Local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom.

Background: Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.

Aim: To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery (TEMS) approach carried out at three large cancer centers in the United Kingdom.

Methods: TEMS database was retrospectively reviewed to assess demographics, operative findings and post operative clinical and oncological outcomes.

Robotics can decrease the rate of post-operative ventral hernia: a single centre retrospective cohort study.

Midline incision for extra-corporeal anastomosis is common with traditional laparoscopic right hemicolectomy. Incisional hernias develop in up to 20% of these patients within a year adding considerable morbidity and healthcare costs. Robotic assisted surgery (RAS) improves technical ease of intra-corporeal anastomosis, preventing midline extraction but its benefit over laparoscopy remains debated.

Development and evaluation of a societal core robotic surgery accreditation curriculum for the UK.

Standardised proficiency-based progression is the cornerstone of safe robotic skills acquisition, however, is currently lacking within surgical training curricula. Expert consensuses have defined a modular pathway to accredit surgeons. This study aimed to address the lack of a formal, pre-clinical core robotic skills, proficiency-based accreditation curriculum in the UK.

Quality-of-life outcomes in older patients with early-stage rectal cancer receiving organ-preserving treatment with hypofractionated short-course radiotherapy followed by transanal endoscopic microsurgery (TREC): non-randomised registry of patients unsuitable for total mesorectal excision.

Background: Older patients with early-stage rectal cancer are under-represented in clinical trials and, therefore, little high-quality data are available to guide treatment in this patient population. The TREC trial was a randomised, open-label feasibility study conducted at 21 centres across the UK that compared organ preservation through short-course radiotherapy (SCRT; 25 Gy in five fractions) plus transanal endoscopic microsurgery (TEM) with standard total mesorectal excision in adults with stage T1-2 rectal adenocarcinoma (maximum diameter ≤30 mm) and no lymph node involvement or metastasis. TREC incorporated a non-randomised registry offering organ preservation to patients who were considered unsuitable for total mesorectal excision by the local colorectal cancer multidisciplinary team.

Radical surgery versus organ preservation via short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study.

Background: Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision.

Survival following rectal cancer surgery: does the age matter?

Information regarding rectal cancer surgery outcomes and survival benefits in the elderly is sparse. Radical rectal surgery can be associated with substantial morbidity and mortality. We investigated age-specific survival for patients undergoing radical rectal surgery to determine outcomes in elderly patients Over a 10-year period data on all patients who underwent rectal cancer surgery was performed.

Early discharge following transanal endoscopic microsurgery is safe.

Aim: Transanal endoscopic microsurgery (TEM) was developed as an alternative to major surgery for rectal tumors; however, there is no consensus as to the optimal postoperative length of stay. The aim of this large series is to show that a policy of presumed early discharge is safe.

Patients And Methods: All patients undergoing TEM at a single center between 2008 and 2011 were included.

Enhanced recovery program following colorectal resection in the elderly patient.

Background: The enhanced recovery program (ERP) aims to reduce the metabolic response to surgery, hastening recovery and shortening hospital stay. Concerns exist regarding morbidity and hospital stay in elderly patients. The present study aimed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group.

Training higher surgical trainees in laparoscopic common bile duct exploration.

Background: Laparoscopic common bile duct (CBD) exploration is regarded as a safe, definitive procedure for ductal calculi, avoiding the complications of endoscopic retrograde cholangiopancreatography. We aimed to evaluate the outcomes of laparoscopic CBD exploration carried out by trainees compared to those of an experienced consultant (R.W.

Spontaneous bowel perforation due to norovirus: a case report.

Norovirus is the leading cause of epidemic gastroenteritis worldwide but the disease is usually self-limiting and generally only causes serious health problems in the young, elderly and immunocompromised. The authors report a case of bowel perforation in an elderly Caucasian lady with confirmed infection with Norovirus genogroup II and no other presumptive cause. To the authors' knowledge this is the first such case of bowel perforation due to Norovirus.

Use of plasma MMP-2 and MMP-9 levels as a surrogate for tumour expression in colorectal cancer patients.

Matrix metalloproteinases, and notably the gelatinases MMP-2 and MMP-9, have important roles in tumour invasion, metastasis and angiogenesis. Our study investigates the distribution of MMP-2 and MMP-9 in colorectal cancer, the correlation with plasma levels, changes following surgical resection and whether plasma levels reflect clinical staging and disease course. MMP-2 and MMP-9 expression in 48 colorectal tumours and 13 adenomatous polyps was analysed by RT-PCR, immunohistochemistry, and quantified by ELISA of tumour lysates.