Diseases of the colon and rectum
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There is ongoing debate about the appropriate criterion for defining a positive circumferential resection margin after radical surgery for rectal cancer. ⋯ A circumferential resection margin of ≤1 mm had a strong association with disease-free survival compared with circumferential resection margins ≤0.5, ≤2.0, and ≤3 mm. A circumferential resection margin ≤1 mm was an independent predictor of a poor outcome in both the nonchemoradiotherapy and chemoradiotherapy groups.
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Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment. ⋯ Our study demonstrates a role for incisional negative pressure wound therapy in decreasing rates of perineal surgical site infection following abdominoperineal resection. Prospective randomized trials will be required to further investigate this intervention.
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Elastic laminal invasion is defined as tumor invasion beyond the peritoneal elastic lamina. It is one of the factors affecting the prognosis of patients with colon cancer. ⋯ Elastic laminal invasion adversely influences prognosis in pT3 and pT4a colon cancer. Although elastic laminal invasion positivity does not affect prognosis in node-positive patients receiving adjuvant chemotherapy, node-negative patients with elastic laminal invasion have a similar risk of recurrence as node-positive patients.
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Comparative Study
Abdominal- versus thigh-based reconstruction of perineal defects in patients with cancer.
An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned. ⋯ This study suggests that the anterolateral thigh flap is an acceptable alternative to the vertical rectus abdominus myocutaneous flap for perineal reconstruction (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A134).
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Hidradenitis suppurativa is a rare chronic inflammatory disorder of apocrine gland-bearing skin, which commonly affects the anogenital region. There has been very little literature to date on the MRI appearances of anogenital hidradenitis suppurativa. ⋯ In hidradenitis suppurativa, anogenital disease is usually subcutaneous but extensive, with only a minority of patients demonstrating deeper involvement. MRI may help define the extent of anogenital disease and assess response to treatment.