Diseases of the colon and rectum
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Comparative Study
Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis.
To identify the risk factors for anastomotic leakage after left-sided colorectal resections with rectal anastomosis. ⋯ Patients with multiple risk factors have higher risk for anastomotic leakage. When patients have three or more risk factors, the creation of a protective stoma should be considered in cases with a low rectal anastomosis, and all these patients should be carefully monitored postoperatively for signs of possible leak.
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Thromboembolism is a significant cause of morbidity and mortality in inflammatory bowel disease. Several prothrombotic conditions have been investigated in inflammatory bowel disease. The aim of this study was to evaluate the incidence of symptomatic postoperative superior mesenteric vein thrombosis in inflammatory bowel disease patients undergoing colonic resections and to identify and characterize their clinical presentation. ⋯ Postoperative superior mesenteric vein thrombosis is a more frequent occurrence than previously reported in patients with inflammatory bowel disease. Direct surgical trauma to the middle colic veins, with resulting thrombosis, is likely to be the precipitating factor in a borderline intrinsically hypercoagulable environment. All patients became asymptomatic after systemic anticoagulation and recovered uneventfully.
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This study was undertaken to identify prognostic factors that can be used to predict prognosis after surgery for lung metastases from colorectal carcinoma. ⋯ An extranodal cancer deposit at the primary tumor site is a new significant prognostic factor after resection of lung metastases from colorectal cancer. A two-ranked classification by extranodal cancer deposit and the number of pulmonary lesions can provide useful prognostic information for the treatment of lung metastasis. Surgical resection of pulmonary metastasis is expected to be very useful for patients in Group A.
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This retrospective study identifies the clinicopathologic factors (age, gender, size of tumor, location, tumor stage, lymph node metastasis, histologic differentiation, and adjuvant therapies) that are useful in predicting long-term survival in patients undergoing total pelvic exenteration for advanced primary rectal cancer. ⋯ Total pelvic exenteration may enable long-term survival in younger patients with stage T3 or T4 primary rectal cancer and little or no lymph node metastasis.
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Comparative Study
Individual cutoff levels of carcinoembryonic antigen and CA 242 indicate recurrence of colorectal cancer with high sensitivity.
This study was designed to identify the sensitivity and specificity associated with recurrent colorectal cancer, principally hepatic metastases, with individual cutoff levels of carcinoembryonic antigen; identify the corresponding data for CA 50 and CA 242; compare these findings with standard cutoff levels, clinical examinations, and patients' personal health assessments; and identify the time between increasing serum levels and detection of actual relapses, particularly hepatic metastases. ⋯ With individual cutoff levels, both carcinoembryonic antigen and CA 242 had high sensitivity and acceptable specificity for indicating recurrent colorectal cancer. Because most (29/33) patients with recurrent disease identified within 3 years after surgery and all 8 with hepatic metastases identified during the sampling period were indicated by carcinoembryonic antigen with the individual cutoff, that method was established as the best for postoperative surveillance.