N. Gouvas - Academia.edu (original) (raw)

Papers by N. Gouvas

European Journal of Anaesthesiology, 2011

Radiotherapy and Oncology, 2011

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 4, 2014

Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt ... more Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt rectal prolapse (ORP) and obstructed defaecation syndrome (ODS). The present study reviews the short-term and functional results of laparoscopic VR. A MEDLINE, Embase, Ovid, and Cochrane database search was performed on all studies reporting on VR for ORP, ODS and other pelvic floor anatomical abnormalities from 2004 until February 2013. No language restrictions were made. All studies on VR were reviewed systematically. The main outcomes were intraoperative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, ORP recurrence, anatomical disorder recurrence, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Twenty three studies including 1,460 patients were eligible for analysis. The conversion rate ranged from 0 to ...

Radiotherapy and Oncology, 2011

The American Journal of Surgery, 2009

BACKGROUND Macroscopic evaluation of a tumor specimen is an independent prognostic factor of onco... more BACKGROUND Macroscopic evaluation of a tumor specimen is an independent prognostic factor of oncologic outcome after total mesorectal excision (TME) for rectal cancer. This study aimed to assess macroscopic quality of specimens acquired after laparoscopic versus open TME in patients with low rectal cancer.

Surgical Oncology, 2009

Introduction: The aim of the study was to evaluate the diagnostic precision of serum carcinoembry... more Introduction: The aim of the study was to evaluate the diagnostic precision of serum carcinoembryonic antigen (CEA) in the detection of local or distant recurrence following resectional surgery for colon and rectal cancer. Methods: Quantitative meta-analysis was performed on 20 studies, comparing serum CEA with radiological imaging and/or pathology in detecting colorectal cancer (CRC) recurrence in 4285 patients. The cut-off for a 'positive' CEA ranged from 3 to 15 ng/ml between the various studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were calculated for each study. Summary receiver operating characteristic curves (SROC) and sub-group analysis were undertaken. Results: The overall sensitivity and specificity of CEA for detecting CRC recurrence was 0.64 (95% CI: 0.61e0.67) and 0.90 (95% CI: 0.89e0.91), respectively. The area under the SROC curve was 0.75 (SE Z 0.04) and the diagnostic odds ratio was 18.44 (95% CI: 11.94e28.49). A CEA cut-off of 5 ng/ml yielded a higher diagnostic odds ratio than a cut-off of 3 ng/ml (15.5 vs. 11.1). Using metaregression analysis the optimum CEA cut-off point for the best combination of sensitivity and specificity was 2.2 ng/ml. On sub-group analysis high quality studies, and those involving !100 patients yielded a marginal improvement in the sensitivity and specificity with minimal change to the SROC. Conclusion: Serum CEA is a test with high specificity but insufficient sensitivity for detecting CRC recurrence in isolation. A cut-off of 2.2 ng/ml may provide an ideal balance of sensitivity and specificity. It may be useful as a first-line surveillance investigation in patients during surgical follow-up based on serial CEA measurements using temporal trends in conjunction with clinical, radiological and/or histological confirmation. ª

The Lancet Oncology, 2009

Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are asso... more Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case-control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Operating time was significantly longer in the EL group by 76.7 min (95% CI 18.77-134.68; p=0.0096). Intra-operative blood loss was greater in the EL group by 536.5 mL (95% CI 353.7-719.2; p<0.0001). Peri-operative mortality (OR 0.81, 95% CI 0.34-1.93; p=0.63) and morbidity (OR 1.45, 95% CI 0.89-2.35; p=0.13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary dysfunction (three studies: OR 3.70, 95% CI 1.66-8.23; p=0.0012) were more prevalent in the EL group. There were no significant differences in 5-year survival (hazard ratio [HR] 1.09, 95% CI 0.78-1.50; p=0.62), 5-year disease-free survival (HR 1.23, 95% CI 0.75-2.03, p=0.41), and local (OR 0.83, 95% CI 0.61-1.13; p=0.23) or distant recurrence (OR 0.93, 95% CI 0.72-1.21; p=0.60). Extended lymphadenectomy does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual dysfunction.

