Background: The process of training surgeons in technique for resection of colorectal cancer should not compromise patient care or outcomes. The aim of this study was to compare morbidity, mortality and survival rates after resection performed by trainees with those for a consultant surgeon.Methods: Outcomes for 150 patients operated on by a single colorectal surgeon at a private hospital were compared with those of 344 patients admitted under the same surgeon and operated on by closely supervised trainee surgeons in a public teaching hospital between 1995 and 2002.Results: Co-morbidity was significantly more common in patients operated on by trainees; their American Society of Anesthesiologists grades were higher and tumours were more advanced. Of 16 postoperative complications evaluated, only respiratory and cardiac problems were significantly more common in patients operated on by trainees. There was no difference in operative mortality, local recurrence or 2-year survival rate after adjustment for age and tumour stage.Conclusion: Outcomes after resection for colorectal cancer did not differ between the consultant and trainees in the context of a closely supervised training programme.

PURPOSE: The aim of this study was to identify and categorize the independent prognostic effects of patient, clinical, operative, and pathology variables on long-term survival after anterior resection or abdominoperineal excision of the rectum for cancer. METHODS: Proportional hazards regression analysis was used to analyze prospective data from 709 patients who underwent surgery at Concord Hospital during a 23-year period. No patient received adjuvant therapy. RESULTS AND CONCLUSIONS: After adjusting for age and clinicopathologic stage, significantly poorer survival was experienced by males, patients with extensive tumor adherent to other organ(s), those with a high-grade tumor or a tumor showing venous invasion, those who had a postoperative cardiovascular or respiratory complication, and those who did not undergo surgery by a colorectal surgeon specialist. The nature of the operation performed had no independent effect on survival.

Background Laparoscopically-assisted resection for large bowel cancer is technically feasible. Sixty-six patients who had resection of the colon or rectum for cancer have been audited prospectively.Methods Clinical and pathological data were collected prospectively as part of the ongoing Concord Hospital colorectal cancer project. Patients were followed up for a median of 29 months.Results In 57 of 66 patients In whom laparoscopic resection was attempted the operation was completed laparoscopically. Three patients died from perioperative myocardial infarction. The median postoperative stay was 14 days. There was a high incidence of postoperative respiratory and cardiac complications. One patient developed a port-site metastasis.Conclusion There was no obvious benefit from laparoscopically-assisted resection of large bowel cancer in these patients.

BACKGROUND:Sharp dissection of adherent tissues resulting from previous sepsis or surgery is frequently time-consuming and sometimes difficult.METHODS:The introduction of saline under pressure into the plane of dissection facilitates this task.RESULTS:Hydrodissection both creates and displays the correct plane between adherent tissues.CONCLUSIONS:This technique increases the safety and decreases the time spent in adhesiolysis in re-operative surgery.

UNLABELLED:BACKGROUNDS AND METHODS: This study reviews the clinical features and reports the preliminary results of treatment of 34 consecutive patients with clinically significant bleeding from chronic, radiation-induced proctitis, using a combination of endoscopic YAG Laser and the application of topical formalin dressings to the rectal mucosa.RESULTS:Bleeding ceased in 25 patients (74%); bleeding continued but occurred only slightly and occasionally in five patients (15%); and three patients required operation to control the bleeding (9%). One patient relapsed after treatment and died while receiving a further transfusion.CONCLUSIONS:This experience has been used to develop a management protocol for patients with this serious complication.

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Loop ileostomy to establish fecal diversion has been used in 79 patients as the initial surgical procedure in severe, debilitating Crohn's colitis or ileocolitis. Clinical improvement, as measured by subjective and objective criteria and length of hos-pitalization, occurred in 72 of 79 patients (91%). Definitive surgery was then undertaken at a later stage under more ideal circumstances without mortality. The high relapse rate of 33% in this series would lead us to recommend definitive surgery electively at an early stage after initial clinical improvement. Four of the 79 patients in this series died; three deaths were related to Crohn's disease, for a total mortality of 5.1%. It is believed that loop ileostomy to establish fecal diversion has a definite role in the initial surgical management of the severely ill patient with Crohn's colitis.