Background
It is not clear whether all patients with rectal cancer need chemoradiotherapy. A restrictive use of neoadjuvant chemoradiotherapy (nCRT) based on MRI findings for rectal cancer was ...investigated in this study.
Methods
This prospective multicentre observational study included patients with stage cT2–4 rectal cancer, with any cN and cM0 status. Carcinomas in the middle and lower third that were 1 mm or less from the mesorectal fascia, all cT4 tumours, and all cT3 tumours of the lower third were classified as high risk, and these patients received nCRT followed by total mesorectal excision (TME). All other carcinomas with a minimum distance of more than 1 mm from the mesorectal fascia and those in the upper third were classified as low risk; these patients underwent TME alone (no nCRT). Patients were followed for at least 3 years. Outcomes were the rates of local recurrence, distant metastasis and survival.
Results
Among 545 patients included, 428 were treated according to the study protocol: 254 (59·3 per cent) had TME alone and 174 (40·7 per cent) received nCRT and TME. Median follow‐up was 60 months. The 3‐ and 5‐year local recurrence rates were 1·3 and 2·7 per cent respectively, with no differences between the two treatment protocols. Patients with disease requiring nCRT had higher 3‐ and 5‐year rates of distant metastasis (17·3 and 24·9 per cent respectively versus 8·9 and 14·4 per cent in patients who had TME alone; P = 0·005) and worse disease‐free survival compared with that in patients who did not need nCRT (3‐ and 5‐year rates 76·7 and 66·7 per cent, versus 84·9 and 76·0 per cent in the TME‐alone group; P = 0·016).
Conclusion
Restriction of nCRT to high‐risk patients achieved good results.
Limiting radiotherapy appears safe.
Porphyrin derivatives are highly relevant to biological processes such as light harvesting and charge separation. Their aromatic electronic structure and their accessible HOMO−LUMO gap render ...porphyrins highly attractive for the development of opto- and electro-active materials. Due to the often difficult covalent synthesis of multiporphyrins, self-assembly using metal complexation as the driving force can lead to well defined objects exhibiting a controlled morphology, which will be required to analyse and understand the electronic properties of porphyrin wires. This article presents two assembly approaches, namely by peripheral coordination or by binding to a metal ion in the porphyrin core, that are efficient and well designed for future developments requiring interactions with a surface.
The use of coordination bonds as a tool to assemble linear scaffolds of two or more porphyrins in solution and/or on surfaces is described in this Feature Article.
Introduction
Introduction of total mesorectal excision (TME) surgery for rectal cancer decreased local recurrence dramatically. Additional neoadjuvant chemoradiation (nCR) is frequently given in UICC ...II and III tumors based on TNM staging which is of limited accuracy. We aimed to evaluate determination of circumferential margin by magnetic resonance imaging (mrCRM) as an alternative criterium for nCR.
Methods
Multicenter prospective cohort study which enrolled 642 patients in 13 centers with non-metastasized rectal adenocarcinoma. Patients with T4 tumors or patients with a mrCRM of 1 mm or less were treated by neoadjuvant chemoradiation. All others proceeded directly to surgery when inclusion criteria and no exclusion criteria were met. Quality of TME and accuracy of mrCRM determination were assessed during pathology workup.
Results
TME was complete in 381 of 389 patients after surgery without nCR (97.9 %) and in 245 of 253 patients (96.8 %) after nCR. Negative pathology circumferential margins (pCRM) were seen in 97.4 % without nCR and in 89 % of patients after nCR. Negative pCRM was predicted by negative mrCRM in 98.3 % of rectal cancers. NCR was given to 253 of 642 patients (39.5 %). Lymph node count was 23 (range 7–79; median/range) for surgery without nCR and 19 (range 2–56) for surgery after nCR.
Conclusions
Surgical quality determined by pathology workup of specimen was very good in this study. Magnetic resonance imaging guided indication for nCR allows to achieve superb results concerning surrogate parameters for good oncological outcome. Thus, use of neoadjuvant chemoradiation with its potential detrimental side effects may be substantially reduced in selected patients.
