The incidence of anastomotic leak after right hemicolectomy for cancer is relatively low, but it may be misjudged. In recent years, the results of some multi-center or nationwide registration studies in Europe have shown that the incidence of anastomotic leak is significantly higher than that of eastern countries. The reasons of these differences may be the different nature of the studies, the lack of rigor in diagnostic criteria or diagnostic methods, the difference in the level of specialization of hospitals or surgeons, and so on. Timely treatment of preoperative comorbidities, reasonable selection of preoperative bowel preparation and anastomotic technique/method might reduce the occurrence of anastomotic leak. The current evidence shows complete mesocolic excision (CME) does not increase the risk of anastomotic leak. The clinical features of ileo-colic anastomotic leak are different from those of rectal surgery. The mild cases can be treated conservatively, and the severe cases are suggested to receive timely diverting ileostomy.
Anastomosis, Surgical/adverse effects* ; Anastomotic Leak/surgery* ; Colectomy ; Europe ; Humans ; Mesocolon/surgery* ; Neoplasms ; Retrospective Studies ; Risk Factors

Anastomotic leak is one of the most severe complications following right hemicolectomy but rarely happens, which should be diagnosed based on clinical manifestations, laboratory and radiographic examinations. Influencing factors of anastomotic leak after right hemicolectomy include bowel preparation, emergency surgery, anastomotic procedure (side-to-side anastomosis vs. end-to-side anastomosis, instrument anastomosis vs. manual technigue and intracorporeal vs. extracorporeal anastomosis), surgical resection range and patient's characteristics. The occurrence of anastomotic leak might be avoided by standardized operations and indocyanine green fluorescence imaging. Active treatment is recommended once anastomotic leak is diagnosed. Most patients can be cured by non-surgical treatments such as adequate drainage and anti-infection therapy. When severe sepsis happens or non-surgical treatment fails, surgical treatment should be carried out in time.
Anastomosis, Surgical/adverse effects* ; Anastomotic Leak/surgery* ; Colectomy ; Colon/surgery* ; Humans ; Indocyanine Green

OBJECTIVETo investigate the predictive value of procalcitonin(PCT) in postoperative intra-abdominal infections (IAI) after definitive operation of intestinal fistulae(IF).

METHODSWith the exclusion of emergence operation, preoperative clinical infection, preoperative renal or hepatic dysfunction, and age less than 18 years, a total of 356 consecutive patients who underwent elective digestive tract reconstruction of intestinal fistulae from February 2012 to December 2015 at Intestinal Fistula Center of Jinling Hospital were prospectively enrolled in the study. All the patients were divided into IAI group (26 cases, 21 of anastomosis leakage and 5 of peritoneal abscess) and non-IAI group (330 cases) based on the existence of postoperative IAI. The non-IAI group was then divided into two subgroups of other infection (93 cases) and non-infection(237 cases) according to the presence of other infections. Plasma PCT level, serum CRP concentration and WBC count were assessed preoperatively and on postoperative days (PODs) 1, 3, 5, 7 by immunofluorescence, turbidimetry and automatic blood analyzer, respectively. The predictive value of each marker for IAI was calculated by receiver operating characteristic (ROC) curve.

RESULTSThere was no significant difference in general clinical data between IAI and non-IAI group (all P>0.05). The proportions of multi-IF (53.8%, 14/26) and colectomy (61.5%, 16/26) in IAI group were higher than those of non-IAI group [20.0% (66/330), χ=15.847, P=0.000 and 31.2%(103/330), χ=9.961, P=0.002]. Differences of preoperative PCT, CRP and WBC levels among IAI, other infection and non-infection groups were not significant. These three markers all increased obviously and immediately after surgery. PCT and WBC values reached the peak point on POD 1, whereas CRP on POD 3. In IAI group, mean PCT values were (5.4±4.2) μg/L, (2.9±1.9) μg/L and (1.6±1.8) μg/L on POD 1, POD 3 and POD 5, respectively, which were higher than those of other infection group [(4.2±8.7) μg/L, (1.9±3.8) μg/L and (0.6±0.8) μg/L] and non-infection group [(2.7±5.8) μg/L, (1.1±1.7) μg/L and (0.5±0.7) μg/L, all P<0.05]. Mean CRP values in IAI group were 99.4 mg/L and 183.9 mg/L respectively on POD 1 and POD 3,and mean WBC values of IAI group on POD 1, POD 3 and POD 5 were 16.0×10/L, 10.8×10/L and 8.7×10/L, respectively, which were all significantly higher than those in the other 2 groups (all P<0.05). No significant differences were obtained between other infection group and non-infection group in all these three markers (all P>0.05). ROC curve demonstrated that PCT had the biggest area under the curve (AUC) of 0.86 and 0.84 on POD 3 and POD 5, with the cut-off value of 0.98 μg/L and 0.83 μg/L, 92.0% sensitivity and 74.0% specificity, 91.0% sensitivity and 73.0% specificity, respectively. The highest AUC was 0.72 on POD 3 for CRP and 0.71 on POD 3 for WBC, with 80.0% sensitivity and 54.0% specificity, 56.0% sensitivity and 73.0% specificity, respectively.

