Hartmann's procedure. Indications, results. Apropos of 105 cases]

The authors report in this retrospective study, 105 cases of patients operated with Hartmann's technic since 1979 to 1990. There were 55 men and 50 women with average age of 70 years (34-90 years old), 71 patients were strucked down by malign disease, 34 by benign disease. 42 surgical operations were performed immediately, 63 were delayed, 26 operations were immediately performed for serious sepsis, 11 for occlusives syndromes. Delayed surgical operations were performed for malignant diseases in 50 cases, elsewhere, there were 6 sigmoiditis with malignant aspect. The upper half rectum was resected at a rate of 38%, the original technic was performed at a rate of 65%. Post operatory mortality was at a rate of 13% (14 died) concerning 25% of immediately operated patients and 6% of delayed operations. Post operatory mortality was at a rate of 15.4% for malignant disease and 8.8% for benign disease. Post operatory results were complicated with 4 occlusives syndromes, 3 fistula from the rectum, 1 cholecystis, 1 small intestine perforation. There were 10 parietal complications and 10 general complications with 7 urinary infections, 4 lung infections and 2 venous thrombosis. The colon anastomosis was performed in a manual way in 23.4% of cases, in a mechanical way in 23% of cases (with EEA or PCEA forceps) with a 8 month average interval between the 2 surgical operations. The mortality rate of this surgical operation is high because patients are old and have heavy deficiencies and are immediately operated for serious diseases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical treatment of acute malignant large bowel obstruction.

OBJECTIVE--To evaluate the morbidity and mortality in all patients operated on urgently for acute large bowel obstruction caused by carcinoma of the colon or rectum during a 10 year period. DESIGN--Retrospective study. SETTING--Aalborg Hospital, Denmark. SUBJECTS--156 consecutive patients operated on for obstructing primary colorectal cancers. MAIN OUTCOME MEASURES--Operations done, morbidity and mortality. RESULTS--95 patients (61%) had advanced disease (Dukes' stage C or "D") and their median age was 73 years (range 38-93). 97 had the obstructing lesion resected with a 30 day mortality of 5%. 43 patients underwent primary resection and 4 died (9%), and 54 underwent staged resection with one death (2%). Complications were common, particularly after staged resections, median hospital stay being 19 days after primary, compared with 30 days after staged resection. 59 patients (38%) had palliative operations with 29 deaths (49%); in 39 the tumor was completely unresectable. CONCLUSION--Patients with obstructing primary colorectal cancers are a high risk group who are characterised by advanced disease and old age. Only prospective trials comparing different operations can assess whether it is possible to achieve a reduction in mortality.     

全电视胸腔镜下肺叶切除术156例报告

目的探讨全电视胸腔镜下肺叶切除术治疗肺部疾病的价值。方法 2008年1月～2011年1月,通过胸部3个微小切口行全电视胸腔镜下肺叶切除术156例,无须放置肋骨撑开器,不牵开肋骨,基本操作顺序与常规开胸肺叶切除相同。肺癌病人均清扫淋巴结。结果本组手术顺利,无围手术期严重并发症及死亡,手术时间(166±58)min,术中出血(210±108)ml,术后住院时间(8.3±3.0)d。术后病理诊断:肺部良性病变28例(17.9%),其中隐球菌感染16例,结核球7例,肺不张5例;肺部恶性肿瘤128例(82.1%),其中细支气管肺泡癌72例,腺癌26例,细支气管肺泡癌合并腺癌17例,鳞癌13例。156例术后随访3～36个月,平均13个月:28例良性疾病无远期感染性并发症;128例恶性肿瘤中,术后3年内发生远处转移6例,主要为脑、肾上腺转移;无死亡病例。结论全电视胸腔镜下肺叶切除术安全、有效。     

Laparoscopic colorectal surgery – results from 200 patients

OBJECTIVE: Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short-term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years. METHOD: A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest. RESULTS: Two hundred and thirty-one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter-quartile range (IQR) 57-76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90-150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15-30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re-operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3-6) and 13 patients (6.5%) were re-admitted within 30 days of hospital discharge. CONCLUSION: Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.     