Purpose
Damage control strategy
(DCS) is a two-staged procedure for the treatment of perforated diverticular disease complicated by generalized peritonitis. The aim of this retrospective multicenter ...cohort study was to evaluate the prognostic impact of an ongoing peritonitis at the time of second surgery.
Methods
Consecutive patients who underwent DCS for perforated diverticular disease of the sigmoid colon with generalized peritonitis at four surgical centers were included.
Damage control strategy
is a two-stage emergency procedure: limited resection of the diseased colonic segment, closure of oral and aboral colon, and application of a negative pressure assisted abdominal closure system at the initial surgery followed by second laparotomy 48 h later. Therein, decision for definite reconstruction (anastomosis or Hartmann’s procedure (HP)) is made. An ongoing peritonitis at second surgery was defined as presence of visible fibrinous, purulent, or fecal peritoneal fluid. Microbiologic findings from peritoneal smear at first surgery were collected and analyzed.
Results
Between 5/2011 and 7/2017, 74 patients underwent a DCS for perforated diverticular disease complicated by generalized peritonitis (female: 40, male: 34). At second surgery, 55% presented with ongoing peritonitis (OP). Patients with OP had higher rate of organ failure (32 vs. 9%,
p
= 0.024), higher Mannheim Peritonitis Index (25.2 vs. 18.9;
p
= 0.001), and increased operation time (105 vs. 84 min.,
p
= 0.008) at first surgery. An anastomosis was constructed in all patients with no OP (nOP) at second surgery as opposed to 71% in the OP group (
p
< 0.001). Complication rate (44 vs. 24%,
p
= 0.092), mortality (12 vs. 0%,
p
= 0.061), overall number of surgeries (3.4 vs. 2.4,
p
= 0.017), enterostomy rate (76 vs. 36%,
p
= 0.001), and length of hospital stay (25 vs. 18.8 days,
p
= 0.03) were all increased in OP group. OP at second surgery occurred significantly more often in patients with Enterococcus infection (81 vs. 44%,
p
= 0.005) and with fungal infection (100 vs. 49%,
p
= 0.007). In a multivariate analysis, Enterococcus infection was associated with increased morbidity (67 vs. 21%,
p
< 0.001), enterostomy rate (81 vs. 48%,
p
= 0.017), and anastomotic leakage (29 vs. 6%,
p
= 0.042), whereas fungal peritonitis was associated with an increased mortality (43 vs. 4%,
p
= 0.014).
Conclusion
Ongoing peritonitis after DCS is a predictor of a worse outcome in patients with perforated diverticulitis. Enterococcal and fungal infections have a negative impact on occurrence of OP and overall outcome.
Photophysical and structural properties of a Cu(I) diimine complex with very strong steric hindrance, Cu(I)(dppS)2(+) (dppS = 2,9-diphenyl-1,10-phenanthroline disulfonic acid disodium salt), are ...investigated by optical and X-ray transient absorption (OTA and XTA) spectroscopy. The bulky phenylsulfonic acid groups at 2,9 positions of phenanthroline ligands force the ground state and the metal-to-ligand charge-transfer (MLCT) excited state to adopt a flattened pseudo-tetrahedral coordination geometry in which the solvent access to the copper center is completely blocked. We analyzed the MLCT state dynamics and structures as well as those of the charge separated state resulting from the interfacial electron injection from the MLCT state to TiO2 nanoparticles (NPs). The OTA results show the absence of the sub-picosecond component previously assigned as the time constant for flattening, while the two observed time constants are assigned to a relatively slow intersystem crossing (ISC) rate (∼13.8 ps) and a decay rate (100 ns) of the Cu(I)(dppS)2(+) MLCT state in water. These results correlate well with the XTA studies that resolved a flattened tetrahedral Cu(i) coordination geometry in the ground state. Probing the (3)MLCT state structure with XTA establishes that the (3)MLCT state has the same oxidation state as the copper center in Cu(II)(dppS)2(2+) and the Cu-N distance is reduced by 0.06 Å compared to that of the ground state, accompanied by a rotation of phenyl rings located at 2,9 positions of phenanthroline. The structural dynamics of the photoinduced charge transfer process in the Cu(I)(dppS)2(+)/TiO2 hybrid is also investigated, which suggests a more restricted environment for the complex upon binding to TiO2 NPs. Moreover, the Cu-N bond length of the oxidized state of Cu(I)(dppS)2(+) after electron injection to TiO2 NPs shortens by 0.05 Å compared to that in the ground state. The interpretation of these observed structural changes associated with excited and charge separated states will be discussed. These results not only set an example for applying XTA in capturing the intermediate structure of metal complex/semiconductor NP hybrids but also provide guidance for designing efficient Cu(I) diimine complexes with optimized structures for application in solar-to-electricity conversion.