CONCLUSIONThe value of procalcitonin above 0.98 μg/L on POD 3 and 0.83 μg/L on POD 5 can predict the occurrence of IAI after definitive operations of intestinal fistulae.

Abdominal Abscess ; etiology ; Anastomotic Leak ; etiology ; Area Under Curve ; Biomarkers ; blood ; Calcitonin ; blood ; Colectomy ; adverse effects ; statistics & numerical data ; Elective Surgical Procedures ; adverse effects ; statistics & numerical data ; Female ; Humans ; Intestinal Fistula ; complications ; surgery ; Intraabdominal Infections ; etiology ; Male ; Postoperative Complications ; epidemiology ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

OBJECTIVETo summarize the perioperative and postoperative complications follow laparoscopic intersphincteric resection (LapISR) in the treatment of low rectal cancer and their management.

METHODSAn observational study was conducted in 73 consecutive patients who underwent LapISR for low rectal cancer between June 2011 and February 2016 in our hospital. The clinicopathological parameters, perioperative and postoperative complications, and clinical outcomes were collected from a prospectively maintained database. Perioperative and postoperative complications were defined as any complication occurring within or more than 3 months after the primary operation, respectively.

RESULTSForty-nine(67.1%) cases were male and 24(32.9%) were female with a median age of 61(25 to 79) years. The median distance from distal tumor margin to anal verge was 4.0(1.0 to 5.5) cm. The median operative time was 195 (120 to 360) min, median intra operative blood loss was 100 (20 to 300) ml, median number of harvested lymph nodes was 14(3 to 31) per case. All the patients underwent preventive terminal ileum loop stoma. No conversion or hospital mortality was presented. The R0 resection rate was 98.6% with totally negative distal resection margin. A total of 34 complication episodes were recorded in 21(28.8%) patients during perioperative period, and among which 20.6%(7/34) was grade III(-IIII( according to Dindo system. Anastomosis-associated morbidity (16.4%,12/73) was the most common after LapISR, including mucosa ischemia in 9 cases(12.3%), stricture in 7 cases (9.6%, 4 cases secondary to mucosa necrosis receiving anal dilation), grade A fistula in 3 cases (4.1%) receiving conservative treatment and necrosis in 1 case (1.4%) receiving permanent stoma. After a median follow up of 21(3 to 60) months, postoperative complications were recorded in 12 patients (16.4%) with 16 episodes, including anastomotic stenosis (8.2%), rectum segmental stricture (5.5%), ileus (2.7%), partial anastomotic dehiscence (1.4%), anastomotic fistula (1.4%), rectovaginal fistula (1.4%) and mucosal prolapse (1.4%). These patients received corresponding treatments, such as endoscopic transanal resection, anal dilation, enema, purgative, permanent stoma, etc. according to the lesions. Six patients (8.2%) required re-operation intervention due to postoperative complications.

CONCLUSIONAnastomosis-associated morbidity is the most common after LapISR in the treatment of low rectal cancer in perioperative and postoperative periods, which must be strictly managed with suitable methods.

Adult ; Aged ; Anal Canal ; surgery ; Anastomosis, Surgical ; adverse effects ; Blood Loss, Surgical ; statistics & numerical data ; Colectomy ; adverse effects ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Surgical Procedures ; adverse effects ; Female ; Humans ; Ileostomy ; adverse effects ; Intestinal Mucosa ; pathology ; Ischemia ; etiology ; Laparoscopy ; adverse effects ; Lymph Node Excision ; statistics & numerical data ; Male ; Margins of Excision ; Middle Aged ; Necrosis ; etiology ; Operative Time ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; complications ; surgery ; Rectovaginal Fistula ; etiology ; therapy ; Surgical Stomas ; Treatment Outcome

BACKGROUNDClarifying the risk factors for postoperative complications and taking measures to minimize these complications will improve the outcomes in patients with ulcerative colitis (UC). This study aimed to systemically explore the risk factors for short-term postoperative complications in Chinese UC patients undergoing ileocolorectal surgery.

