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Background The optimal management of colorectal cancer with synchronous liver metastases has not yet been elucidated. The aim of the present study was systematically to review current evidence concerning the timing and sequence of surgical interventions: colon first, liver first or simultaneous. Methods A systematic literature review was performed of clinical studies comparing the timing and sequence of surgical interventions in patients with synchronous liver metastases. Retrospective studies were included but case reports and small case series were excluded. Preoperative and intraoperative data, length of hospital stay, perioperative mortality and morbidity, and 1-, 3- and 5-year survival rates were compared. The studies were evaluated according to a modification of the methodological index for non-randomized studies ( MINORS) criteria. Results Eighteen papers were included and 21 entries analysed. Five entries favoured the simultaneous approach regarding duration of procedure, whereas three showed no difference; five entries favoured simultaneous treatment in terms of blood loss, whereas in four there was no difference; and all studies comparing length of hospital stay favoured the simultaneous approach. Five studies favoured the simultaneous approach in terms of morbidity and eight found no difference, and no study demonstrated a difference in perioperative mortality. One study suggested a better 5-year survival rate after staged procedures, and another suggested worse 1-year but better 3- and 5-year survival rates following the simultaneous approach. The median MINORS score was 10, with incomplete follow-up and outcome reporting accounting primarily for low scores. Conclusion None of the three surgical strategies for synchronous colorectal liver metastases appeared inferior to the others. [ABSTRACT FROM AUTHOR]

Background: Optical techniques using previously unexploited properties of light interaction with tissue may be valuable in the detection, diagnosis and staging of colorectal neoplasia. Methods: A Medline search (1990 to present) was conducted on optical diagnostics in the detection of colorectal neoplasia. The reference list of each identified article was reviewed for further relevant papers. Results and conclusion: Chromoendoscopy is the only optical adjunct to colonoscopy that has been tested in large randomized clinical trials. It improves the detection of small and flat colorectal adenomas, and of neoplasia in chronic ulcerative colitis and hereditary non-polyposis colorectal cancer. All other techniques are the subject of ongoing research and the practicality of population screening with any of the methods has yet to be established. Optical techniques may, however, permit immediate clinical diagnosis, removing the need for histological analysis. They may also improve the diagnosis of early colonic neoplasia. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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Background: Clinical trials are important but many factors limit their success, including the costs of long-term follow-up and participants often not being representative of the general population. The National Cancer Data Repository (NCDR) contains data about patients with cancer in England that may help overcome some of these problems. This study compared treatment and outcome information between the Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial and the NCDR. Methods: Participants in the CLASICC trial were identified in the NCDR, and management and outcome data were compared. Data on all surgically treated English patients with colorectal cancer were extracted from the NCDR and compared with those of CLASICC participants. Results: Survival and treatment data for those in the CLASICC trial were available in the NCDR for 98·9 and 95·8 per cent of patients respectively. There was agreement in operation type for 86·1 per cent of patients but surgical approach coding was poor, with only 58·4 per cent of laparoscopic procedures coded in the NCDR. There was no significant difference in survival calculated from either data set. Surgical information was available in the NCDR for 19 of 20 trial participants with missing data. The trial population was younger ( P < 0·001), of better socioeconomic status ( P = 0·001) and with earlier disease ( P < 0·001) than the general surgically treated colorectal cancer population. Rectal cancer survival was similar, but 5-year survival after treatment of colonic cancer was significantly better in the trial than in the national data: 57·1 (95 per cent confidence interval 51·5 to 62·3) versus 49·8 (49·3 to 50·2) per cent respectively. Conclusion: The National Cancer Data Repository demonstrates potential for informing clinical trials, but limitations prevent full intention-to-treat analyses. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a follow-up analysis of Great Britain's Medical Research Council Conventional vs. Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASSICC) trial conducted between 1996 and 2002. In assessing the 5-year outcomes of 413 patients with colonic cancer and 381 with rectal cancer among 27 British medical centers, the study found no major differences in overall survival (OS), disease-free survival (DFS), and local and distant recurrence rates between those who had open surgery and patients who underwent laparoscopic surgery.

The article discusses a study on the colon J pouch (CJP) and the transverse coloplasty pouch (TCP) after low resection for rectal cancer, the fourth most common cancer in Western countries. Patients with rectal cancer who underwent low anterior resection were reconstructed using a pouch procedure. A randomized clinical trial was conducted in patients who underwent randomization to compare the reconstructions. Researchers revealed comparable outcomes for TCP and CJP.

The article reports on the results of a randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery program. A description of the clinical trial procedure is provided. The study showed that the length of hospital stay after laparoscopic resection was 32 percent shorter than for open resection. The study also revealed that the combined hospital, convalescent and readmission stay was 37 percent shorter. The study concludes that short-term outcomes are better following laparoscopic surgery despite perioperative optimization of open surgery for colorectal cancer.

A letter to the editor is presented in response to the article "Randomized Clinical Trial Comparing Inflammatory and Angiogenic Response After Open Versus Laparoscopic Curative Resection for Colonic Cancer," published in a previous issue.