Diseases of the colon and rectum
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Randomized Controlled Trial Multicenter Study Comparative Study
Safety and efficacy of ulimorelin administered postoperatively to accelerate recovery of gastrointestinal motility following partial bowel resection: results of two randomized, placebo-controlled phase 3 trials.
Gastrointestinal recovery is a critical milestone after bowel resection with postoperative ileus resulting in increased risk of complications and prolonged hospitalization. ⋯ Although the efficacy of ulimorelin in reducing the duration of postoperative ileus was not demonstrated in these studies, intravenous ulimorelin at doses of 160 µg/kg and 480 µg/kg was generally well tolerated in postcolectomy patients. Similar to other promotility agents, ulimorelin may find an application in other indications better suited to its attributes.
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Multicenter Study Comparative Study
CEA - a predictor for pathologic complete response after neoadjuvant therapy for rectal cancer.
Preoperative chemoradiation therapy in patients with rectal cancer results in pathologic complete response in approximately 10% to 30% of patients. Accurate predictive factors for obtaining pathologic complete response would likely influence the selection of patients best treated by chemoradiation therapy as the primary treatment without radical surgery. ⋯ We demonstrated an association between low pretreatment CEA levels, interruption in chemoradiation therapy, and pathologic complete response in patients treated with neoadjuvant chemoradiation therapy for locally advanced rectal cancer. The predictive value of CEA in smokers can be limited, and further studies are needed to evaluate the impact of smoking on the predictive value of CEA levels for pathologic complete response in rectal cancer.
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Multicenter Study Comparative Study
Recalibration and validation of a preoperative risk prediction model for mortality in major colorectal surgery.
In 2009, Barwon Health designed a risk stratification model for mortality in major colorectal surgery with the use of only preoperative risk factors. The Barwon Health 2009 model was shown to predict mortality reliably, and it was comparable to other models, such as the original, POSSUM. However, the Barwon Health 2009 model was never validated with data other than those used to develop the model. ⋯ We have developed a model that can accurately predict mortality after major colorectal surgery by using only data that are available preoperatively. After recalibration, the model was successfully validated in a second hospital.