Challenges and outcome of Wilms' tumour management in a resource-constrained setting

BACKGROUND

To review the results of Wilms' tumour patients in a tertiary referral hospital in a developing country and to find ways of improving long-term survival.

PATIENTS AND METHODS

Between January 1998 and May 2004, 40 patients with Wilms' tumour (WT) were admitted to Queen Elizabeth Central Hospital. Their files were reviewed and general physical condition on admission, pre-operative investigations, management and outcome were noted.

RESULTS

The mean age of presentation was 4.2 years with an equal distribution between the sexes. The mean BMI was 15 kg/m2 and more than 80% of the patients were either mildly (PCV <33%) or severely anaemic (PCV <24%). All patients presented with abdominal distension. Half of them had additional complaints including abdominal pain, haematuria, dyspnoea, oedema and or weight loss. Thirty-nine out of the forty patients received pre-operative chemotherapy. Of the 36 patients that underwent surgery, 32 underwent total nephrectomy, one a partial nephrectomy, and in three the tumour was irresectable. There were no intra-operative tumour ruptures. Only 15% of the patients completed their post-operative course of chemotherapy. The 1-year survival lies between 25% and 53%. Fifteen of the 36 patients operated were known to have a recurrence.

CONCLUSION

The patients presented in an advanced stage of the disease. Survival rates are disappointing and recurrence rates are high. Some improvement in outcome may be expected with the implementation of more aggressive treatment protocols but early diagnosis, completion of treatment regimens are needed. Pro-active follow-up is essential to measure outcome.

C-Reactive Protein as a Negative Predictive Marker for Anastomotic Leakage After Minimally Invasive Esophageal Surgery

BACKGROUND

Serum C-reactive protein (CRP) is commonly used by surgeons to raise suspicion of anastomotic leakage and other infectious complications, but most studies on optimal cut-off values are retrospective with a small sample of patients. The aim of this study was to determine the accuracy and optimal cut-off value of CRP for anastomotic leakage in patients following esophagectomy for cancer.

MATERIALS AND METHODS

Consecutive minimally invasive esophagectomy for esophageal cancer patients was included in this prospective study. Anastomotic leakage was confirmed if a defect or leakage of oral contrast was seen on a CT scan, by endoscopy or if saliva was draining from the neck incision. Diagnostic accuracy of CRP was assessed by receiver operator curve (ROC) analysis. Youden's index was adopted to determine the cut-off value.

RESULTS

A total of 200 patients were included between 2016 and 2018. Postoperative day 5 showed the highest area under the ROC (0.825) and optimal cut-off value of 120 mg/L. This resulted in a sensitivity of 75%, specificity of 82%, negative predicting value of 97%, and positive predicting value of 32%.

CONCLUSIONS

CRP on postoperative day 5 can be used as a negative predictor for and can be used as a marker to raise suspicion of anastomotic leakage following esophagectomy for esophageal cancer. When CRP exceeds 120 mg/L on postoperative day 5, additional investigations should be considered.

Double-Barrel Urocolostomy After Pelvic Exenteration: Short-Term Morbidity and Patient-Reported Quality of Life

BACKGROUND

Total pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies. Traditionally, an ileal conduit is created on the right abdominal wall for urinary diversion and an end-colostomy on the left abdominal wall for fecal diversion. However, this approach is associated with increased morbidity and a negative impact on quality of life (QoL). A unilateral double-barrel urocolostomy (DBUC) offers an alternative using the sigmoid colon for urinary drainage. This can potentially reduce complications, improve QoL, and preserve the right vertical rectus abdominis muscle (VRAM) flap for pelvic reconstruction. This study aimed to evaluate the impact of the DBUC on 90-day morbidity and QoL of patients undergoing pelvic exenteration for locally advanced colorectal and anal cancer.

METHODS

Data were prospectively collected from all patients who underwent pelvic exenteration with DBUC reconstruction for colorectal and anal cancer at our tertiary care center between January 2020 and May 2023.

RESULTS

This study enrolled 20 patients. Postoperative complications were observed in 19 patients, including seven major complications. Two complications were directly attributable to the DBUC. Patients reported favorable QoL outcomes in terms of global health, functional ability, and symptom management, with expected limitations in physical performance due to extensive abdominal surgery. At 1 year after surgery, all the patients preferred the DBUC over separate bilateral ostomies.

CONCLUSION

The DBUC procedure has demonstrated safety and efficacy in terms of short-term morbidity and favorable patient-reported QoL, making it an attractive alternative to dual ostomies for patients undergoing pelvic exenteration, particularly when VRAM reconstruction is considered.