surgery blog for surgeons
{ Monthly Archives }
Once again a mid 2004 multicenter trial but very interesting because of the high relevance in the daily practice of surgery.
The conclusion is straight and clear: “..for primary hernias, the open technique of tension-free repair is superior to the laparoscopic technique, both in terms of recurrence rates and in terms of safety.”
This is a somehow old (mid 2004) but nevertheless very important multicenter trial which aroused my interest due to the fact that I do laparoscopically (hand)assisted colectomies.
The conclusion is: “..the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer”.
Though, “no advantage of laparoscopically assisted surgery was evident with respect to either all stages of cancer or high-risk subgroups”. The collecting of data for the trial began 1994. Therefore the new, hand assisted approach in the laparoscopic surgery, could not be considered.
A recent publication from the laboratory institute in the university clinics in Hamburg, Germany discusses a new approach to diagnosing colorectal carcinoma: detection of tumor DNA in stool samples. Here is the abstract of the publication in the german “Aerzteblatt”:
Detection of tumour DNA in stool is a new screening approach aimed at improving the early diagnosis of colorectal cancer. DNA from colorectal adenomas or carcinomas can be detected using specific mutations or methylation patterns. Altered DNA can in principle be detected in a high excess of normal DNA with high sensitivity, but low cost routine screening assays have yet to be developed. The combination of markers and methods must be refined to detect early stage tumours reliably. Only a test with high sensitivity could replace colonoscopy as the recommended screening method in the future.
The guys of the Mayo Clinic performed an interesting retrospective study about new-onset diabetes as a marker of underlying pancreatic cancer. They found that approxymately 1% of diabetes subjects aged > or =50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes.
Especially in patients with a positive family history for pancreatic carcinoma and a new-onset of DM a suggestion of a follow up would be a good idea.
The day before yesterday I did a cholecystectomy of a patient with a stone passage and elevated transaminases, alcaline phosphatase and bilirubine. At the laparoscopy we saw a liver in an advanced stage of cirrhosis. This explained the preoperative estimated splenomegaly and a consecutive thrombopeny. We discovered that the reason for the liver cirrhosis was a hepatitis C. Neither this condition, nor the cirrhosis or any other finding were known previously. The 46 yo patient lives in Marocco visiting now his brother in Germany and told us that he rarely goes to a physician, who lately (about a year ago) found a diabetes and nothing else (!).