The Lancet Oncology, 2010

Lateral pelvic lymph-node dissection: still an option for cure. By - Hideaki Yano, Brendan J Mora... more Lateral pelvic lymph-node dissection: still an option for cure. By - Hideaki Yano, Brendan J Moran, Toshiaki Watanabe, Kenichi Sugihara.

International Journal of Colorectal Disease, 2009

The study compares the short-term results of the laparoscopic and open approach for the surgical ... more The study compares the short-term results of the laparoscopic and open approach for the surgical treatment of rectal cancer. Consecutive cases with rectal cancer operated upon with laparoscopy from 2004 to 2007 were compared to open rectal cancer cases. Total mesorectal excision (TME) was attempted in all cases. Forty-two cases were included in the OPEN and 45 in the LAP group and were matched for age, gender, disease stage and operation type. Duration of surgery was longer and blood transfusion requirements were less in the LAP group. Higher blood loss was observed in patients with neoadjuvant treatment in both groups. Patients with neoadjuvant treatment in the OPEN group had higher operation time, but that was not the case in the LAP group. There were three conversions (7%). Overall morbidity was higher in the OPEN group. LAP group patients were found to recover faster. R0 resection was achieved in 88% in the OPEN and 94% in the LAP group. Less morbidity and faster recovery is offered after laparoscopic TME. Quality of surgery assessed by histopathology is similar between the approaches. Neoadjuvant chemoradiation seems to have significant impact on blood loss but results in longer operation times of the OPEN group.

International Journal of Colorectal Disease, 2009

CITATIONS 182 READS 218 5 authors, including: Some of the authors of this publication are also wo... more CITATIONS 182 READS 218 5 authors, including: Some of the authors of this publication are also working on these related projects: MECCLANT TRIALS: mechanical bowel prep with oral antibiotics vs current practice for colon and rectal surgery View project

Diseases of the Esophagus, 2011

Skip to Main Content. ...

Diseases of the Esophagus, 2011

Esophageal emptying assessed at the 'timed barium' esophagogram correlates well w... more Esophageal emptying assessed at the 'timed barium' esophagogram correlates well with symptomatic outcomes after pneumatic dilation for esophageal achalasia, although 30% of patients with satisfactory outcome exhibit partial improvement in emptying. The aim of the study was to investigate any correlation of esophageal emptying to symptomatic response after laparoscopic Heller's myotomy and Dor's fundoplication. 'Bread and barium' (transit time of a barium opaque bread bolus) and 'timed barium' (height of esophageal barium column 5 minutes after ingestion of 200-250 mL of barium suspension) esophagogram was used to assess esophageal emptying in 73 patients with esophageal achalasia before 1 and 5 years (31 cases) after laparoscopic myotomy and anterior fundoplication. Symptoms assessment was based to a specific score. At 1-year follow-up, excellent and good symptomatic results were obtained in 95% of the cases. Esophageal maximum diameter, esophageal transit time, and esophageal barium column were significantly correlated to each other and to symptom score postoperatively (P < 0.001). Complete and partial (<90% and 50-90% postoperative reduction in barium column, respectively) emptying was seen in 55% and 31% of patients with excellent result. Patients with a pseudodiverticulum postoperatively had a more delayed esophageal emptying than those without. Symptomatic outcome and esophageal emptying did not deteriorate at 5-year follow-up. Esophageal emptying assessed by 'barium and bread' and 'timed barium' esophagogram correlated well with symptomatic outcome after laparoscopic myotomy for esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. Outcomes do not deteriorate by time. Because of wide availability, esophagogram can be applied in follow-up of postmyotomy patients in conjunction with symptomatic evaluation.

