Diseases of the colon and rectum
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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.
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Robot-assisted laparoscopic rectopexy for total rectal prolapse is safe and feasible. Small series proved clinical and functional short-term results comparable with conventional laparoscopy. No long-term results have been reported yet. ⋯ Long-term results of robot-assisted laparoscopic rectopexy are satisfying. Further studies comparing robot-assisted and conventional laparoscopy, including cost-effectiveness, are needed.
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Comparative Study
En bloc pancreaticoduodenectomy and right colectomy in the treatment of locally advanced colon cancer.
Carcinoma of the right colon invading the pancreas or duodenum is rare. Evidence of the indication, operative morbidity, and survival of en bloc pancreaticoduodenectomy and right colectomy for right colon cancer invading adjacent organs is limited. ⋯ En bloc pancreaticoduodenectomy and right colectomy can be performed safely with an acceptable morbidity and mortality rate in selected patients with locally advanced right-side colon cancer. The long-term results are promising.
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Prognosis in rectal cancer is closely related to mesorectal integrity, margin status, and adequate lymph node dissection. The impact of laparoscopy on the pathologic and short-term outcomes remains controversial. ⋯ Laparoscopy for primary rectal cancer is associated with a greater number of lymph nodes as well as short-term benefits.
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Redo surgery for failed colorectal or coloanal anastomosis is a surgical challenge, but despite its technical difficulties and the high associated morbidity risk, it may represent the only valuable option to improve patients' quality of life by avoiding a permanent stoma and decreasing chronic pelvic symptoms. ⋯ Redo surgery for failed colorectal or coloanal anastomosis is a valuable surgical option which allows avoidance of a permanent stoma in nearly 90% of patients. It remains a major undertaking with high intraoperative and postoperative morbidity.