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Chen MZ, Devan Nair H, Saboo A, Lee SCL, Gu X, Auckloo SMA, Tamang S, Chen SJ, Lowe RW, Strugnell N. A single centre audit: repeat pre-operative colonoscopy. ANZ J Surg 2022; 92:2571-2576. [PMID: 35642258 DOI: 10.1111/ans.17813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/03/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Repeat colonoscopy may be required for tumour localisation. The aim of the study is to explore the clinical settings it was used and benchmark the quality of initial colonoscopy against standardized guidelines for tumour localisation, tattooing and colonoscopy reporting amongst clinicians. METHODS A retrospective study from 2016 to 2021 has been performed on patients who underwent elective colorectal cancer resections at the Northern Hospital. Patient demographics, colonoscopic and operative details were retrieved from the Bi-National Colorectal Cancer Audit (BCCA) Registry database and hospital medical records. PRIMARY OUTCOMES changes in operative approach and delays to operation. SECONDARY OUTCOMES reasons for a repeat colonoscopy and complications from repeat colonoscopy. RESULTS A total of 339 patients were included in this study. 94 (28.6%) underwent a repeat colonoscopy. Re-scoping rate was 29.6% for surgeons, and 26.2% for non-operating endoscopists. Surgeons had a 5.9% localisation error rate, and non-operating endoscopist 6.95% (p = 0.673). Surgeons did not have a lower rate of repeat colonoscopy (p = 0.462). Repeat endoscopy was associated with a longer time to definitive operation (p < 0.001). No complications were associated with a repeat colonoscopy. CONCLUSION There was no difference in localisation error rates or repeat colonoscopy amongst surgeons (29.6%) and non-operating endoscopists (26.2%) (p = 0.462). This could be explained by the standardized endoscopy training in Australia governed by a common training board. Lack of tattooing at index colonoscopy and inadequate documentation often led to a repeat endoscopy, which was associated with a longer time to definitive operation. Standardized guidelines in tattooing of lesions and colonoscopy reporting should be implemented.
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Affiliation(s)
- Michelle Zhiyun Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Hareshdeva Devan Nair
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Apoorva Saboo
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sharon Chih Lin Lee
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Xinchen Gu
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | | | - Sandeep Tamang
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Sally Jiasi Chen
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Ryan William Lowe
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Neil Strugnell
- Colorectal Surgery Unit, Department of General Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Nakanishi R, Yamaguchi T, Akiyoshi T, Nagasaki T, Nagayama S, Mukai T, Ueno M, Fukunaga Y, Konishi T. Laparoscopic and robotic lateral lymph node dissection for rectal cancer. Surg Today 2020; 50:209-216. [PMID: 31989237 PMCID: PMC7033048 DOI: 10.1007/s00595-020-01958-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/29/2019] [Indexed: 12/11/2022]
Abstract
In the era of neoadjuvant chemoradiotherapy/radiotherapy and total mesorectal excision, overall oncological outcomes after curative resection of rectal cancer are excellent, with local recurrence rates as low as 5–10%. However, lateral nodal disease is a major cause of local recurrence after neoadjuvant chemoradiotherapy/radiotherapy and total mesorectal excision. Patients with lateral nodal disease have a local recurrence rate of up to 30%. The oncological benefits of lateral pelvic lymph node dissection (LPLND) in reducing local recurrence, particularly in the lateral compartment, have been demonstrated. Although LPLND is not standard in Western countries, technical improvements in minimally invasive surgery have resulted in rapid technical standardization of this complicated procedure. The feasibility and short- and long-term outcomes of laparoscopic and robotic LPLND have been reported widely. A minimally invasive approach has the advantages of less bleeding and providing a better surgical view of the deep pelvic anatomy than an open approach. With precise autonomic nerve preservation, postoperative genitourinary dysfunction has been reported to be minimal. We review recent evidence on the management of lateral nodal disease in rectal cancer and technical improvements of LPLND, focusing on laparoscopic and robotic LPLND.
