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Aim: Locally advanced intestinal neoplasms including colon cancer may require radical en bloc pancreaticoduodenectomy and right hemicolectomy (PD‐RC) to achieve curative, margin‐negative resection, but the safety and benefit of this uncommon procedure has not been established. The Association of Coloproctology of Great Britain and Ireland IMPACT initiative has also highlighted a lack of awareness about current services available within the UK for patients with advanced colorectal cancer and concerns about low‐volume centres managing complex cases. Thus, we aimed to review the feasibility, safety and long‐term outcomes of this procedure at a single high‐volume hepatopancreaticobiliary surgery unit in the UK. Method: A retrospective cohort study was performed using a database of all consecutive patients with intestinal cancer who had been referred to our regional advanced multidisciplinary team and undergone PD‐RC in a 7‐year period (2013–2020). Clinico‐pathological and outcome data were reviewed. Results: Ten patients (mean age 54 ± 13, 8/10 men) were identified. Final histology revealed the primary tumour sites were colon (n = 7) and duodenum (n = 3). R0 resection was achieved in all cases. The major complication rate (Clavien–Dindo ≥ 3) was 10% (1/10) with no deaths within 90 days of surgery. The Kaplan–Meier estimated 5‐year overall survival was 83.3% (95% CI 58.3%–100%). Univariate survival analysis identified perineural invasion and extra‐colonic origin as predictors of poor survival (log‐rank P < 0.05). Conclusion: En bloc PD‐RC for locally advanced intestinal cancer can be performed safely with a high proportion of margin‐negative resections and resultant long‐term survival in carefully selected patients. [ABSTRACT FROM AUTHOR]

Abstract: Aim: Ileocolonic neuroendocrine tumours (NETs) are diagnosed as part of bowel cancer screening programmes (BCSPs). The aim of this study was to identify and characterize NETs diagnosed within the English BCSP, a double‐screen programme that uses guaic faecal occult blood test (gFOBT) screening and colonoscopy, by interrogating the national colorectal screening database and validating the findings with individual BCSP centres. Method: The Exeter database was interrogated by running queries to identify participants with coded NETs (from the start of the programme in July 2006 – 1 December 2014). A written proforma was sent to the responsible BCSP clinician for validation and characterization. Results: During this period, 13 061 716 participants were adequately screened using gFOBTs, and 259 765 participants had definitively abnormal results. There were 146 unique participants with NET‐related codes from 216 707 BCSP colonoscopies. The diagnosis rates per 100 000 colonoscopies were 29 rectal, 18 colonic and 11 ileal NETs. The majority of rectal NETs had Grade 1 (80%) and Stage T1 (85.1%) disease. Over half of ileal NETs (53.6%) in this study had invasive disease, with 85.2% having nodal and 36.1% having metastastatic disease. Conclusion: The current study highlights the rate of colorectal NETs diagnosed in the English BCSP. These data highlight a higher‐than‐anticipated incidence, and the potential additional benefit of BCSPs in identifying occult NETs. [ABSTRACT FROM AUTHOR]

Aim The Wales-Trent Bowel Cancer Audit ( WTBA) was carried out in 1993, and since 2001 Welsh Bowel Cancer Audits ( WBCA) have taken place annually. Screening for bowel cancer in Wales was introduced in 2008. This study compared patient variables, the role of surgery and operative mortality rates over the 15-year interval between the WTBA and the last WBCA before the introduction of population screening. Method Data from the WTBA in 1993 were compared with those of the WBCA including patients diagnosed between April 2007 and March 2008. Results In 1993, 1536 patients were diagnosed with colorectal cancer ( CRC) compared with 1793 in 2007-2008. Patient demographics and American Society of Anesthesiology ( ASA) score did not change during these periods. Surgical treatment for CRC decreased (93% in 1993 vs 80% in 2007-2008; P < 0.001) particularly in the use of resectional surgery (84% in 1993 vs 71% in 2007-2008; P < 0.001). The 30-day postoperative mortality rate fell from 7.4% in 1993 to 5.9% in 2007-2008 ( P = 0.097). Advanced disease at operation was more prevalent in the WTBA (25% of all operated patients were Stage IV in 1993 vs 13% in 2007-2008; P < 0.001). The use of surgery in patients with metastatic disease also declined over this period. Conclusion Surgery is used less frequently in the management of CRC compared with 15 years previously, and is a factor in the reduction of the interpreted 30-day operative mortality. [ABSTRACT FROM AUTHOR]

The article presents abstracts related to coloproctology which includes "Colorectal cancer surgery: a french survey of more than 84,000 patients," by L. Maggiori and colleagues, "Colon and rectal surgery for cancer without mechanical bowel preparation: one-center randomized prospective trial," by S. Scabini and colleagues, and "'Slipping through the bowel cancer screening programme!' BCSP," by R. Hallifax and colleagues.

