Silver Nitrate for Anal Fistulas: A Word of Caution Doll, Dietrich; Vassiliu, Pantelis
Diseases of the colon & rectum,
2015-December, 2015-Dec, 2015-12-00, 20151201, Letnik:
58, Številka:
12
Journal Article
Background
The study aims to determine the survival and recurrence rates of pilonidal sinus disease (PSD) carcinoma.
Methods
The data were collected retrospectively by searching the worldwide ...literature for all reports of carcinoma developing on the background of PSD. The results were presented using Kaplan–Meier curves.
Results
Between 1900 and 2022, 140 cases of PSD carcinoma were published in 103 papers, with follow‐up data available in 111 cases. Squamous cell carcinoma constituted 94.6% of the cases (n = 105). The disease‐specific survival rate was 61.7% for 3 years, 59.8% for 5 years, and 53.2% for 10 years. There was a significant survival difference between stages: 80.0% in stages I and II, 70.8% in stage III, and 47.8% in stage IV (p = 0.01). The 5‐year survival in G1‐tumors was better than G2 and G3‐tumors at 70.5% and 32.0%, respectively (p = 0.002). Recurrence occurred in 46.6% of the patients. The time‐to‐recurrence in patients treated with curative intention averaged 15.1 months (1–132 months). Local, regional, and distant recurrence was observed in 75.6%, 33.3%, and 28.9% of the recurrent tumors, respectively.
Conclusions
Pilonidal sinus carcinoma has a worse prognosis than primary cutaneous squamous cell carcinoma. Poor prognostic factors include advanced‐stage disease and poor differentiation.
...Tocchi et al1 characterized their patients' disease by clinical presentation and only included patients with chronic nonrecurrent disease in this study, which makes the results more comparable ...with those other studies. If patients from this group undergoing surgery using methylthioninium chloride are analyzed, the 5-year recurrence free survival rate is 15.1% after primary midline closure and 9.6% after open wound treatment (Fig. 2). ...we can conclude that excision followed by primary open wound healing exerts...
In the original article, the last paragraph erroneously states that author's upcoming study was going to be published in Diseases of the Colon and Rectum.
BACKGROUND:Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute ...postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery.
METHODS:We prospectively assessed preoperative PPT in a cohort undergoing anorectal surgery, known as a moderately to severely painful procedure. Linear mixed-effects models were used to assess the relationship with postoperative VAS pain scores at 1 and 3 days as well as 4 weeks postoperatively. Logistic regression was used to study the relationship with additional postoperative analgesic consumption.
RESULTS:We studied 128 patients and found that preoperative PPT is significantly associated with postoperative pain (P value for interaction = .025). Logistic regression modeling additionally revealed an association between the preoperative PPT and the need for additional postoperative analgesics, with odds of requiring additional analgesia decreasing by about 10% for each 1-point increase in PPT (odds ratio OR = 0.90; 95% confidence interval CI, 00.81–0.98; P = .012).
CONCLUSIONS:Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients’ high variability in pain sensitivity to facilitate appropriate postoperative analgesia, timely discharge, and prevent readmission.
...recurrences may occur up to 21 years after primary surgery, with three quarter of recurrences occurring during the first 5 postoperative years 2,4. ...we are very interested in the results of ...Bascom and Bascom, if two questions can be clarified:
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