Routine compared with nonscheduled follow-up of patients with “curative” surgery for colorectal cancer

Background: The main rationale for follow-up of colorectal cancer patients resected for “cure” is that early detection and treatment of recurrence and metachronous disease should result in improved survival. Our purpose was to assess in a prospective fashion the impact on survival of a follow-up program versus that of undergoing nonscheduled visits. Methods: Within the 14-year period from 1975 through 1988, a prospective study was carried out on 800 patients with colorectal adenocarcinoma radically resected with no evidence of synchronous cancers of the colon and rectum or in other organs, of whom 322 patients were to attend a 5-year follow-up, and 478 patients were free to make nonscheduled visits on account of symptoms. Results: Asymptomatic recurrence was found at follow-up in 92 (28%) of 322 patients, whereas 175 (36%) of 478 patients had a symptomatic recurrence detected at a nonscheduled visit. Diagnosis of resectable recurrence was established within a median time of 21.5 months. Surgical resection of recurrence was performed in 30 (32%) of 92 and in 13 (7%) of 175 patients (32 vs. 7%;p<0.001). Resection was curative in 13 (14%) of 92 and in two (1%) of 175. Five-year survival of resected recurrence was 10% in 30 of 92 patients and 0.8% in 13 of 175 (10 vs. 0.8%;p<0.01). Two patients are alive with no evidence of disease or two (2%) of 92. Metachronous colorectal lesions were treated for cure in 63 (19.5%) of 322 patients. The effectiveness of scheduled follow-up was 4% (13 of 322 patients). Conclusions: These results underline the rationale for a follow-up program in early detection and surgical treatment of recurrent disease in patients operated on for colorectal cancer.     

Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach

Aim

Colorectal cancer is one of the most common malignancies in general population. The incidence seems to be higher in older age. Surgery remains the treatment of choice and laparoscopic approach offers numerous benefits. We report our personal experience in elderly patients operated on for colorectal cancer with laparoscopic resection.

Patients and methods

From January 2003 to September 2013, out of 160 patients aged 65 years or older and operated with minimally invasive techniques, 30 cases affected by colorectal cancer and operated on with laparoscopic approach were analyzed in this study.

Results

Male/female ratio was 1.35 and mean age 72 years. Constipation, weight loss, anemia and rectal bleeding were the most commonly reported symptoms. Lesions involved descending-sigmoid colon in 53% of cases, rectum in 37% and ascending colon in 10%. Among laparoscopic colorectal operations laparoscopic left colectomy was the most frequently performed, followed by right colectomy, abdominoperineal resection and Hartmann procedure. Operative times ranged from 3 to 5 hours depending on surgical procedure performed. Mean hospital stay was 6 days (range 4–9). Conversion to open approach occurred only in a case of laparoscopic right colectomy (3%) for uncontrolled bleeding. A single case of mortality was reported. In two cases (7%) anastomotic leakage was observed, conservatively treated in one patient and requiring reoperation in the other one.

Conclusions

Laparoscopic colorectal surgery is feasible and effective for malignancies in elderly population offering several advantages including immunologic and oncologic ones. However an experienced surgical team is essential in reducing risks and complications.     

Laparoscopic colorectal surgery. Analysis of the first 237 cases

This study was made to prospectively assess the results of our first 237 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal procedures. Between May 1995 and July 1999, two hundred thirty seven laparoscopic (assisted) colorectal procedures were performed: 97 sigmoidectomies, 31 right hemicolectomies, 26 rectosigmoidectomies, 23 abdominoperineal rectum amputations and 60 other procedures. The following parameters were recorded and analysed: patients gender, age, diagnosis, procedure, conversion to open surgery, peroperative and postoperative complications, duration of procedure, mortality and length of hospitalization. There were 104 men (44%) and 133 women (56%) with a mean age of 62 years. Hundred and fifty-one operations were performed for benign indications (diverticular disease (51.6%), benign colonic polyps (17.5%) and others (30.9%)) and 86 for cancer (palliative and curative). The conversion rate was 4%. Postoperative complications occurred in 65 patients (27%). In 20% of these cases re-operation was necessary. The most common cause was bowel obstruction. Surgery lasted an average of 110 minutes. Mean overall hospital stay was 11 days. Sixty per cent left the hospital within eight days after operation. The 60-day mortality rate was 2.9%. The feasibility and safety of laparoscopic colorectal surgery has been established in a variety of procedures for different indications. Care must be taken in the case of acute diverticulitis which in our series is associated with higher minor and major complication rate and conversion rate. Although our results for malign cases are good, the definitive incidence of neither port-site metastasis nor local recurrence is known and no long-term results after laparoscopic surgery for carcinoma are available, we believe that curative procedures for cancer should continue to be carried out only within the framework of prospective studies unless the patient is more than 75-year old, is in bad general condition or when a palliative procedure has to be performed.     

Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery

Background: Prospective randomized multicenter studies comparing laparoscopic with open colorectal surgery are not yet available. Reliable data from prospective multicenter studies involving consecutive patients are also lacking. On the basis of the personal caseloads of specialized surgeons or of retrospective analyses, it is difficult to judge the true effectiveness of this new technique. This study aims to investigate the results of laparoscopic colorectal surgery in consecutive patients operated on by unselected surgeons. Methods: This observational study was begun August 1, 1995, in the German-speaking part of Europe (Germany and Austria) and 43 centers initially agreed to participate. All consecutive cases were documented. All data were rendered anonymous. Analysis was performed on an intention-to-treat basis. The study committee was blinded to the participating center. Results: By the end of the 1st year, 500 patients (M:F ratio 0.83, mean age 62.9 years) had been treated by 18 centers; 269 operations were performed for benign indications and 231 for cancer (palliative and curative). Most operations were done on the distal colon or rectum. An anastomosis was performed in 84%, with an overall leakage rate of 5.3% (colon 3.6% and rectum 11.8%), which required surgical reintervention in 1.7%. The mean operating time was 176 min and showed a decreasing tendency over the period under study. The conversion rate was 7.0% and the overall complication rate 21.4%. The reoperation rate was 6.6%; the most common cause was bleeding. There was one ureteral lesion (0.2%), but urinary tract infections were fairly common (4.8%). A postoperative pneumonia was diagnosed in 1.6% of the cases. No thromboembolic complications were reported. The 30-day mortality rate was 1.4% and overall hospital mortality 1.8%. Conclusions: Laparoscopic colorectal operations are still rare (about 1% of all colorectal operations in Germany). Laparoscopic procedures are more common on the left colon and rectum than on the right colon. The surgical complication rate is acceptable, comparable with rates reported by others for open surgery. Cardiopulmonary and thromboembolic complications were rarely seen. Mortality and surgical morbidity rates do not differ significantly among participating centers. A learning curve, reflected by a shortening of the operating time and a somewhat lower conversion rate, was observed over the observation period. Received: 3 February 1997/Accepted: 22 April 1997     

Synchronous colorectal cancers]

The frequency of synchronous colorectal cancers ranges from 1.7 to 9.3% according to the series. The incidence of these cancers has been appreciated in various ways, according to variable diagnostic criteria, especially because some authors have included in situ carcinomas developing on degenerated polyps. A retrospective study of the synchronous cancers operated in our department from January, 1980 to August, 1990 allowed us to assess their frequency and location and to discuss the therapeutic choices. Two hundred and forty-nine patients with cancers of the colon or of the rectum have been operated during that period. Twelve (4.8%) presented with more than one colorectal cancer, all discovered simultaneously. The average age of the patients operated for synchronous cancer was higher that that of those operated of isolate cancer (68.8 years versus 63.3). Two thirds of the synchronous cancers were located in the sigmoid loop or the colon and, in one third of all cases, on non-adjacent segments of the colon. The frequent association of colic adenomatous polyps and of synchronous cancers--in one half of the patients in our series--must raise a discussion on the merits of systematic subtotal, or even total, colectomy in the treatment of synchronous colorectal cancers. This is also true for tumoral sites in 2 different segments of the colon. Segmental colectomy may be advocated in the other cases: cancers located on one segment, polyps located only on the resected segment of the colon, or polyps that can be resected via endoscopy.     