Digestive Surgery, 2012

Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients i... more Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients is rather limited. The aim of the study was to investigate the role of laparoscopy within a 'fast-track' protocol in patients who underwent sphincter-preserving surgery for rectal cancer. 156 consecutive patients with low rectal cancer from three centers were assigned in four groups: the open fast track (OPEN-FT), the laparoscopic fast track (LAP-FT), the open (OPEN), and the laparoscopic (LAP). The fast-track protocol was applied in one center and traditional care in the other two. All patients underwent sphincter-preserving surgery and were followed-up for 30 days. Overall morbidity was less in the fast-track groups (p = 0.007). On the other hand, no statistical significance could be identified in mortality, readmission or reoperations rates among the groups (p = 0.562, p = 0.896, p = 0.238). Fast-track patients required significantly less intramuscular opioids for postoperative analgesia (p < 0.001). Primary (p < 0.001) and total hospital stays (p < 0.001) were significantly shorter in the fast-track groups. The implementation of a fast-track protocol is feasible and safe in low rectal cancer patients. Laparoscopy seems to be a basic element of such protocol as it further enhances recovery and reduces morbidity.

Digestive Diseases, 2007

Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clea... more Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clearance. To assess lymph node yield after laparoscopic total mesorectal excision (TME) for rectal cancer as compared to the open approach. 74 patients with middle and low rectal cancer were prospectively randomized in two groups. Group A included 39 patients who had an open TME (35 with low anterior resection of the rectum (LARR) and 4 with abdominoperineal resection of the rectum (APR)). In group B, there were 34 patients who had a laparoscopic TME (27 with LARR and 7 with APR). 10 of the LARR patients in group A and 14 of the LARR patients in group B had a defunctioning ileostomy. All operations were performed by one surgeon or under his supervision. Gender and age distribution were similar for both groups (group A: 23 males; mean age 69 (41-85); group B: 20 males; mean age 72 (31-84)). The mean distance of the tumor from the dentate line was 7.6 cm (1-12 cm) for group A and 6.1 cm (1-12 cm) for group B. Anastomosis was formed at a mean distance of 5.5 cm (1.5-8.5 cm) from the dentate line in group A and 3.5 cm (1-4.5 cm) in group B. At histology, in group A there were 5 T4 tumors, 9 T3, 10 T3+ (<1 mm distance from the circumferential resection margin), 13 T2 and 2 T1. In group B, there were 3 T4 tumors, 14 T3, 8 T3+, 7 T2 and 2 T1. Differences between groups were not significant. The mean number of lymph nodes retrieved in group A specimens was 19.2 (5-45) and in group B 19.2 (8-41) (p = 0.2). In group A, 3.9 (1-9) regional, 13.9 (3-34) intermediate and 1.5 (1-3) apical lymph nodes were retrieved. The respective values in group B were 3.7 (3-7), 14.4 (4-33) and 1.3 (1-3). Differences between groups were not significant. Also, the incidence of lymph node involvement by the tumor was not significantly different between groups (group A: 23; group B: 19). Laparoscopic resection of the rectum can achieve similar lymph node clearance to the open approach. Also, distribution of the lymph nodes along the resected specimens is similar between the two approaches.

Colorectal Disease, 2012

Complete mesocolic excision (CME) with central vessel ligation (CVL) as performed in Erlangen off... more Complete mesocolic excision (CME) with central vessel ligation (CVL) as performed in Erlangen offers the best long-term outcome for colon cancer. The aim of this study was to assess specimens after laparoscopic vs open CME-CVL macroscopically and morphometrically in patients with left and right colon cancers. All specimens were freshly photographed. Precise tumour morphometry and grading of the surgical plane were performed as described by pathologists in Leeds, UK. Thirty-four specimens from right-sided cancers were divided into 18 transverse colon cancers (nine laparoscopic vs nine open) and 16 caecum-ascending colon cancers (seven laparoscopic vs nine open) and 56 specimens from left-sided cancers (33 laparoscopic vs 23 open). There was no difference between laparoscopically and open acquired left- and right-sided specimens. Specimens of transverse colon displayed differences in length of central ligation to tumour (open 11.67 cm vs laparoscopic 8.72 cm, P = 0.049), length of central ligation to bowel wall (open 9.11 cm vs laparoscopic 6.5 cm, P = 0.015) and lymph node clearance (open 46.33 vs laparoscopic 39.33, P = 0.033). Laparoscopy seems to offer specimens of similar quality after CME-CVL surgery for colon cancer to the open approach. Issues of completeness of excision from laparoscopy are raised for tumours located in the transverse colon.

