AIM:

The study included an investigation of factors determining suboptimal adjuvant chemotherapy t of patients diagnosed with stage III colon cancer.

METHOD:

All 606 patients diagnosed with stage III colon cancer between 2006 and 2008 in the western part of the Netherlands were included. Patient (gender, age, comorbidity, socioeconomic status (SES)), tumour (location, stage, grade) and treatment factors (emergency surgery, laparoscopic surgery, reoperation, hospital stay, multidisciplinary meeting) were examined in logistic regression analyses predicting a complicated postoperative period and omission, delay and discontinuation of adjuvant chemotherapy.

RESULTS:

Overall, 27% of all patients experienced a complicated postoperative period, which was independently associated with emergency surgery, older age, multiple comorbidity, male gender and poor tumour grade. Of patients who survived this period, 60% received chemotherapy. Chemotherapy was omitted more often in females, elderly, patients with stage IIIB, reoperation, prolonged hospital stay and (borderline) after open surgery. Of patients who received chemotherapy, 86% started within 8 weeks after surgery. Patients with a higher SES, reoperation and prolonged hospital stay had a higher probability of a delayed start. Sixty-seven percent of patients completed their chemotherapy. For females, elderly and patients with prolonged hospital stay a higher probability of discontinuation was noted.

CONCLUSION:

Age was the most important predictive factor for receiving adjuvant chemotherapy. However, at all ages, complicated postoperative recovery negatively influenced the administration of chemotherapy to stage III colon cancer patients, as well as a timely start and completion of chemotherapy. This article is protected by copyright. All rights reserved.

AIM:

The short term outcome was examined of perineal vertical rectus abdominis myocutaneous (VRAM) flap reconstruction following abdominal perineal excision (APE).

METHOD:

Retrospective case note review of all patients undergoing APE and primary vertical rctus abdominal muscule (VRAM) reconstruction between July 2001 and February 2012 in a District General Hospital tertiary referral centre for APE. Complications were categorised using the Clavien-Dindo classification, which grades complications from I-V in order of increasing severity.

RESULTS:

Fift five consecutive patients (31 male, median age 65 (38-84) years underwent APE with VRAM flap reconstruction, 15 for anal cancer and 40 for rectal cancer. Median length of stay was 11 days but was significantly shorter in the laparoscopic group compared to the open group (8 vs. 12 days; p<0.01) and in patients who did not experience a had no complication (p<0.05). Four (7%) patients had major complications (Grade 3 and above) directly related to the flap or donor site.

CONCLUSION:

VRAM reconstruction of the perineum can be safely performed following APE with results that compare favourably with other techniques. Most flap complications are minor, although these are still associated with an increase in the length of hospital stay. This article is protected by copyright. All rights reserved.

In the UK, colorectal surgery has evolved from traditional open surgery to a minimally invasive approach. In 2001, a UK survey found only 11.3% of malignant colorectal resections and 10% of anterior resections were performed laparoscopically(1) . However, subsequent publications including the CLASICC trial that led to revised NICE guidelines, have changed the landscape with 34% of elective cases in 2010-2011 being performed laparoscopically (2,3,4,5) . This article is protected by copyright. All rights reserved.

AIM:

The existing evidence on the relationship between Helicobacter pylori infection and the risk of colorectal neoplasia is inconsistent. We conducted a systematic review with a meta-analysis to explore this relationship and to determine whether the relationship varies according to the study characteristics.

METHOD:

We searched the PubMed database and the reference lists of pertinent articles published up to July 2012. Summary odds ratios (ORs) with their 95% confidence intervals (CIs) were estimated using a random-effects model.

RESULTS:

Twenty-seven studies including 3792 cases of colorectal adenoma (CRA) and 3488 cases of colorectal cancer (CRC) were identified. Overall, H. pylori infection was associated with an increased risk of CRA (OR = 1.66, 95% CI 1.39-1.97, I(2) = 54.3%) and CRC (OR = 1.39, 95% CI 1.18-1.64, I(2) = 35.8%), although there was significant heterogeneity among the studies. Subgroup analysis revealed that the positive correlation did not differ by sex, geographic variation, or subsite of neoplasia, but might vary by the method of detection of H. pylori. The study was underpowered to determine the risk of colorectal neoplasia associated with CagA-positive H. pylori.

CONCLUSION:

This meta-analysis demonstrates a positive association between H. pylori infection and the risk of colorectal neoplasia. This article is protected by copyright. All rights reserved.

We read the recent article reporting a randomized controlled trial comparing hand-assisted laparoscopic colectomy (HALC) with total laparoscopic colectomy for right-sided colonic cancer [1]. We believe it is an important study demonstrating the safety and feasibility of HALC for this condition and we would like to make the following comments focused on hand-device placement and trocar arrangement. This article is protected by copyright. All rights reserved.