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  • 1
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    Neoadjuvant 5-FU or Capecitabine Plus Radiation With or Without Oxaliplatin in Rectal Cancer Patients: A Phase III Randomized Clinical Trial (2015)
    Oxford University Press
    Details
    Publication Date: 2015-09-17
    Description: Background: National Surgical Adjuvant Breast and Bowel Project R-04 was designed to determine whether the oral fluoropyrimidine capecitabine could be substituted for continuous infusion 5-FU in the curative setting of stage II/III rectal cancer during neoadjuvant radiation therapy and whether the addition of oxaliplatin could further enhance the activity of fluoropyrimidine-sensitized radiation. Methods: Patients with clinical stage II or III rectal cancer undergoing preoperative radiation were randomly assigned to one of four chemotherapy regimens in a 2x2 design: CVI 5-FU or oral capecitabine with or without oxaliplatin. The primary endpoint was local-regional tumor control. Time-to-event endpoint distributions were estimated using the Kaplan-Meier method. Hazard ratios were estimated from Cox proportional hazard models. All statistical tests were two-sided. Results: Among 1608 randomized patients there were no statistically significant differences between regimens using 5-FU vs capecitabine in three-year local-regional tumor event rates (11.2% vs 11.8%), 5-year DFS (66.4% vs 67.7%), or 5-year OS (79.9% vs 80.8%); or for oxaliplatin vs no oxaliplatin for the three endpoints of local-regional events, DFS, and OS (11.2% vs 12.1%, 69.2% vs 64.2%, and 81.3% vs 79.0%). The addition of oxaliplatin was associated with statistically significantly more overall and grade 3–4 diarrhea ( P 〈 .0001). Three-year rates of local-regional recurrence among patients who underwent R0 resection ranged from 3.1 to 5.1% depending on the study arm. Conclusions: Continuous infusion 5-FU produced outcomes for local-regional control, DFS, and OS similar to those obtained with oral capecitabine combined with radiation. This study establishes capecitabine as a standard of care in the pre-operative rectal setting. Oxaliplatin did not improve the local-regional failure rate, DFS, or OS for any patient risk group but did add considerable toxicity.
    Electronic ISSN: 1460-2105
    Topics: Medicine
    Published by Oxford University Press
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    PAPER CURRENT
  • 2
    Electronic Resource
    Electronic Resource
    Alternatives to Ileostomy After Colectomy for Inflammatory Bowel Disease (1985)
    Palo Alto, Calif. : Annual Reviews
    Annual Review of Medicine 36 (1985), S. 315-327 
    Details
    ISSN: 0066-4219
    Source: Annual Reviews Electronic Back Volume Collection 1932-2001ff
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1146/annurev.me.36.020185.001531
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  • 3
    Electronic Resource
    Electronic Resource
    Podium presentations (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. P1 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02053958
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  • 4
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy: A critical appraisal (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 28-34 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopy ; Laparoscopic colectomy ; Colectomy ; Colon resection ; Colon and rectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups (P 〈0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group (P 〈 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050298
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  • 5
    Electronic Resource
    Electronic Resource
    The use of staplers for anterior anastomoses (1982)
    Springer
    World journal of surgery 6 (1982), S. 525-530 
    Details
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé La pince agrafeuse E.E.A. est un instrument bien adapté, pratique et fiable. Elle permet de réaliser des anastomoses intestinales avec une sécurité et une rapidité equivalentes à celles des techniques classiques. Elle permet surtout de réaliser des anastomoses colo-rectales très basses mais malheureusement les difficultés opératoires sont alors souvent plus grandes que lors de la constitution de l'anastomose à la main. Le taux des complications opératoires n'est pas augmenté mais à long terme celui des rétrécissements est plus grand cependant que le taux des récidives post-opératoires demande a etre apprécié avec soin.