Techniques in Coloproctology, 2008

Background Worldwide, the annual mortality from CRC is estimated to be 500.000. The incidence and... more Background Worldwide, the annual mortality from CRC is estimated to be 500.000. The incidence and mortality of CRC increase with age especially after 60 years of age. In Sudan there are no present population-based cancer registries that can provide database for epidemiological studies on CRC and its risk factors, for an effective implementation of the suitable screening programs. Methods A retrospective hospital-based study was conducted on all CRC patients who attended Soba University Hospital (SUH) between January 2004 and December 2007 to describe the pattern of CRC according to age, race, gender and sub-site location of the tumor. We considered that SUH is one of the largest central hospitals in Sudan that has integrated gastrointestinal and endoscopy units and receives patients from different sources of referral. Results During the study period, 202 patients with CRC attended both hospital clinical wards and endoscopy units between the ages of 10-90 years. Age was found to be independently significantly associated with both proximal and distal CRC (p=0.01). Gender and race were found to be insignificantly associated with both proximal and distal CRC (p=0.839 and 0.522 respectively). Fifty-two percent of patients were found to be of 50 years of age and below. The mean age for CRC was found to be 50 years. Almost 70% of the patients were found to have distal CRC and about 85% of them were having rectal cancer. Conclusions Fifty-two percent of the patients were found to be of 50 years of age and below with predominance of distal CRC among all patients. This gives a clue that screening with flexible sigmoidoscopy starting at the age of 40 can be of an appreciated secondary preventive value.

European Journal of Anaesthesiology, 2011

Radiotherapy and Oncology, 2011

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, Jan 4, 2014

Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt ... more Laparoscopic ventral rectopexy (VR) with the use of prosthesis has been advocated for both overt rectal prolapse (ORP) and obstructed defaecation syndrome (ODS). The present study reviews the short-term and functional results of laparoscopic VR. A MEDLINE, Embase, Ovid, and Cochrane database search was performed on all studies reporting on VR for ORP, ODS and other pelvic floor anatomical abnormalities from 2004 until February 2013. No language restrictions were made. All studies on VR were reviewed systematically. The main outcomes were intraoperative complications, conversion, procedure duration, short-term mortality and morbidity, length of stay, ORP recurrence, anatomical disorder recurrence, faecal incontinence and constipation, quality of life (QoL) score and patient satisfaction. Quality assessment and data extraction were performed independently by three observers. Twenty three studies including 1,460 patients were eligible for analysis. The conversion rate ranged from 0 to ...

Radiotherapy and Oncology, 2011

The American Journal of Surgery, 2009

BACKGROUND Macroscopic evaluation of a tumor specimen is an independent prognostic factor of onco... more BACKGROUND Macroscopic evaluation of a tumor specimen is an independent prognostic factor of oncologic outcome after total mesorectal excision (TME) for rectal cancer. This study aimed to assess macroscopic quality of specimens acquired after laparoscopic versus open TME in patients with low rectal cancer.

Surgical Oncology, 2009

Introduction: The aim of the study was to evaluate the diagnostic precision of serum carcinoembry... more Introduction: The aim of the study was to evaluate the diagnostic precision of serum carcinoembryonic antigen (CEA) in the detection of local or distant recurrence following resectional surgery for colon and rectal cancer. Methods: Quantitative meta-analysis was performed on 20 studies, comparing serum CEA with radiological imaging and/or pathology in detecting colorectal cancer (CRC) recurrence in 4285 patients. The cut-off for a 'positive' CEA ranged from 3 to 15 ng/ml between the various studies. Sensitivity, specificity and diagnostic odds ratio (DOR) were calculated for each study. Summary receiver operating characteristic curves (SROC) and sub-group analysis were undertaken. Results: The overall sensitivity and specificity of CEA for detecting CRC recurrence was 0.64 (95% CI: 0.61e0.67) and 0.90 (95% CI: 0.89e0.91), respectively. The area under the SROC curve was 0.75 (SE Z 0.04) and the diagnostic odds ratio was 18.44 (95% CI: 11.94e28.49). A CEA cut-off of 5 ng/ml yielded a higher diagnostic odds ratio than a cut-off of 3 ng/ml (15.5 vs. 11.1). Using metaregression analysis the optimum CEA cut-off point for the best combination of sensitivity and specificity was 2.2 ng/ml. On sub-group analysis high quality studies, and those involving !100 patients yielded a marginal improvement in the sensitivity and specificity with minimal change to the SROC. Conclusion: Serum CEA is a test with high specificity but insufficient sensitivity for detecting CRC recurrence in isolation. A cut-off of 2.2 ng/ml may provide an ideal balance of sensitivity and specificity. It may be useful as a first-line surveillance investigation in patients during surgical follow-up based on serial CEA measurements using temporal trends in conjunction with clinical, radiological and/or histological confirmation. ª