Background The government’s proposals to openly report clinical outcomes poses challenges to the National Bowel Cancer Audit now funded by the UK department of health. Aim To identify the benefits and risks of open reporting and to propose ways the risks might be minimized. Methods A review of the literature on clinical audit and the consequences of open reporting. Results There are significant potential benefits of a national audit of bowel cancer including protecting patients from sub-standard care, providing clinicians with externally validated evidence of their performance, outcome data for clinical governance and evidence that increases in government expenditure are achieving improvements in survival from bowel cancer. These benefits will only be achieved if the audit captures most of the cases of bowel cancer in the UK, the data collected is complete and accurate, the results are risk adjusted and these are presented to the public in a way that is fair, clear and understandable. Involvement of clinicians who have confidence in the results of the audit and who actively compare their own results against a national standard is essential. It is suggested that a staged move to open reporting should minimise the risk of falsely identifying an outlying unit. Conclusion The fundamental aim of the National Bowel Cancer Audit is the pursuit of excellence by identification and adoption of best practice. This could achieve a continuous improvement in the care of all patients with bowel cancer in the UK. The ACPGBI suggests a safer way of transition to open reporting to avoid at least some of its pitfalls. [ABSTRACT FROM AUTHOR]

Indocyanine green near-infrared fluorescence imaging in laparoscopic resection of small bowel carcinoma for definitive central vascular ligation - a video vignette I Dear Editor, i Cancer of the small intestine is rare [1]. It is speculated that complete mesocolic excision (CME) with central vascular ligation (CVL) [2] is effective for small intestinal cancer as well as colon cancer, but the small intestinal mesentery has complicated vessels, making it difficult to identify the vessels targeted by CVL [3]. [Extracted from the article]

Objective The influence of the type of abdominal incision on post-operative pain and pulmonary function was investigated in patients operated upon for a right-sided cancer of the large bowel. Patients and methods Fifty-three patients scheduled for a right hemicolectomy due to a right-sided colon cancer were randomized to a median vertical (M) or a transverse incision (T). Forty patients, 23 with a M and 17 with a T incision, completed the study and could be evaluated. Pain at rest and after physical activity was assessed with a visual analogue scale, and was also measured as reflected in the need for analgesics. Respiratory function was assessed with pre- and post-operative spirometry. Results Pain after activity was significantly less in patients with a T incision. This group also needed less analgesia. Vital capacity (VC) and forced expiratory volume in 1 s (FEV 1.0) were profoundly reduced after surgery in both groups of patients, but improvement of respiratory function was faster in patients with a transverse incision. No problem with access to the operative field was noted. Conclusion We conclude that a transverse incision is preferable to a midline incision and should be used in right hemicolectomy. This abdominal incision reduces effort-induced pain and interferes less with post-operative pulmonary function, and may reduce the risk of pulmonary complications. [ABSTRACT FROM AUTHOR]

The article presents abstracts in colon cancer including "Sentinel lymph node biopsy in anal squamous cell carcinoma: a systematic review," "Learning the hard way: the importance of accurate data" and "The experience of a single consultant surgeon of open and laparoscopic surgery for bowel cancer."

Objectives To assess knowledge of Bowel Cancer Awareness Week (BCAW) amongst patients attending their general practice surgery and to identify whether BCAW could increase knowledge of colorectal cancer symptoms. Method Questionnaire study with ethics committee approval. Patients attending non-emergency clinics in a single general practice during the week following BCAW were given a questionnaire. Respondents were asked for knowledge of colorectal cancer symptoms, sources of this information and awareness of BCAW compared to similar knowledge of breast cancer. Results Seventy-seven patients responded (96% response rate, median age 42, 40% male). Eighty-five percent could name a breast cancer symptom compared to only 44% who could name a colorectal cancer symptom (McNemar's χ², P<0.0001). Respondents identified more sources of information for breast than colorectal cancer. Only 21% had heard of BCAW and none could name any symbol for bowel cancer awareness whereas 69% were aware of Breast Cancer Awareness Month and 28% could name its symbol (McNemar's χ², P<0.0001). Multivariate analysis demonstrated that patients who were aware of BCAW were 4.6 times more likely to have knowledge of colorectal cancer symptoms (95% CI 1.25-17.1). Conclusions Despite their similar incidence, knowledge of colorectal cancer is much less than breast cancer. In part this may be due to the greater publicity given to breast cancer. BCAW can increase knowledge of colorectal cancer symptoms but currently, too few people are aware of it. Objectives To assess knowledge of Bowel Cancer Awareness Week (BCAW) amongst patients attending their general practice surgery and to identify whether BCAW could increase knowledge of colorectal cancer symptoms. Method Questionnaire study with ethics committee approval. Patients attending non-emergency clinics in a single general practice during the week following BCAW were given a questionnaire. Respondents were asked for knowledge of... [ABSTRACT FROM AUTHOR]

The article presents the author's insights on his sentiments over an article showing the discrepancy between the perceived performance and the national bowel cancer audit programme (NBOCAP) of a small colorectal unit.