    Notes: Abstract The EEA stapler is a convenient, well-designed, and reliable instrument. It will anastomose the bowel with reliability and speed at least equivalent to hand-sewn techniques, and probably offers a technical advantage in performing very low rectal anastomoses. Unfortunately, intraoperative misadventures are greater with this device than with hand-sewn techniques, and its use would seem best restricted to those situations in which it has its greatest advantage. Postoperative complications are not increased by its use, but the long-term incidence of anastomotic stricture and possibly increased rate of local recurrence need to be clarified.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01657865
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  • 6
    Electronic Resource
    Electronic Resource
    Postoperative intra-abdominal and pelvic sepsis complicating ileal pouch-anal anastomosis (1988)
    Springer
    International journal of colorectal disease 3 (1988), S. 149-152 
    Details
    ISSN: 1432-1262
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a series of 500 patients who underwent ileal pouch-anal anastomosis for ulcerative colitis or polyposis coli, significant intra-abdominal or pelvic sepsis developed in 30 (6%). Among the patients who did not require laparotomy because they responded to treatment with antibiotics or local drainage (surgical or radiologically guided) or both, no pouches were excised and the ileostomy closure rate (92%) was similar to that for the patients who did not have sepsis. The 17 patients whose sepsis did require laparotomy had a high rate of pouch excision (41%) (p〈0.0001) and a low rate of ileostomy closure (29%) (p〈0.0001). Factors identified as possibly associated with severe sepsis included female gender and ulcerative colitis complicated by toxicity or malignancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648357
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  • 7
    Electronic Resource
    Electronic Resource
    Intraabdominal abscesses following laparoscopic and open appendectomies (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 327-328 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Perforated ; Appendicitis ; Abscess
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The purpose of this review was to evaluate the incidence of postoperative intraabdominal abscess formation following laparoscopic and open appendectomies. Methods: The current study retrospectively examines appendectomies performed during the period from January 1993 to July 1994. Excluded were cases which were started laparoscopically but converted to open procedures. There were 1,287 cases identified; 597 were perforated (46%), 114 were gangrenous (9%), and 576 were acute (45%). These diagnoses represent intraoperative diagnoses. Results: Of the 576 appendectomies for acute appendicitis, 64 (11%) were performed laparoscopically. There were four intraabdominal abscesses (0.7%), all occurring after open procedures. Of the 114 appendectomies for gangrenous appendicitis, 16 (14%) were done laparoscopically. There were two postoperative abscesses (1.8%), one following an open and one following a laparoscopic procedure. There was no significant difference in abscess rate between laparoscopic and open appendectomies for either acute or gangrenous appendicitis. Of the 597 appendectomies for perforated appendicitis, 28 (5%) were done laparoscopically. There were 19 postoperative abscesses in the whole group, accounting for a 3.2% abscess rate. Sixteen abscesses occurred after open appendectomies and three occurred after laparoscopic appendectomies (2.9% vs 11%, P=0.054). The preoperative diagnosis was incorrectly identified as acute appendicitis in 95 cases subsequently found to have perforated appendicitis; there was only 1 postoperative abscess in this group. There was no difference in postoperative stay in the open vs laparoscopic group (6.3 days vs 6.1 days). Conclusions: We found no significant difference in the rate of postoperative intraabdominal abscess formation between laparoscopic and open appendectomies in cases of acute or gangrenous appendictis. However, laparoscopic appendectomy for perforated appendicitis was associated with an important trend toward a higher rate of postoperative intraabdominal abscess formation than open appendectomy. This observation calls for closer prospective scrutiny of laparoscopic appendectomy in the setting of performated appendicitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00187382
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  • 8
    Electronic Resource
    Electronic Resource
    Inferior vena caval blood flow and cardiac hemodynamics during carbon dioxide pneumoperitoneum (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 920-924 
    Details
    ISSN: 1432-2218
    Keywords: Cardiac hemodynamics ; CO2 pneumoperitoneum ; Inferior vena caval blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The effects of carbon dioxide pneumoperitoneum on venous return and cardiac hemodynamics during laparoscopic surgery were studied. Methods: Twelve adult pigs underwent placement of an electromagnetic flow meter across the infrarenal vena cava (IVC) as well as placement of Swan Ganz and arterial monitoring catheters. Measurements of the flow through infrarenal IVC, cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP), and heart rate were recorded at baseline, 5 and 60 min following insufflation to 15 mmHg with CO2, and 5 min following desufflation. Stroke volumes and systemic vascular resistance (SVR) were calculated as well. Results: Flow through the IVC dropped by 24 and 31% at 5 and 60 min (p=0.03 and 0.02, respectively). Paradoxically, cardiac output rose by 14 and 28% at 5 and 60 min (p=0.03 at 60 min). Central venous and pulmonary capillary wedge pressures rose transiently by 35 and 36% at 5 min before returning to baseline (p〈0.01). Mean arterial pressure and heart rate remained relatively constant during insufflation. Systemic vascular resistance diminished from 938 dynes/cm/s prior to insufflation to its nadir at 60 min of 650 dynes/cm/s (p〈0.01). Conclusions: These observations suggest potentially complex interactions between the mechanical and systemic effects of the CO2 pneumoperitoneum on venous return. Transient elevations in cardiac filling pressures occur by an unknown mechanism, and a generalized enhanced inotropic state mediated via increased sympathetic outflow is observed in this hypercapnic anesthetized animal model.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188484
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