The Lancet Oncology, 2009

Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are asso... more Lateral pelvic lymph-node metastases occur in 10-25% of patients with rectal cancer, and are associated with higher local recurrence and reduced survival rates. A meta-analysis was undertaken to assess the value of extended lateral pelvic lymphadenectomy in the operative management of rectal cancer. We searched Medline, Embase, Ovid, Cochrane Library, and Google Scholar for studies published between 1965 and 2009 that compared extended lymphadenectomy (EL) with standard rectal resection. 20 studies, which included 5502 patients from one randomised, three prospective non-randomised, and 14 retrospective case-control studies published between 1984 and 2009, met our search criteria and were assessed. 2577 patients underwent EL and 2925 underwent non-EL for rectal cancer. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. End-points evaluated included peri-operative outcomes, 5-year survival and recurrence rates. Operating time was significantly longer in the EL group by 76.7 min (95% CI 18.77-134.68; p=0.0096). Intra-operative blood loss was greater in the EL group by 536.5 mL (95% CI 353.7-719.2; p<0.0001). Peri-operative mortality (OR 0.81, 95% CI 0.34-1.93; p=0.63) and morbidity (OR 1.45, 95% CI 0.89-2.35; p=0.13) were similar between the two groups. Data from individual studies showed that male sexual dysfunction and urinary dysfunction (three studies: OR 3.70, 95% CI 1.66-8.23; p=0.0012) were more prevalent in the EL group. There were no significant differences in 5-year survival (hazard ratio [HR] 1.09, 95% CI 0.78-1.50; p=0.62), 5-year disease-free survival (HR 1.23, 95% CI 0.75-2.03, p=0.41), and local (OR 0.83, 95% CI 0.61-1.13; p=0.23) or distant recurrence (OR 0.93, 95% CI 0.72-1.21; p=0.60). Extended lymphadenectomy does not seem to confer a significant overall cancer-specific advantage, but does seem to be associated with increased urinary and sexual dysfunction.

The Lancet Oncology, 2010

Lateral pelvic lymph-node dissection: still an option for cure. By - Hideaki Yano, Brendan J Mora... more Lateral pelvic lymph-node dissection: still an option for cure. By - Hideaki Yano, Brendan J Moran, Toshiaki Watanabe, Kenichi Sugihara.

International Journal of Colorectal Disease, 2009

The study compares the short-term results of the laparoscopic and open approach for the surgical ... more The study compares the short-term results of the laparoscopic and open approach for the surgical treatment of rectal cancer. Consecutive cases with rectal cancer operated upon with laparoscopy from 2004 to 2007 were compared to open rectal cancer cases. Total mesorectal excision (TME) was attempted in all cases. Forty-two cases were included in the OPEN and 45 in the LAP group and were matched for age, gender, disease stage and operation type. Duration of surgery was longer and blood transfusion requirements were less in the LAP group. Higher blood loss was observed in patients with neoadjuvant treatment in both groups. Patients with neoadjuvant treatment in the OPEN group had higher operation time, but that was not the case in the LAP group. There were three conversions (7%). Overall morbidity was higher in the OPEN group. LAP group patients were found to recover faster. R0 resection was achieved in 88% in the OPEN and 94% in the LAP group. Less morbidity and faster recovery is offered after laparoscopic TME. Quality of surgery assessed by histopathology is similar between the approaches. Neoadjuvant chemoradiation seems to have significant impact on blood loss but results in longer operation times of the OPEN group.

