This study evaluated the safety and outcomes of simultaneous resection of primary rectal cancer and synchronous liver metastases compared to a staged approach. The study reviewed 198 patients treated at a single cancer center between 1984-2008. Results showed no significant differences in postoperative complications or mortality between simultaneous and staged resections. However, simultaneous resection was associated with shorter hospitalization. The study demonstrated the safety and feasibility of simultaneous resection in appropriately selected patients with rectal cancer and liver metastases when performed by experienced surgeons.
O. Glehen - HIPEC in colorectal carcinomatosisGlehen
Pr Olivier Glehen presents HIPEC in colorectal carcinomatosis in Slovenia 2013. Présentation de la CHIP dans la carcinose péritonéale d'origine colorectale.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
This is a general overview of options available to patients with liver dominant metastatic disease as well other focal areas of disease which may benefit from services provided by an interventional radiologist
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
The article lays an emphasis on the laparoscopic surgical method used to treat colorectal cancer. It reviews the current status of the laparoscopic colorectal surgeries and recommendation of evidences for short- and long-term outcome. The early results were against laparoscopic approach. There was a need of properly designed study to validate or invalidate these findings. Seven large-scale trials compared laparoscopic and open colectomy for colon carcinoma and examined short-term and long-term outcomes. These trials included the Clinical Outcomes of Surgical Therapies (COST) trial funded by the National Cancer Institute in the United States, the Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in the United Kingdom, the Colon Cancer Laparoscopic or Open Resection (COLOR), a multicenter European trial.
For the validation of the argument that laparoscopy is safe, meta-analysis was performed. Certain conclusions of meta-analysis are also presented in this article. The individual merits and weaknesses of laparoscopic surgery as compared with open surgery as the primary treatment of colorectal cancer are being highlighted in this article.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. Simultaneous resection for rectal cancer with
synchronous liver metastasis is a safe procedure
Gerd R. Silberhumer, M.D., Ph.D.a,b, Philip B. Paty, M.D.a,
Larissa K. Temple, M.D.a, Raphael L. C. Araujo, M.D.c, Brian Dentond,
Mithat Gonen, M.D.d, Garret M. Nash, M.D.a, Peter J. Allen, M.D.c,
Ronald P. DeMatteo, M.D.c, Jose Guillem, M.D.a,
Martin R. Weiser, M.D.a, Michael I. D’Angelica, M.D.c,
William R. Jarnagin, M.D.c, Douglas W. Wong, M.D.a,
Yuman Fong, M.D.
2. Introduction
• Each year about 40,000 patients are newly diagnosed with
rectal cancer and about 20,000 rectal cancer–related deaths
are documented in the United States.
• Fifteen to 25% of patients present with synchronous liver
metastasis at the time of diagnosis.
• Surgical resection of the primary tumor and the liver
metastasis remains the only potential treatment for cure, with
5-year survival rates between 25% and 40%.
3. Introduction
• The traditional surgical strategy for colorectal cancer
presenting with synchronous liver metastases has been to
resect the primary cancer, followed by resection of the
hepatic tumors after chemotherapy.
• Because of improved safety of hepatic surgery in recent
years, the surgical management of synchronous disease has
begun a paradigm change.
• Several experienced centers have reported safety of
combined procedures for resection of colon cancer and
synchronous colorectal cancer.
4. • It is understandable that concerns remain regarding
the perceived risks of combining pelvic surgery with
hepatectomy.
• Few studies, however, have reported the actual clinical
outcome of such combined rectal and liver resections.
• In this study, we present data from a tertiary referral
center showing the safety and feasibility of
simultaneous rectal and liver resections for stage IV
rectal cancer
5. Methodology
• Study type-retroscpective cohort study
• Study centre-Memorial Sloan Kettering Cancer
Center (MSKCC)
• Sample size- 198 (rectal and liver surgery for
stage IV rectal cancer)
• Study duration-1984 and 2008
6. Methodology
• Synchronous metastasis was defined as patients presenting with
rectal cancer and liver metastasis at the time of diagnosis.
• Preoperative tumor staging followed the guidelines of the American
Joint Committee on Cancer
• Hepatic metastases were detected by combinations of computed
tomography, magnetic resonance imaging), and intraoperative
ultrasound.
• Chemotherapy before rectal and/or hepatic resection included any
systemic or regional chemotherapy with or without concomitant
external beam radiation.
7. Methodology
• Level of rectal primary was defined as the distance measured
from the anal verge to the tumor at the time of presurgical
evaluation.