温水保留灌肠18氟-脱氧葡萄糖正电子发射计算机断层成像术对鉴别结直肠意外发现高代谢灶良恶性的诊断价值

目的探讨温水保留灌肠对”氟一脱氧葡萄糖正电子发射计算机断层成像术（18F—FDGPET．CT）检查意外发现的结直肠高代谢灶鉴别良恶性的诊断价值。方法2010年6月至2012年12月间在中山大学附属第六医院行PET．CT检查时意外发现有77例患者结直肠存在性质不明的高代谢灶,予以行温水保留灌肠PET—CT扫描,根据最终的诊断分为恶性病变（包括结直肠癌和恶性腺瘤）、良性病变（包括良性腺瘤和炎性病变）和生理性摄取,对高代谢灶的放射性摄取程度（最大标准摄取值,SUVmax）和灌肠前后SUVmax的变化（滞留指数,RI）进行组间比较。结果77例患者行温水保留灌肠PET—CT扫描后,诊断结直肠恶性病变23例,良性腺瘤16例,炎性病变7例,生理性摄取31例。恶性与良性病变常规SUVmax及RI比较,差异均无统计学意义（均P〉0．05）。肿瘤性病变与非肿瘤性摄取之间SUVmax的差异均无统计学意义（均P〉0．05）;但肿瘤性病变与炎性病变之间的RI差异有统计学意义（P〈0．05）。温水保留灌肠PET．CT对结直肠生理性摄取诊断的准确性为100％。对结直肠良、恶性病变判断的灵敏度为95．6％,特异度为96．3％,准确性为96．1％。结论温水保留灌肠PET—CT有助于常规PET—CT意外发现的结直肠高代谢灶中良恶性病变的鉴别,有效排除肠道生理性摄取的影响,避免不必要的结肠镜检查。     

结直肠间质瘤14例临床分析

目的探讨结直肠间质瘤的临床诊断、治疗和预后。方法回顾性分析中国人民解放军总医院1993年3月至2002年3月收治的14例结直肠间质瘤的临床、病理资料及随访结果。结果临床表现为消化道出血(7/14)、腹部不适(4/14)、腹部肿块(2/14),无症状1例。病变部位为结肠6例,直肠8例。14例均行手术治疗,诊断为良性2例,交界性1例,恶性11例。免疫组化CD117( )92%(13/14),CD34( )78%(11/14)。随访率71%,病人平均生存时间为56个月。结论低位直肠恶性间质瘤病人,宜经骶尾部或会阴部切口行直肠局部切除术。     

Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute's prospective analysis

BACKGROUND: Laparoscopic surgery for gastrointestinal benign disease has gained worldwide acceptance; totally laparoscopic surgery for malignant diseases remains controversial. The purposes of this study were to examine prospectively our experience with laparoscopic gastric resections, to evaluate the surgical outcomes, and to discuss the role of these procedures in the treatment of benign and malignant diseases of the stomach. To the best of our knowledge, this is the largest prospective study of totally laparoscopic total and partial gastrectomies in Western countries. STUDY DESIGN: Thirty-three patients who underwent totally laparoscopic gastric resection between April 1995 and January 2004 were studied prospectively. Eight patients underwent laparoscopic total gastrectomy and 25 patients had laparoscopic partial gastrectomy. There were 21 women and 12 men with a mean age of 71 +/- 10 years. RESULTS: Twenty-one patients (63.6%) were operated on for malignant diseases and 12 patients (36.4%) had benign lesions. Conversion to laparotomy was not required in any case. Mean operative time was 138 +/- 40 minutes and mean blood loss was 58 +/- 85 mL. There were no major intraoperative complications except for one splenectomy, and there were no perioperative deaths. Two postoperative complications occurred; one patient developed an intraperitoneal abscess with a small duodenal fistula after total gastrectomy and was treated by peritoneal lavage and drain placement. The other patient developed delayed gastric emptying after subtotal gastrectomy and was managed conservatively. Mean ambulation time and mean hospital stay were 2.3 +/- 0.7 days and 14.6 +/- 5 days, respectively. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 22 +/- 12 (range 10 to 53). CONCLUSIONS: This prospective trial demonstrated that totally laparoscopic total and partial gastric resections had good results and were feasible and safe procedures. In addition, we concluded that the totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.     