Zusammenfassung
Rektovaginale Fisteln sind seltene, aber für den Patienten sehr gravierende Krankheitsbilder. Die rektovaginale Fistel stellt die komplizierteste Form der anorektalen Fisteln der Frau ...dar. Konservative Therapieoptionen sind nicht vorhanden. Die operativen Maßnahmen sind aufwändiger als für die klassische kryptoglanduläre Fistel. Aufgrund der anatomischen Gegebenheiten ist es notwendig, den Abstand zwischen Vagina und Rektum/Anorektum zu vergrößern. Die Interposition von vitalem Gewebe oder biologischen Ersatzgeweben ist notwendig, um eine akzeptable Erfolgsrate zu verzeichnen. Sehr häufig kombiniert ist die Fistel mit einem deutlichen Sphinkterdefekt. Dies ist als Folge eines stattgehabten DR-III- oder DR-IV-Schadens zu sehen.
Aim
Preclinical studies have suggested that nitinol‐based compression anastomosis might be a viable solution to anastomotic leak following low anterior resection. A prospective multicentre open label ...study was therefore designed to evaluate the performance of the ColonRing™ in (low) colorectal anastomosis.
Method
The primary outcome measure was anastomotic leakage. Patients were recruited at 13 different colorectal surgical units in Europe, the United States and Israel. Institutional review board approval was obtained.
Results
Between 21 March 2010 and 3 August 2011, 266 patients completed the study protocol. The overall anastomotic leakage rate was 5.3% for all anastomoses, including a rate of 3.1% for low anastomoses. Septic anastomotic complications occurred in 8.3% of all anastomoses and 8.2% of low anastomoses.
Conclusion
Nitinol compression anastomosis is safe, effective and easy to use and may offer an advantage for low colorectal anastomosis. A prospective randomized trial comparing ColonRing™ with conventional stapling is needed.
Zusammenfassung
Die Therapie des Hämorrhoidalleidens reicht von konservativen Methoden bis hin zu operativen Eingriffen, wobei sich diese am Beschwerdebild und dem Ausprägungsgrad des ...Hämorrhoidalleidens orientieren. Die standardisierte Einteilung des Hämorrhoidalleidens erfolgt nach Goligher. Es wird hierbei nicht zwischen segmentärem und zirkulärem Befall unterschieden. Eine Behandlung sollte immer individualisiert und symptomorientiert erfolgen. Für die Behandlung des zirkulären Befalls bietet sich die Anwendung eines zirkulären Klammernahtgerätes an.
The treatment for hemorrhoids ranges from conservative management to surgical procedures. The procedures are tailored to the individual grading of hemorrhoids and the individual complaints. The ...standard Goligher classification of the hemorrhoids is the basis for further treatment and no differentiation is made between segmental hemorrhoids and circular hemorrhoids. In the case of advanced circular hemorrhoid disease the surgical procedure with a stapler, so-called stapler anopexy, is the procedure of choice.
PDF
