Surgical oncology
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Extended spinal anaesthesia using a spinal micro-catheter was used as a primary method of anaesthesia for elective colorectal cancer surgery in 68 high risk patients over a 14-year period in our institution. The technique was also useful in eight elective and 13 emergency abdominal surgeries. All patients suffered from severe chronic obstructive airway disease requiring multiple inhalers and drugs (ASA III). ⋯ Postoperative pain relief was obtained by administering intravenous morphine through a patient controlled analgesia machine in the critical care ward area (High Dependency Unit). There was a low incidence of minor postoperative side effects such as nausea (14.6%), vomiting (7.9%), minor post dural puncture headache (5.6%) and pruritus (5.6%). We conclude that spinal anaesthesia with a micro-catheter may be used as a primary method of anaesthesia for colorectal cancer surgery and other major abdominal surgery in high-risk patients for whom general anaesthesia would be associated with higher morbidity and mortality.
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The therapeutic results of managing proximal tibial osteosarcoma have been dramatically improved because of the recent advancements in imaging, chemotherapy, and surgical techniques. Further, the prognosis of patients with proximal tibial osteosarcoma is improved and the chance of survival with limb salvage surgery is increased. Among the limb salvage procedures, endoprosthetic reconstruction is now preferred to other methods such as allograft, composite allograft prosthesis, or arthrodesis. However, the treatment for proximal tibial osteosarcoma with proximal tibiofibular joint involved has not been reported. ⋯ Custom prosthetic reconstruction could yield as much satisfactory results as neoadjuvant chemotherapy and limb salvage surgery, for patients with osteosarcoma in proximal tibia and proximal tibiofibular joint. During the present study, most patients had good or excellent motor functioning with few incidences of complications. However, more attention should have been given to both the quality of function and long-term survival of patients.
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Major abdominal surgery, and also radical cystectomy, is followed by a delayed return of bowel function attributable to postoperative ileus (POI), which, in addition, stands out as one of the most frequent complications that causes increased length of stay (LOS). Some variability exists in the definition of POI since time to return of peristalsis and time to first passage of flatus, which are commonly referred to as indicators of bowel activity, have their own weaknesses, observer dependent and time dependent, among other variables. A number of causes have been recognized to induce or maintain the condition of ileus. ⋯ No effects were observed on postoperative protein depletion, despite the provision of early artificial nutrition. Our results suggest that a short median time of return of both peristalsis and flatus, and to regular diet resumption with a low incidence of POI, can be obtained in the majority of patients with a perioperative regimen aimed at reducing the effect of some of the causes associated with induction or maintenance of POI. Further studies of multimodality perioperative care plans, similar to that used in the present study, are required.
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Patients with advanced incurable colorectal cancer (CRC) face a grim prognosis. The goal of palliative intervention is directed at alleviating disease-related symptoms and improving quality of life. The provision of optimal palliative care for these patients is a compound and demanding process. ⋯ Surgical resection may provide good palliation of symptoms and prevent future tumor-related complications. Metal stents are also able to provide good palliative relief of obstruction and should be used when appropriate. The best palliative care will often require a multidisciplinary approach that involves input from surgical and nonsurgical teams, where treatment plans will be made in accordance with the wishes of the patient and family with a goal of decreasing morbidity and a focus on quality of life.
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Colorectal cancer (CRC) is a multi-pathway disease. A molecular approach to the classification of CRC utilises: (1) the type of genetic instability, specifically microsatellite instability (MSI) versus stable (MSS), and (2) the presence of DNA methylation or the CpG island methylator phenotype (CIMP). ⋯ This review will show that the existence of two or more independent pathways to CRC is relevant to cancer prevention. In particular, new strategies for detecting and managing sessile serrated polyps will need to be developed and evaluated.