International Journal of Colorectal Disease, 2009

CITATIONS 182 READS 218 5 authors, including: Some of the authors of this publication are also wo... more CITATIONS 182 READS 218 5 authors, including: Some of the authors of this publication are also working on these related projects: MECCLANT TRIALS: mechanical bowel prep with oral antibiotics vs current practice for colon and rectal surgery View project

Diseases of the Esophagus, 2011

Skip to Main Content. ...

Diseases of the Esophagus, 2011

Esophageal emptying assessed at the 'timed barium' esophagogram correlates well w... more Esophageal emptying assessed at the 'timed barium' esophagogram correlates well with symptomatic outcomes after pneumatic dilation for esophageal achalasia, although 30% of patients with satisfactory outcome exhibit partial improvement in emptying. The aim of the study was to investigate any correlation of esophageal emptying to symptomatic response after laparoscopic Heller's myotomy and Dor's fundoplication. 'Bread and barium' (transit time of a barium opaque bread bolus) and 'timed barium' (height of esophageal barium column 5 minutes after ingestion of 200-250 mL of barium suspension) esophagogram was used to assess esophageal emptying in 73 patients with esophageal achalasia before 1 and 5 years (31 cases) after laparoscopic myotomy and anterior fundoplication. Symptoms assessment was based to a specific score. At 1-year follow-up, excellent and good symptomatic results were obtained in 95% of the cases. Esophageal maximum diameter, esophageal transit time, and esophageal barium column were significantly correlated to each other and to symptom score postoperatively (P < 0.001). Complete and partial (<90% and 50-90% postoperative reduction in barium column, respectively) emptying was seen in 55% and 31% of patients with excellent result. Patients with a pseudodiverticulum postoperatively had a more delayed esophageal emptying than those without. Symptomatic outcome and esophageal emptying did not deteriorate at 5-year follow-up. Esophageal emptying assessed by 'barium and bread' and 'timed barium' esophagogram correlated well with symptomatic outcome after laparoscopic myotomy for esophageal achalasia. Complete symptomatic relief does not necessarily reflect complete esophageal emptying. Outcomes do not deteriorate by time. Because of wide availability, esophagogram can be applied in follow-up of postmyotomy patients in conjunction with symptomatic evaluation.

Digestive Surgery, 2012

Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients i... more Data on the role of laparoscopy within an enhanced recovery protocol for rectal cancer patients is rather limited. The aim of the study was to investigate the role of laparoscopy within a 'fast-track' protocol in patients who underwent sphincter-preserving surgery for rectal cancer. 156 consecutive patients with low rectal cancer from three centers were assigned in four groups: the open fast track (OPEN-FT), the laparoscopic fast track (LAP-FT), the open (OPEN), and the laparoscopic (LAP). The fast-track protocol was applied in one center and traditional care in the other two. All patients underwent sphincter-preserving surgery and were followed-up for 30 days. Overall morbidity was less in the fast-track groups (p = 0.007). On the other hand, no statistical significance could be identified in mortality, readmission or reoperations rates among the groups (p = 0.562, p = 0.896, p = 0.238). Fast-track patients required significantly less intramuscular opioids for postoperative analgesia (p < 0.001). Primary (p < 0.001) and total hospital stays (p < 0.001) were significantly shorter in the fast-track groups. The implementation of a fast-track protocol is feasible and safe in low rectal cancer patients. Laparoscopy seems to be a basic element of such protocol as it further enhances recovery and reduces morbidity.