新型冠状病毒肺炎疫情期间外科手术安全防控体会

目的探讨新型冠状病毒肺炎疫情期间外科手术安全防控措施及流程。方法解读新型冠状病毒肺炎诊疗方案、新型冠状病毒肺炎防控方案以及医疗机构内新型冠状病毒肺炎感染预防与控制技术指南后,笔者所在医院制定及完善了手术安全防控措施及流程。结果统计笔者所在医院从2020年1月22日至2020年2月10日行手术患者567例,其中手术中心手术501例,介入中心手术66例。所有手术中,急诊手术303例,限期及择期手术264例。在急诊手术中,占前3位的分别是剖腹产130例,占42.9%;腹部消化系统手术63例,占20.8%;头颅手术31例,占10.2%。限期及择期手术中占前4位的是眼科良性疾病手术65例,占24.6%;肿瘤患者57例,占21.6%;骨科手术53例,占20.1%;冠脉造影25例,占9.4%。所有手术患者均顺利完成手术,术后均恢复良好,无外科严重并发症发生,无感染相关并发症发生。结论在新型冠状病毒肺炎疫情期间,通过调整优化措施及流程,可以开展外科手术和实施疫情防控。     

经肛门括约肌手术在直肠外科中的应用

目的 探讨经肛门括约肌路径的手术(Mason手术)在直肠外科中的应用.方法 回顾性分析1990年8月至2008年12月150例中下段直肠疾病患者施行Mason手术的经验. 结果150例中直肠绒毛状腺瘤75例,早期直肠癌48例,进展期直肠癌9例.以直肠类癌为主的黏膜下结节23例,直肠肿瘤中行直肠部分切除术120例,直肠节段切除术6例.直肠阴道/尿道瘘21例,其中一次修补成功者17例(81%).术后伤口积液感染6例(4%),直肠-皮肤瘘5例.获随访的46例早期直肠癌中2例肿瘤局部复发(2/46).其中存活超过5年者39例,占84.5%(39/46).150例术后均未发生肛门失禁.结论 Mason手术具有手术进路直达,术野表浅和显露良好的特点,适用于可行局部手术治疗的中下段直肠良恶性疾病.     

Safety and learning curve in robotic colorectal surgery

Robotic surgery has recently started to be used for minimally invasive colorectal surgery. Because of limited access and high cost, very few colorectal units are available in the US. We describe our experience with benign and malignant disease since September 2008 in a dedicated colorectal practice. A prospective collected robotic database was queried for colon and rectal procedures. Anonymized demographic, intraoperative, and postoperative data, and pathology information, were collected and analyzed. A total of 48 robotic procedures for colorectal maladies were performed in the study period. There were 35 females and 13 males. The average age was 57 years. Twenty-two cases were performed for diverticulitis, 13 for malignancy (10 distal rectum (<8 cm anal verge), two rectosigmoid, and one ascending colon cancer), 10 for rectal prolapse, two for rectovaginal fistula, and one for incidental appendiceal mucocele found during a gynecologic resection. The average operating room time (OR) was 162 min and there were no conversions to open procedures. Blood loss averaged 104 mL. Mean length of hospital stay (LOS) was 5.4 days. Patient readmission occurred in 27.3% of cases. The anastamotic leak rate was 2.1% (one patient). No mortalities were reported. When the analysis was performed for colorectal malignancies (13 procedures), there were nine females and four males. Average age was 59 years. The mean OR time was 191.1 min. Mean intraoperative blood loss was 123 mL and there were no conversions to open surgery. Average LOS was 7.0 days. There was one anastamotic leak (7.7%). The length of stay was increased for the patient with anastamotic leak (18 days) and for a patient with high stoma output and postoperative ileus (17 days). Readmission rate was 30.1%. The total number of lymph nodes retrieved averaged 19.5, with a mean distal margin of 3.0 cm and in all cases negative radial margins. Robotic colorectal surgery for benign and malignant disease is safe, and short-term outcomes are comparable with those of traditional and laparoscopic surgery. Oncologic resections were adequate with excellent lymph node sampling and radial and distal margins.     

