Introduction: Laparoscopic resection of rectal cancer has been proven efficacious but morbidity and oncological outcome need to be investigated in a randomized clinical trial. Trial design: Non-inferiority randomized clinical trial. Methods: The COLOR II trial is an ongoing international randomized clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy analysis. Results: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal in both treatment groups. Most tumors are located in the mid-rectum (41%). Conclusion: Laparoscopic surgery in the treatment of rectal cancer is feasible. The results and safety of laparoscopic surgery in the treatment of rectal cancer remain unknown, but are subject of interim analysis within the COLOR II trial. Completion of inclusion is expected by the end of 2009. Trial registration: Clinicaltrials.gov, identifier: NCT00297791 (www.clinicaltrials.gov).
Abstract Background Management of spontaneous intra-abdominal abscess (IAA) in patients with Crohn’s disease (CD) with radiologically guided percutaneous drainage (PD) was debated. Methods This is a secondary analysis from a multicenter, retrospective cohort study of all the patients with CD who underwent PD followed by surgery at 19 international tertiary centers. Results Seventeen patients (4.8%) who did not undergo surgery after PD were compared to those who had PD followed by surgical intervention 335/352 (95.2%). Patients who had PD without surgery were those with longer disease duration, more frequently had previous surgery for CD (laparotomies/laparoscopies), enteric fistula, on steroid treatment before and continue to have it after PD. Patients who had PD without subsequent surgical resection had a higher risk of stoma construction at later stages 8/17 (47.1%) versus 90/326 (27.6%) (P < .01). Patients with PD with no subsequent surgery had numerically higher rates of abscess recurrence 5/17 (29.4%) compared to those who had PD followed by surgery 45/335 (13.4%) the difference was not statistically significant (P = .07). Conclusions Even with the low number of patients enrolled in this study who had PD of IAA without subsequent surgery, the findings indicate a markedly worse prognosis in terms of recurrence, length of stay, readmission, and stoma construction. Watchful waiting after PD to treat patients with spontaneous IAA might be indicated in selected patients with poor health status or poor prognostic factors.
Corrected by: Comparison between Preoperative Quantitative Assessment of Bowel Wall Vascularization by Contrast-Enhanced Ultrasound and Operative Macroscopic Findings and Results of Histopathological Scoring in Crohn's DiseaseUltraschall Med 2011; 32(02): E1-E1DOI: 10.1055/s-0031-1299323
INTRODUCTION: Severe skin scarring after multiple abdominal surgeries may lead to serious difficulties in stoma care, especially in patients with IBD. We demonstrate the technique of Donut Island Flap that we used in a female patient with colonic Crohn’s disease that presented with intractable chronic ileostomy leakage. A relocation of the ileostomy was not possible because an alternative stoma site was not available anymore. TECHNIQUE: The scarred peristomal skin was radially excised up to a diameter of 10 cm. A pedicled anterolateral thigh perforator island flap was elevated from the right leg and was passed behind the rectus femoris muscle and through the inguinal tunnel into the defect. The ileostomy was passed through a small opening in the middle of the flap. The donor site at the thigh was closed primarily. RESULTS: No postoperative complications occurred. Three months after surgery, the ostomy care is providing no difficulties for the patient. CONCLUSION: The Donut Island Flap is a reliable and relatively simple technique to provide an adequate surrounding for ileostomy whose care is seriously impeded by severe skin scarring.
