Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Comparative Study
Long-term quality of life in pouch patients compared with stoma patients following rectal cancer surgery.
Low and ultralow anterior resection for rectal cancer with colorectal or coloanal anastomosis does not compromise oncological results compared with abdominoperineal excision. Although avoidance of a permanent colostomy is regarded as beneficial for a patient's quality of life (QoL), patients undergoing sphincter-sparing surgery may develop a number of functional problems. A colonic pouch significantly improves functional outcome after rectal resection and low anastomosis and may positively influence QoL. The aim of this study was to compare QoL in long-term survivors who underwent ultralow anterior resection with total mesorectal excision and colonic J-pouch anastomosis (CPA) with patients treated with abdominoperineal excision (APE) and end colostomy for rectal cancer. ⋯ QoL after rectal resection and CPA was better than after APE in several respects. However, QoL should not be regarded as an isolated concept but rather as one of several possible clinical outcomes of interest.
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Intra-operative neuromonitoring is increasingly applied in several surgical disciplines and has been introduced to facilitate pelvic autonomic nerve preservation. Nevertheless, it has been considered a questionable tool for the minimization of risk, as the results are variable and might be misleading. The aim of the present experimental study was to develop an intra-operative neuromonitoring system with improved reliability for monitoring pelvic autonomic nerve function. ⋯ Online signal processing of internal anal sphincter activity aids reliable identification of pelvic autonomic nerves with potential for improvement of intra-operative neuromonitoring in pelvic surgery.
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Recent surveys in Europe and North America have demonstrated significant challenges in the implementation of evidence-based surgical practice. ⋯ There appears to be a high rate of evidence in agreement with some interventions but not others. The systemic barriers to implementing evidence-based perioperative care need attention.
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Abdominoperineal resection for rectal cancer is associated with higher rates of local recurrence and poorer survival than anterior resection. The aim of this study was to evaluate the outcome of conventional abdominoperineal resection in a large national series. ⋯ Intra-operative perforation is a major risk factor for local and distant recurrence and survival and therefore should be avoided.
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To review the literature on lithotomy-related neurovascular complications (LRNVC) of the lower limbs after colorectal surgery. ⋯ In colorectal surgery, lower limb LRNCVs, and CS are rare. A high index of clinical suspicion and early decompression may reduce morbidity.