Digestive Diseases, 2007

Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clea... more Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clearance. To assess lymph node yield after laparoscopic total mesorectal excision (TME) for rectal cancer as compared to the open approach. 74 patients with middle and low rectal cancer were prospectively randomized in two groups. Group A included 39 patients who had an open TME (35 with low anterior resection of the rectum (LARR) and 4 with abdominoperineal resection of the rectum (APR)). In group B, there were 34 patients who had a laparoscopic TME (27 with LARR and 7 with APR). 10 of the LARR patients in group A and 14 of the LARR patients in group B had a defunctioning ileostomy. All operations were performed by one surgeon or under his supervision. Gender and age distribution were similar for both groups (group A: 23 males; mean age 69 (41-85); group B: 20 males; mean age 72 (31-84)). The mean distance of the tumor from the dentate line was 7.6 cm (1-12 cm) for group A and 6.1 cm (1-12 cm) for group B. Anastomosis was formed at a mean distance of 5.5 cm (1.5-8.5 cm) from the dentate line in group A and 3.5 cm (1-4.5 cm) in group B. At histology, in group A there were 5 T4 tumors, 9 T3, 10 T3+ (<1 mm distance from the circumferential resection margin), 13 T2 and 2 T1. In group B, there were 3 T4 tumors, 14 T3, 8 T3+, 7 T2 and 2 T1. Differences between groups were not significant. The mean number of lymph nodes retrieved in group A specimens was 19.2 (5-45) and in group B 19.2 (8-41) (p = 0.2). In group A, 3.9 (1-9) regional, 13.9 (3-34) intermediate and 1.5 (1-3) apical lymph nodes were retrieved. The respective values in group B were 3.7 (3-7), 14.4 (4-33) and 1.3 (1-3). Differences between groups were not significant. Also, the incidence of lymph node involvement by the tumor was not significantly different between groups (group A: 23; group B: 19). Laparoscopic resection of the rectum can achieve similar lymph node clearance to the open approach. Also, distribution of the lymph nodes along the resected specimens is similar between the two approaches.

Colorectal Disease, 2012

Complete mesocolic excision (CME) with central vessel ligation (CVL) as performed in Erlangen off... more Complete mesocolic excision (CME) with central vessel ligation (CVL) as performed in Erlangen offers the best long-term outcome for colon cancer. The aim of this study was to assess specimens after laparoscopic vs open CME-CVL macroscopically and morphometrically in patients with left and right colon cancers. All specimens were freshly photographed. Precise tumour morphometry and grading of the surgical plane were performed as described by pathologists in Leeds, UK. Thirty-four specimens from right-sided cancers were divided into 18 transverse colon cancers (nine laparoscopic vs nine open) and 16 caecum-ascending colon cancers (seven laparoscopic vs nine open) and 56 specimens from left-sided cancers (33 laparoscopic vs 23 open). There was no difference between laparoscopically and open acquired left- and right-sided specimens. Specimens of transverse colon displayed differences in length of central ligation to tumour (open 11.67 cm vs laparoscopic 8.72 cm, P = 0.049), length of central ligation to bowel wall (open 9.11 cm vs laparoscopic 6.5 cm, P = 0.015) and lymph node clearance (open 46.33 vs laparoscopic 39.33, P = 0.033). Laparoscopy seems to offer specimens of similar quality after CME-CVL surgery for colon cancer to the open approach. Issues of completeness of excision from laparoscopy are raised for tumours located in the transverse colon.

Techniques in Coloproctology, 2008

Background Worldwide, the annual mortality from CRC is estimated to be 500.000. The incidence and... more Background Worldwide, the annual mortality from CRC is estimated to be 500.000. The incidence and mortality of CRC increase with age especially after 60 years of age. In Sudan there are no present population-based cancer registries that can provide database for epidemiological studies on CRC and its risk factors, for an effective implementation of the suitable screening programs. Methods A retrospective hospital-based study was conducted on all CRC patients who attended Soba University Hospital (SUH) between January 2004 and December 2007 to describe the pattern of CRC according to age, race, gender and sub-site location of the tumor. We considered that SUH is one of the largest central hospitals in Sudan that has integrated gastrointestinal and endoscopy units and receives patients from different sources of referral. Results During the study period, 202 patients with CRC attended both hospital clinical wards and endoscopy units between the ages of 10-90 years. Age was found to be independently significantly associated with both proximal and distal CRC (p=0.01). Gender and race were found to be insignificantly associated with both proximal and distal CRC (p=0.839 and 0.522 respectively). Fifty-two percent of patients were found to be of 50 years of age and below. The mean age for CRC was found to be 50 years. Almost 70% of the patients were found to have distal CRC and about 85% of them were having rectal cancer. Conclusions Fifty-two percent of the patients were found to be of 50 years of age and below with predominance of distal CRC among all patients. This gives a clue that screening with flexible sigmoidoscopy starting at the age of 40 can be of an appreciated secondary preventive value.