METHODSForty-nine UC patients undergoing proctocolectomy or ileostomy were retrospectively enrolled. Univariate and multivariate logistic regression analyses were conducted to reveal the risk factors among the clinical, laboratory, and surgical variables as well as preoperative medications.

RESULTSTwenty-two (44.9%) patients who suffered from at least one short-term postoperative event had more severe hypoalbuminemia (P = 0.007) and an increased prevalence of preoperative corticosteroid usage (prednisone more than 20 mg daily or equivalent) for more than 6 weeks (59.1% vs. 25.9%, P = 0.023) compared with patients without short-term postoperative complications. Based on the multivariate logistic regression analysis, the odds ratio (95% confidence interval) values of these two risk factors were 1.756 (0.889-3.470, P = 0.105) and 3.233 (0.916-11.406, P = 0.068), respectively. In 32 severe UC patients, prolonged preoperative hospital stay worsened the short-term postoperative outcomes.

CONCLUSIONSPreoperative corticosteroids usage and hypoalbuminemia worsened the short-term outcomes following ileocolorectal surgery in Chinese UC patients.

Adrenal Cortex Hormones ; adverse effects ; Adult ; Colectomy ; Colitis, Ulcerative ; surgery ; Female ; Humans ; Hypoalbuminemia ; complications ; Logistic Models ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Risk Factors

OBJECTIVETo investigate the associated factors for postoperative ileus following radical resection for colorectal cancer.

METHODSClinical data of 1366 colorectal cancer patients undergoing radical resection by the same surgical team in our hospital from January 2000 to September 2011 were analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were used to identify the associated factors of postoperative ileus.

RESULTSA total of 70 patients(5.1%) developed postoperative ileus. Univariate and multivariate analyses showed that N2(OR=1.893, 95%CI:1.083-3.306), history of colorectal cancer resection(OR=4.899, 95%CI:1.490-16.110), preoperative obstruction (OR=2.616, 95%CI:1.297-5.280), right hemicolectomy(OR=2.024, 95%CI:1.052-3.894) and left hemicolectomy(OR=3.030, 95%CI:1.401-6.550) were risk factors for postoperative ileus following radical resection for colorectal cancer, while laparoscopic operation(OR=0.520, 95%CI:0.319-0.849) was protective.

CONCLUSIONSPostoperative ileus following radical resection for colorectal cancer is associated with surgical procedures. Laparoscopic colorectal resection can reduce the incidence of postoperative ileus.

Colectomy ; adverse effects ; Colorectal Neoplasms ; surgery ; Factor Analysis, Statistical ; Humans ; Ileus ; etiology ; surgery ; Incidence ; Laparoscopy ; Multivariate Analysis ; Postoperative Complications ; Retrospective Studies ; Risk Factors

Colectomy ; Embolism, Air ; etiology ; Humans ; Laparoscopy ; Male ; Middle Aged ; Pneumoperitoneum, Artificial ; adverse effects

OBJECTIVETo investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease.

METHODSClinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression.

RESULTSFourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present.

CONCLUSIONSCDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.

Abdominal Abscess ; pathology ; Adolescent ; Adult ; Aged ; Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; pathology ; Chi-Square Distribution ; Colectomy ; adverse effects ; Crohn Disease ; surgery ; Female ; Humans ; Intestinal Fistula ; pathology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Steroids ; therapeutic use ; Surgical Wound Infection ; etiology ; surgery ; Young Adult

No abstract available.
Adult ; Antimetabolites, Antineoplastic/*adverse effects ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy ; Bone Marrow Examination ; Chemotherapy, Adjuvant ; Colectomy ; Colorectal Neoplasms/*drug therapy/pathology/surgery ; Cytogenetic Analysis ; Fluorouracil/*adverse effects ; Humans ; Leukemia, Myeloid, Acute/*chemically induced/diagnosis/drug therapy ; Male ; Treatment Outcome

PURPOSE: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation. MATERIALS AND METHODS: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared. RESULTS: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups. CONCLUSION: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Colectomy/*adverse effects/methods ; Female ; Humans ; Inflammation/etiology/metabolism ; Insulin-Like Growth Factor Binding Protein 3/blood ; Interleukin-6/blood ; Laparoscopy/adverse effects ; Male ; Middle Aged ; Postoperative Period ; Sigmoid Neoplasms/*surgery ; Treatment Outcome ; Vascular Endothelial Growth Factor A/blood