Penetrierende Kriegsverletzungen der Colorectalregion

INTRODUCTION: Colorectal war injuries can be treated with primary repair or by colostomy. We report our experience with both treatments. METHODS: During the Croatian war from July 1991 to March 1994, 155 patients with colorectal injuries were treated at the Surgical Clinic, University Hospital Split. This group represents 7% of all patients (n = 2220) with gunshot and shrapnel wounds treated in this period at our clinic. The median patient age was 24.7 years (range 14-70 years). The majority of the patients (96.7%) were male. Concomitant injuries of the colon (83.7%) and rectum (69%) were found more frequently than isolated ones. 50 patients were operated on as emergencies in our clinic, while 105 were operated on in field hospitals. In 28 patients primary repair of the colorectal injury was performed (without derivation), whereas 127 patients were treated by colostomy. In those patients 106 wounds were closed electively during a second operation. The average in hospital stay was 32.3 days (range 10-65 days). RESULTS: Using PATI and FCIS scores for colorectal injuries, 80% of our patients had life-threatening injuries. In the cases with primary repair the percentage of complications was high (92%). In the cases with the diverting colostomy it was only 34%. The high complication rate in the cases with primary repair was directly related to the presence of the anastomotic leaks and subsequent peritonitis. Explorative laparotomy was an effective diagnostic tool especially in the field hospitals. The overall mortality rate was 3.2%. CONCLUSION: In our operative strategy we preferred derivation operations in order to decrease major complications due to anastomotic leakage or peritonitis.     

结肠镜、腹腔镜联合切除结直肠肿瘤的临床研究

目的:探讨结肠镜与腹腔镜联合切除结直肠肿瘤的临床疗效。方法:经病理诊断为结直肠肿瘤患者24例,按肿瘤良恶性分成A、B两组。A组于腹腔镜监视下,经结肠镜切除直肠腺瘤4例,结肠间质瘤2例,结肠腺瘤样息肉7例。B组在结肠镜指示下,经腹腔镜切除结肠癌7例,直肠癌4例。结果:A组患者平均手术时间为(15±3.4)min,术后发生肠道出血2例,无肠穿孔病例。B组患者均在腹腔镜下完成肿瘤切除术,平均手术时间为(129±17.5)min,术后无切口感染或吻合口漏。A组患者术后第3天痊愈出院,B组术后第9天痊愈出院。结论:结肠镜与腹腔镜联合切除结直肠肿瘤可以优势互补,是安全可行的。     

Synchronous colorectal and renal carcinomas. Is it a definite clinical entity?

The aim of the study was to assess the frequency of synchronous colorectal and renal cancers among our patients. To this end we reviewed 781 consecutive patients operated on for colorectal carcinoma in our institution. Three patients (0.4%) had diagnosis of synchronous renal-cell cancer during the work-up for their colorectal primary tumours. The colon and rectum are frequently affected by multiple malignant tumours. Second primaries are not frequently associated with colorectal cancer. On the other hand, renal cell carcinoma has been described as being associated with other synchronous malignancies in up to 27.4% of cases. A recent report has described a 4.8% incidence of synchronous colorectal and renal carcinomas, which is much higher than that previously reported in the literature (0.03-0.5%). We found a 0.4% incidence of simultaneous colorectal cancer and renal cell carcinoma. The latter was invariably asymptomatic and diagnosed during the work-up for the colorectal cancer. We are unable to confirm the observation of a higher than expected incidence of synchronous colorectal and renal neoplasms. Nevertheless, the surgeon should be conscious of this association, when considering renal lesions detected during the work-up for colorectal cancer.     

Clinical features and treatment of lower intestinal hemorrhage

We have experienced 471 patients with anal bleeding during the past seven years. The Results are as follows: 1. As for the types of disease, incidence of hemorrhoid, colorectal cancer and ulcerative colitis (UC) was high, while that of small intestinal problems was low. 2. In the cases of remarkable bleeding from the lower intestinal tract, massive or acute progressive bleeding was less frequent than expected. 3. Inflammatory diseases were the main causes of massive bleeding. Bleeding by UC was the major indication for urgent operation. In the cases with acute massive hemorrhage, basic complications were often found and the possibility of the diseases of small intestine and blood vessel disorders also should be considered. 4. At the examination of bleeding patients, it is efficient to explore the lower colon and rectum first by colonoscopy or sigmoidoscopy, for most of the bleeding lesions are found in these portions. 5. As for surgical treatment, most of colorectal cancer patients with hemorrhage are able to be operated with wait- and -see management. For UC patients, complete cure operation is possible even if they have high-dose steroid medication.     

Laparoscopic colorectal anastomosis: risk of postoperative leakage

Background: We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open colorectal surgery. Methods: The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics, surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were rendered anonymous. Results: Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%), and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%, and the 30-day mortality rate was 1.57%. Conclusions: The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery. Received: 24 August 1998/Accepted: 25 November 1998