 254.84 minutes in EMS group and BS group (p¼0.534). In EMS group, open surgery was more frequently performed (67.3% vs 40.0%, p¼0.028). There were no differences in length of distal and proximal resection margin (p¼0.820 and p¼0.620), number of metastatic lymph nodes (p¼0.221), flatus passage (p¼0.242), diet start (p¼0.336), and hospital stay (p¼0.444) between the two groups. There was no difference in postoperative morbidity (19.1% vs 24.0%, p¼0.762) between the two groups. Mean overall survival (OS) was 86.49 (EMS group) and 115.73 months (BS group), 3-year OS rate was 76.3% (EMS group) and 90.7% (BS group) (p¼0.172). Mean disease-free survival (DFS) was 75.87 (EMS group) and 97.82 (BS group), 3-year DFS rate was 77.1% (EMS group) and 76.2% (BS group) (p¼0.929). CONCLUSIONS: Based on above result, postoperative course and oncologic outcomes of EMS group were similar to that of BS group. We think that BS after colonic stent may be a good surgical option for malignant obstruction in right sided colon. Hemorrhoids treatment with transanal hemorrhoidal dearterialization method Afshin Heydari, MD, Enrico Merolla, MD, Reza Fazl Alizadeh, MD, Simona Giuratrabocchetta, MD, Micaela Piccoli, MD, Gianluigi Melotti, MD, FACS Nuovo Ospedale Civile S. Agostino-Estense (NOCSAE), Modena, Italy INTRODUCTION: The transanal hemorrhoidal dearterialization (THD) device is a specifically designed proctoscope for Dopplerguided transanal ligation of hemorrhoidal arteries. It can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. The objective of this study was to evaluate outcomes and possible complications of THD.
J Am Coll Surg
METHODS: Between January 2011 and June 2014, 146 patients with grade II in 31 (21.2%), grade III in 102 (69.8%), and grade IV in 13 (8.9%) were submitted to THD operation. The operation was performed under spinal anesthesia in an ambulatory setting. Following THD surgery, patients were regularly evaluated at 1 week, 1 month, and 1 year after operation. RESULTS: The mean age of the 146 patients was 60 (range, 28-90) years. 84 (57.5%) were men, and 62 were women (42.4%). There were two cases of postoperative bleeding; only one required local hemostasis using local sclerosal injection (0.6%). At twelve-month follow up, prolapse was noticed in 7 patients who underwent operation for grade III and IV. The clinical follow-up range for all the patients was 12.8 months (range 1-24 months). Hemorrhoidal thrombosis, chronic pain, and fecal incontinence were not observed, however some patients reported rectal tenesmus in immediate postoperative time. CONCLUSIONS: Our study indicates that THD is a minimally invasive procedure, which is safe and effective in treating hemorrhoids, and can be performed in ambulatory settings. In the future we plan to increase the number of the patients and compare THD with other procedures to show the significant potentials of this procedure and define adequate indications for this approach. IgG4+ plasma cells in inflammatory bowel disease (IBD): true biomarker or nonspecific marker of inflammation? Elizabeth He, MD, Timothy Witalka, Matthew Hoscheit, N Valluru, MD, Xianzhong Ding, MD, Dana M Hayden, MD Loyola University Medical Center, Maywood, IL INTRODUCTION: IgG4+plasma cells (PC) have been identified in several sclerosing diseases of the gastrointestinal tract, however their role in inflammatory bowel disease has yet to be elucidated. METHODS: Immunohistochemical staining for IgG4+PC was performed on 80 bowel resection samples from patients with Crohn’s disease (CD) and ulcerative colitis (UC), 2009-2013 and retrospective chart review was performed. RESULTS: Only one specimen had >50 IgG4+ PC/HPF diagnostic of IgG4-sclerosing disease, however, mean IgG4+PC level was increased in both CD and UC when compared to controls (10.7 vs 2.33, p¼0.000 and 15.8 vs 2.33, p¼0.000). No significant difference in level was found in CD vs UC even though levels tended to be higher in UC samples (15.8 vs 10.7, p¼0.282). Infiltration depth was also not different. However, when evaluating IBD patients alone, females had deeper infiltration than males (p¼0.033) and obese patients (BMI>30) had higher levels of IgG4+PC compared to normal weight (p¼0.001). Age and race did not correlate with level or infiltration. IgG4+PC levels were not associated with steroids, anti-TNF agents, TPN, weight loss, previous bowel resection, age <20 years at diagnosis or surgery, or smoking. CONCLUSIONS: IgG4+ PC are associated with actively inflamed IBD tissue when compared to controls. Depth of infiltration and level did not differ between CD and UC. Although some patient characteristics, like female gender and higher BMI, were associated