Aim To determine the presence and duration of survival advantages was investigated for resection margin status (R0, R1 or R2) following surgery for locally recurrent rectal cancer (LRRC).
Method A ...systematic review of the literature was performed for studies comparing resection margin status for LRRC. Weighted mean differences and meta‐analysis of hazard ratios were used as a measure of median and overall cumulative survival.
Results Twenty‐two studies were included, providing outcome for 1460 patients undergoing surgery for LRRC. 57% underwent an R0 resection, 25% an R1 resection and 11% an R2 resection. The most commonly performed operations were abdominoperineal excision (35%), exenteration (23%) and anterior resection (21%). The range of median survival per resection margin was R0 28–92 months, R1 12–50 months, R2 6–17 months. Patients undergoing an R0 resection survived on average for 37.6 (95% confidence interval: 23.5–51.7) months longer than those undergoing R1 resection and 53.0 (31.2–74.8) months longer than those undergoing R2 resection. This correlated to a hazard ratio of 2.03 (1.73–2.38) for R0 vs R1 and 3.41 (2.21–5.25) for R0 vs R2. Patients undergoing R1 resection survived on average 13.3 (7.23–19.4) months longer than those undergoing R2 resection hazard ratio of 1.68 (1.33–2.12).
Conclusion Patients undergoing R0 resection have the greatest survival advantage following surgery for recurrent rectal cancer. There is a survival advantage for R1 over R2 resection, but there may be no benefit of R2 resection over palliative treatment.
The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical ...acivirt, was modelled.
This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.
A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.
As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
Aim
The benefits of a laparoscopic approach to restorative proctocolectomy (RPC) are controversial. The aim of this meta‐analysis was to compare the outcome following laparoscopic and open RPC, with ...particular attention to adverse events and long‐term function.
Method
A systematic search of the MEDLINE, EMBASE and Ovid databases was performed for studies published until March 2012. The primary end‐point was long‐term function. Secondary end‐points were intra‐operative details, short‐term postoperative outcome and postoperative adverse events. Weighted mean difference (WMD) and odds ratio (OR) were calculated using fixed/random effect meta‐analytic techniques.
Results
The final analysis included 27 comparative studies of 2428 patients, of whom 1097 (45.1%) underwent laparoscopic surgery. A laparoscopic approach was associated with a significantly longer operation time (WMD 70.1 min, P < 0.001), shorter length of hospital stay (WMD −1.00 day, P < 0.001), reduced intra‐operative blood loss (WMD −89.10 ml, P < 0.001) and a lower incidence of wound infection (OR 0.60, P < 0.005). No significant differences were observed in the rate of pouch failure. Although there was no significant difference in the number of daily bowel movements (OR 0.04, P = 0.950), laparoscopic surgery led to fewer nocturnal bowel movements (WMD −1.14, P < 0.001) and reduced pad usage during the day (OR 0.22, P < 0.001) and night (OR 0.33, P < 0.001). The post hoc power to detect differences in adverse event rates ranged from 5% to 42%.
Conclusion
Laparoscopic and open approaches to RPC produced equivalent adverse event rates and long‐term functional results. However, the present evidence is underpowered to detect true differences in adverse event rates.
Background
The aim of this meta‐analysis was to compare short‐term and oncological outcomes following colorectal resection performed by surgical trainees and expert surgeons.
Methods
Systematic ...literature searches were made to identify articles on colorectal resection for benign or malignant disease published until April 2013. The primary outcome was the rate of anastomotic leak. Secondary outcomes were intraoperative variables, postoperative adverse event rates, and early and late oncological outcomes. Odds ratios (ORs), weighted mean differences (WMDs) and hazard ratios (HRs) for outcomes were calculated using meta‐analytical techniques.
Results
The final analysis included 19 non‐randomized, observational studies of 14 344 colorectal resections, of which 8845 (61·7 per cent) were performed by experts and 5499 (38·3 per cent) by trainees. The overall rate of anastomotic leak was 2·6 per cent. Compared with experts, trainees had a lower leak rate (3·0 versus 2·0 per cent; OR 0·72, P = 0·010), but there was no difference between experts and expert‐supervised trainees (3·2 versus 2·5 per cent; OR 0·77, P = 0·080). A subgroup of expert‐supervised trainees had a significantly longer operating time for laparoscopic procedures (WMD 10·00 min, P < 0·001), lower 30‐day mortality (OR 0·70, P = 0·001) and lower wound infection rate (OR 0·67, P = 0·040) than experts. No difference was observed in laparoscopic conversion, R0 resection or local recurrence rates. For oncological resection, there was no significant difference in cancer‐specific survival between trainees and consultants (3 studies, 533 patients; hazard ratio 0·76, P = 0·130).
Conclusion
In selected patients, it is appropriate for supervised trainees to perform colorectal resection.
No adverse outcomes if supervised adequately
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