• Resections of 3 or more contiguous liver segments were
considered as a major liver procedure.
• All patients were classified using the Clinical Risk Score
defined by Fong
8. Methodology
• All postoperative complications were captured for the entire
hospitalization and for at least 30 days following rectal and/or hepatic
resection.
• Complications were graded according to the criteria described by Dindo et
al
• Postoperative mortality included any death during postoperative
hospitalization or within 30 days after rectal and/or hepatic procedure.
• Clinical data evaluated included total operation time, estimated blood
loss, and length of hospitalization.
• For patients who underwent a staged treatment approach, complications
and length of hospitalization were generated as the sum from rectal and
liver procedure
9. Statistical analysis
• Univariate tests for differences between the simultaneous resection
cohort and the staged resection cohort were conducted using
Fisher’s exact test for categorical covariates and 2-sample t tests for
continuous covariates.
• Analysis of variance models were used to estimate correlations
between several disease treatment variables such as length of
hospitalization and size of metastases.
• Logistic regression was used to estimate the probability and odds
ratios for several variables relating to complication severity.
• All statistical analyses were performed using SAS version 9.2 (SAS
Institute, Cary, NC
20. • The treatment approach did not result in a significant
difference in the rate of R1 liver resections
11
6
0
2
4
6
8
10
12
simultaneous staged
R1 Liver Resection %
Statistically not significant (p 0.28)
21. • In 7.5% of patients in the staged group, a positive resection margin at the
rectal side was detected compared with 2.1% in the simultaneous
2.1
7.5
0
1
2
3
4
5
6
7
8
simultaneous staged
Margin positive at Rectal side
Statistically not significant (p 5.08)
22. • In neither of the groups was a patient found to have positive
resection margins in both the liver and the rectum.
• In the simultaneously resected group,
– 7.6% of patients underwent an R2 resection with pump placement for
adjuvant chemotherapy for 2-staged liver resection.
27. • occurrence of severe
complications was not associated with
– OR time (P .17)
– the number of liver lesions (P .14)
– the level of rectal cancer (P .80)
– the size of liver lesions (P .14)
• Neither the type of rectal or liver procedure had an impact on
the severity of complications (P .40 and .19).
29. • Patients who underwent an abdominoperineal resection
(APR) had a longer mean hospitalization period of compared
with patients who underwent a low anterior resection (P <.01)
• patients who were treated with a major liver resection had to
stay significantly longer the hospital (P <.01)
32. • Complications/outcome
• No significant differences regarding postoperative
complications were observed between the 2 treatment
strategies (P .70)
• No perioperative mortalities were reported in either
group.
• The mean hospitalization period was significantly
longer in staged resectedpatients (P .01).
34. Discussion
• Most centers still recommend a staged surgical approach with
removal of the primary cancer first, followed by liver resection
after adjuvant chemotherapy
• This traditional standard posits that a simultaneous liver
resection to be too challenging for these patients undergoing
pelvic surgery
35. • Recent improvements in the surgical and anesthetic techniques
have greatly enhanced the safety of major operative procedures
including pelvis procedures and hepatectomies.
• This has allowed a reconsideration of combined pelvic and hepatic
procedures
• most authors of prior studies recommended a simultaneous
treatment approach only in patients with small liver lesions or with
colon cancer
36. • In addition, the use of adjuvant chemotherapy after resection
of the primary tumor before the liver resection has been
advocated as providing oncologic benefit although without
definitive supporting data
• Most of these prior recommendations are based on series
with very small numbers of patients with rectal tumors
37. • The same author had previously reported the safety of
a simultaneous primary and liver resection approach
for stage IV colon cancer patients
– Martin R, Paty P, Fong Y, et al. Simultaneous liver and
colorectal resections are safe for synchronous colorectal
liver metastasis. J Am Coll Surg 2003;197:233–41;
discussion, 241–2
• This study is an extension of previous work and
documents the safety and feasibility of a combined
treatment approach even for rectal cancer
38. • In this retrospective study, only patients receiving the rectal as
well as the liver procedure at MSKCC were included to provide
uniform
data documentation and surgical standards.
• This study design also demonstrates the patient selection
criteria at a tertiary center for simultaneous resection.
• Thus, rectal tumors requiring APR were more likely to be
chosen for a staged approach.
