Diseases of the colon and rectum
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This study was designed to evaluate factors that might be predictive of readmission and early and long-term outcomes for patients readmitted after ileal pouch-anal anastomosis. ⋯ Early readmission after ileal pouch-anal anastomosis is common. Associated comorbidity, laparoscopic approach, reconstruction of the ileal pouch-anal anastomosis at the index surgery, and postoperative blood transfusion are associated with readmission.
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The purpose was to determine if the perioperative benefits associated with laparoscopic colectomies are maintained as operative time increases. ⋯ Increasing operative time does not appear to adversely affect perioperative outcomes in segmental colectomies. Total abdominal colectomies lasting more than 270 minutes were associated with increased postoperative complications, days to surgical diet, and length of stay.
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This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database. ⋯ In the present study, patients selected for laparoscopic colorectal surgery were associated with reduced postoperative mortality when compared with those undergoing the conventional technique. This finding merits further investigation.
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Circumferential resection margin involvement after rectal cancer surgery is associated with local recurrence and decreased survival, but definitions of "safe" margins vary. This study assessed the influence of various circumferential margins on long-term outcome from rectal cancer surgery. ⋯ Circumferential margins < or =2 mm are associated with significantly reduced cancer-specific survival, and margins < or =1 mm with increased local recurrence, when other factors are accounted for, challenging the assumption that a circumferential resection margin of < or =1 mm is safe.
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Colorectal cancers arise via cumulative genetic and molecular changes that cause mucosal instability, premalignant polyps, and malignant transformation. Distinct neoplastic pathways characterized by chromosomal instability, genetic mutation, and epigenetic methylation have been described, but their associated precursor polyps have not. This study analyzes characteristics of precursor polyps occurring within different molecular subtypes of sporadic colorectal cancer. ⋯ Patients with microsatellite unstable colorectal cancers demonstrate an increased serrated polyp-to-adenoma ratio compared with microsatellite stable cancers regardless of methylator status. Loss of microsatellite stability appears to be a key event in serrated polyp and cancer formation. An increased proportion of serrated polyps to adenomas discovered in patients on colonoscopy should arouse suspicion that cancers arising in these patients are probably microsatellite unstable.