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Affiliation(s)
- Ryota Nakanishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomohiro Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takashi Akiyoshi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Nagayama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Toshiki Mukai
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 31-8-3, Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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Nguyen HH, Bechara R, Paterson WG, Hookey LC. Two-year retrospective analysis of patients undergoing direct to procedure flexible sigmoidoscopy investigation with rectal bleeding as a primary complaint. Endosc Int Open 2018; 6:E1059-E1064. [PMID: 30105294 PMCID: PMC6086679 DOI: 10.1055/a-0600-2157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Rectal bleeding affects ~15 % of the general population and is a common reason for referral to gastroenterologists by primary care physicians. Direct to procedure flexible sigmoidoscopy is an appealing modality to investigate rectal bleeding due its diagnostic yield, safety profile, and accessibility. Patients referred on a routine basis for direct to procedure clinic by primary care physicians with the sole complaint of rectal bleeding have not previously been studied. Our study aims to explore the spectrum of diagnoses and evaluate for potential clinical predictors of underlying pathology in this specific patient population. METHODS In total, 528 charts of patients referred to the Kingston General Hospital and Hotel Dieu Hospital endoscopy units (Kingston, Canada) with the sole complaint of rectal bleeding were reviewed. All of these patients were referred on a routine basis to direct to procedure clinic from primary care physicians. The performance of various clinical variables in predicting significant pathology was assessed by univariate analysis. RESULTS The diagnostic spectrum of the cohort studied included hemorrhoids (75.5 %), anal fissures (4 %), ulcerative colitis (3.2 %), Crohn's disease (1.1 %), indeterminate proctitis/colitis (1.7 %), and colorectal malignancy (2.7 %). Of the various clinical variables assessed, only male sex predicted significant pathology (25.2 % of males vs 17.6 % of females, P < 0.05). CONCLUSION Our study highlights the need for a thorough investigation of rectal bleeding given the lack of clinical predictors. Future prospective studies with more patients are needed to fully assess the utility of various clinical variables in predicting pathology in this patient population. This would allow for more effective triaging of a routine rectal bleeding, a very common reason for patient referral to gastroenterologists by primary care physicians. Flexible sigmoidoscopy was not associated with complications or missed diagnosis in our study. As such, the technique appears to be a suitable initial investigative modality for patients with rectal bleeding.
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Affiliation(s)
- Henry H. Nguyen
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Calgary AB, Canada
| | - Robert Bechara
- Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada
| | - William G. Paterson
- Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada
| | - Lawrence C. Hookey
- Gastrointestinal Diseases Research Unit (GIDRU), Department of Medicine, Queen’s University, Kingston ON, Canada,Corresponding author Dr Lawrence Hookey Division of GastroenterologyHotel Dieu Hospital166 Brock StreetKingstonOntarioCanada+1-403-592-5090
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Developments in Screening Tests and Strategies for Colorectal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:326728. [PMID: 26504799 PMCID: PMC4609363 DOI: 10.1155/2015/326728] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/19/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Worldwide, colorectal cancer (CRC) is the third most common cancer in men and second most common in women. It is the fourth most common cause of cancer mortality. In the United States, CRC is the third most common cause of cancer and second most common cause of cancer mortality. Incidence and mortality rates have steadily fallen, primarily due to widespread screening. METHODS We conducted keyword searches on PubMed in four categories of CRC screening: stool, endoscopic, radiologic, and serum, as well as news searches in Medscape and Google News. RESULTS Colonoscopy is the gold standard for CRC screening and the most common method in the United States. Technological improvements continue to be made, including the promising "third-eye retroscope." Fecal occult blood remains widely used, particularly outside the United States. The first at-home screen, a fecal DNA screen, has also recently been approved. Radiological methods are effective but seldom used due to cost and other factors. Serum tests are largely experimental, although at least one is moving closer to market. CONCLUSIONS Colonoscopy is likely to remain the most popular screening modality for the immediate future, although its shortcomings will continue to spur innovation in a variety of modalities.
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