39. • Larger liver tumors requiring major liver resection were more
likely to be chosen for a staged approach
• This article therefore shows not only the safety of a
simultaneous approach, but also that such safety relies on
patient selection by experienced surgeons
40. • The tendency to have sphincter preservation in the
simultaneously resected patients may also reflect the
increasing numbers of sphincter preserving procedures after
2000
• The option to preserve the sphincter has been optimized in
recent years by better neoadjuvant treatment options, as well
as by improvements in stapling devices and improvements in
surgical techniques.
41. • Similarly, a propensity for simultaneously resected
patients to have limited liver resections may reflect the
trend for more parenchyma-sparing procedures during
the last decade
• In this study population,
– around 70%of simultaneously resected patients received
neoadjuvant chemotherapy compared with around 50% of
patients in the staged group.
– Smaller sizes of liver lesions might be caused by improved
response of liver metastases to currently established
neoadjuvant chemotherapy agents
42. • In these simultaneous resection procedures, author preferred
to perform the liver resection before the rectal procedure
– This order allows the ‘‘clean’’ liver procedure to be performed before
the ‘‘contaminated’’ intestinal procedure
– During the hepatectomy, low fluid administration is generally used to
prevent venous bleeding from the resection surface of the liver
• Thus, performing the liver resection first minimizes the
relative hypotension during this ‘‘low central venous pressure
anesthesia’’ and allows fluid resuscitation during the rectal
portion of the procedure
43. • Furthermore, the venous congestion from the Pringle
maneuver might endanger a newly created bowel
anastomosis, if the rectal has been performed before the liver
resection
44. Simultaneous resection
N 134
Staged Resection
N-106
right colon primaries (p < 0.001)
smaller (p < 0.01)
fewer (p < 0.001) liver metastases
less extensive liver resection (p < 0.001
Complications: 49% Complication- 69%
Fewer hospital stay
Simultaneous colon and liver resection is safe and efficient in the treatment of
patients with colorectal cancer and synchronous liver metastasis.
Similar perioperative mortality
45. 1985-2006
N – 610
Simultaneous-135 staged-475
• Simultaneous colorectal and minor hepatic resections are safe and
should be performed for most patients with SCRLM.
• Due to increased risk of severe morbidity, caution should be
exercised before performing simultaneous colorectal and major
hepatic resections.
46. Simultaneous n=70 Staged n=160
median 4 cm 3.7cm
Major liver resections 32% 33%
Complication rate 56% 55%
Fewer hospital stay
By avoiding a second laparotomy, simultaneous colon and
hepatic resection reduces overall hospital stay, with no
difference in morbidity and mortality rates or in severity of
complications, compared with staged resection.
Simultaneous resection is an acceptable option in patients with
resectable synchronous colorectal metastasis.
47. • Perioperative morbidity and mortality did not differ between
simultaneous resections and staged resections for selected patients with
SCRLM
– morbidity, 47.3% versus 54.3%
– mortality, 1.5% versus 2.0% respectively; both p > 0.05
• Simultaneous liver resections of three or more segments would not
increase the rate of complications compared to staged resections (56.8%
and 42.4%, respectively; p = 0.119)
• Patients with simultaneous resections experienced shorter duration of
surgery and postoperative hospitalization time as well as less blood loss
during surgery (all p < 0.05)
48. Take home message
• combined procedures for stage IV rectal cancer patients are
safe and feasible in carefully selected and evaluated patients
at experienced centers
• The rates of complications between staged- and
simultaneously resected patients did not show statistical
difference
• Complication rates of this rectal study
• population were comparable with recently published studies
• combining stage IV colon cancer patients
49. • Mortality in this current series is also consistent with the
mortality rate of 2% generally reported for rectal procedures
alone or for major liver resection alone
• In patients undergoing major liver resection, the rate of
severe complications was acceptable with 23% in the
simultaneous and 18% in the staged group, which is
comparable with other studies
50. • Benefit of combined approach:
– Lower total blood loss
– shorter total operative time
– a shorter hospital stay
– Low cost
– faster recovery and initiation of chemotherapy
– psychological benefits
• allowing a single procedure for eradication of all
disease instead of employing 2 procedures scheduled
over a period of months
51. • The possibility that some patients will never be candidates for
staged liver resection because of tumor progression under
adjuvant chemotherapy will be eliminated by a synchronous
resection approach.
• For example, in a Dutch study, only 10% of patients presenting
with stage IV colorectal cancer finally underwent liver
resection
52. • A synchronous treatment strategy could be
considered when liver and colorectal surgeons
agree on safety of this approach.