Diseases of the colon and rectum
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Inferior outcomes in younger patients with colorectal cancer may be associated with multiple factors, including tumor biology, delayed diagnosis, disparities such as access to care, and/or treatment differences. ⋯ In an equal-access system, young age at presentation (<50 years) was associated with advanced stage and higher recurrence of colorectal cancer, but similar survival in comparison with older patients. Although increased adjuvant therapy use in younger patients may partially account for stage-specific increases in survival, the relative decreased chemotherapy use overall requires further evaluation.
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Novel local anesthetic blocks have become increasingly popular in the multimodal pain management following abdominal surgery, but have not been evaluated in a procedure-specific manner in colorectal surgery. ⋯ Novel local anesthetic wound infiltration techniques in colorectal surgery appear to reduce opiate requirements, to reduce pain scores, and to improve recovery in comparison with placebo/routine analgesia.
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Visceral obesity appears to be an emerging parameter affecting postoperative outcome after abdominal surgery. However, total visceral fat remains time consuming to calculate, and there is still a lack of data about its value as an independent risk factor in colorectal surgery. ⋯ Perirenal fat surface is an excellent and easy-to-reproduce indicator of visceral fat volume. Furthermore, perirenal fat surface is an independent risk factor for postoperative outcome in colorectal surgery that appears to be of higher predictive value than BMI and waist-hip ratio.
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Abdominal surgery in the obese can be a major challenge in the perioperative period. Peripheral neuropathy is an uncommon but well-described complication after abdominal surgery. ⋯ The incidence of postoperative peripheral neuropathy was 2.0% in minimally invasive surgery and 0.2% in open surgery. Minimally invasive surgery, age, lithotomy positioning, operative time, and Pfannenstiel incision all significantly increased the risk of peripheral neuropathy. However, only obesity was an independent risk factor for peripheral neuropathy in patients undergoing minimally invasive colorectal surgery. Preventive measures should be instituted and documented in obese patients undergoing minimally invasive colorectal procedures.
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Various factors make complete en bloc resection by endoscopic techniques alone of some laterally spreading colorectal tumors difficult or unsafe. Drawing on recent radical developments in endoscopic and laparoscopic techniques for managing colorectal lesions, we aimed to develop a safe resection procedure by using a combination of laparoscopy and endoscopy. We have named this procedure laparoscopic endoscopic cooperative colorectal surgery. ⋯ Laparoscopic endoscopic cooperative colorectal surgery involves removal of a minimal length of colon and is a feasible procedure for en bloc resection of some colonic lateral spreading tumors that would be difficult to resect endoscopically.